Case Reports. Infection due to<i>Scedosporium apiospermum</i>in renal transplant recipients: a report of two cases and literature review of central nervous system and cutaneous infections by<i>Pseudallescheria boydii/Sc. apiospermum</i>

SUMMARY Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.

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“…Localized cutaneous disease due S. apiospermum/P. boydii in immunocompromised individuals has been reported (36,49,53,79,114,156,299,432,455).…”

Section: Ii) Extrapulmonary Infections (A) Cutaneous and Subcutaneoumentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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“…In approximately one-fourth of cases a nodular lymphangitic pattern of spread was noted (4,5,7,17,21,32,46), a pattern classically associated with organisms such as Sporothrix schenckii, Mycobacterium marinum, Francisella tularensis, Nocardia brasiliensis, and Leishmania brasiliensis (15). S. apiospermum should be considered in the differential diagnosis of patients who present with this clinical finding, particularly if they are immunocompromised.…”

mentioning

confidence: 99%

Scedosporium apiospermumSoft Tissue Infection Successfully Treated with Voriconazole: Potential Pitfalls in the Transition from Intravenous to Oral Therapy

Schaenman¹,

DiGiulio

Mirels

et al. 2005

J Clin Microbiol

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An immunocompromised patient with an invasive soft tissue infection due to Scedosporium apiospermum was successfully treated with voriconazole and surgical debridement. After transition from intravenous to oral therapy, successive adjustments of the oral dose were required to achieve complete resolution. For soft tissue infections due to molds characterized by thin, septate hyphae branching at acute angles, voriconazole should be considered a first-line antifungal agent. The potential usefulness of plasma voriconazole levels for guiding optimal therapy should be investigated. CASE REPORTA 58-year-old woman who had been treated chronically for Behçet's disease with prednisone, at doses ranging from 10 to 40 mg per day over 10 years, developed pain, swelling, and erythema of the left wrist. These symptoms were felt by her rheumatologist to represent an unusually severe exacerbation of arthritis, and a single dose of infliximab at 3 mg/kg was given intravenously. In addition, prednisone was increased from 20 to 100 mg per day, and amoxicillin-clavulanic acid at 875 mg twice daily was empirically started. Due to continued pain and erythema, the patient underwent exploratory surgery of her left wrist 10 days later at a local community hospital. Intraoperatively, thickening and early mucinous degeneration of the tenosynovium of an extensor tendon was noted from the wrist to the distal end of the third metacarpal. Surgically obtained tissue grew rare methicillin-sensitive Staphylococcus aureus but was negative for fungi and mycobacteria based on both cultures and histopathology. Antibiotic therapy was changed from oral amoxicillin-clavulanic acid to intravenous oxacillin at 2 g every 4 h, and her oral prednisone dosage was reduced gradually from 100 mg daily to 20 mg daily over the following week.The patient's symptoms continued to progress, however, with erythema spreading from the dorsum of the left wrist to the elbow. At 4 weeks after the exploratory surgery, the patient was admitted to Stanford University Medical Center. Oxacillin was discontinued, and intravenous vancomycin, given as 1 g every 12 h, was initiated. The following day, surgical exploration and debridement of the left wrist and forearm were performed, and necrosis involving multiple extensor tendons of the wrist was noted intraoperatively. Specimens from her wrist joint and tendons were sent for bacterial, mycobacterial, and fungal cultures. Small, gray colonies of a mold grew in a culture derived from an extensor tendon. Early examination of this mold revealed thin, septate hyphae branching at acute angles. On the basis of this morphology, intravenous voriconazole was initiated at a loading dose of 6 mg/kg every 12 h for two doses, followed by 4 mg/kg given every 12 h; prednisone was continued at 20 mg daily. Two days later, diminished pain and erythema of the patient's forearm and elbow were noted. The mold was ultimately identified as Scedosporium apiospermum. The patient showed continued improvement over a 10-day course of intravenous voriconazole...

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“…Infection by spores occurs through respiratory tract, surgical wounds and skin. When colonization occurs it can cause ocular, lymphocutaneous, pulmonary and disseminated central nervous system infections in both immunocompetent and immunosuppressed patients (1)(2)(3)(4)(5)(6)(7)(8). Definitive diagnosis is crucial because S. apiospermum is susceptible to newer triazoles like voriconazole (9,10) but almost always resistant to amphotericin B.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Scedosporium Apiospermum Infection Following Renal Re-Transplantation

Ahmed¹,

Ditmars²,

Sheppard

et al. 2004

American Journal of Transplantation

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Immunosuppression for organ transplantation results in increased susceptibility to opportunistic infections including fungal, such as Scedosporium apiospermum. Even though many reported cases of this infection had both local and systemic manifestations, majority of the systemic infections had a fatal outcome. We report a case of a 50-year-old Caucasian male with lymphocutaneous and presumed pulmonary Scedosporium infection 4 years after renal transplantation that was successfully treated with voriconazole and discontinuation of immunosuppression. He received a second transplant 3 years later in the absence of clinical evidence of S. apiospermum infection. Unfortunately, 4 months after transplantation he developed recurrence of the same infection localizing to the soft tissues. Presently this infection is under control with surgical excision and voriconazole therapy. To our knowledge this is the first reported case of recurrent S.apiospermum infection in a renal transplant recipient. We suggest prophylactic antifungal therapy in all re-transplants with this infection.

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Case Reports. Infection due toScedosporium apiospermumin renal transplant recipients: a report of two cases and literature review of central nervous system and cutaneous infections byPseudallescheria boydii/Sc. apiospermum

Cited by 50 publications

References 62 publications

Infections Caused byScedosporiumspp

Infections Caused byScedosporiumspp

Scedosporium apiospermumSoft Tissue Infection Successfully Treated with Voriconazole: Potential Pitfalls in the Transition from Intravenous to Oral Therapy

Recurrence of Scedosporium Apiospermum Infection Following Renal Re-Transplantation

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