Fatal Fungemia with Scedosporium prolificans in a Patient with Acute Myeloid Leukemia

Abstract

Scedosporium prolificans (S. prolificans) is a type of mold, which rarely affects immunocompromised people. We treated a 71-year-old woman with acute myeloid leukemia (AML-M5a) with low-dose cytarabine, acralubicin, and filgrastim as the induction therapy. On day 7 after the initiation of chemotherapy, she became febrile and agranulocytic, and developed anal pain ; therefore, we discontinued the chemotherapy on day 8. Broad-spectrum antibiotics, micafungin, and then liposomal amphotericin B were ineffective. The serum concentration of β-D-glucan was 525 pg/mL. She died of multiple organ failure on day 17. S. prolificans was detected from the blood culture on day 13. Physicians should consider Scedosporium spp. infection when principal antifungal agents are ineffective and fungal infection is strongly suspected.

Fungal Infections Complicating Lung Transplantation

“…Scedosporiosis is a rare complication of hematological malignancies, particularly acute myeloid leukemia (AML). 252,258,278,285,[294][295][296][297] In 1995, four cases of scedosporiosis (all fatal) were reported in neutropenic patients with hematological malignancies in Spain. 298 In 1997, Spanish investigators reported 16 cases of scedosporiosis seen at six centers between 1989 and 1994; 15 had hematological malignancy.…”

The Effective Treatment of Lung Infection Due to <i>Scedosporium prolificans</i> with Voriconazole and Surgery

“…S. prolificans is resistant to most clinically available antifungal agents (3, 6). As such, S. prolificans infection is often fatal after dissemination to multiple organs.…”

“…Immunocompromised or immunosuppressed patients, including patients with HIV, organ transplant recipients, hematopoietic stem cell transplant recipients, and patients with hematologic malignancies, are more likely to be infected with Scedosporium (3, 4, 6). However, one study reported that 21% of 270 patients with Scedosporium infection were immunocompetent (1).…”

“…Four species have been revealed as human pathogens: S. prolificans , S. aurantiacum , S. apiospermum (teleomorphic state, Pseudallescheria apiosperma ), and S. boydii (teleomorphic state, P. boydii ) (1, 2). Scedosporium is multidrug resistant and may cause various infections, such as epidural abscess, endocarditis, keratitis, pneumonia, and fungemia (3, 4). In particular, S. prolificans is resistant to most currently available antifungal agents, and is associated with a high mortality rate of up to 95% in immunocompromised patients (1, 2).…”

Scedosporium and Lomentospora Infections: Contemporary Microbiological Tools for the Diagnosis of Invasive Disease

“…The clinical utility of this test is well summarized by meta-analyses [ 56 , 57 ] and demonstrates generally good sensitivity and specificty (for any IFD) in various patient populations. This has typically included a small number of patients with Scedosporium and L. prolificans infections and is supported by the detection of BDG in serum in reports of Scedosporium brain abscess and L. prolificans fungemia [ 58 , 59 , 60 ]. The serum BDG test may thus be a useful diagnostic adjunct.…”