Clinical Significance of Scedosporium apiospermum in Patients with Cystic Fibrosis

Abstract

The incidence of airway colonization by Scedosporium apiospermum and of related sensitization was investigated prospectively in 128 patients with cystic fibrosis over a 5-year period, and results were compared with clinical data. Scedosporium apio-spermum, recovered from sputum samples in 11 of 128 (8.6%) patients, was the most frequent filamentous fungus after Aspergillus fumigatus. Counterimmuno-electrophoresis, used to detect scedosporiosis serologically, was positive in 27 of 128 (21.1%) patients. The discrepancy between the mycological and serological results may be related to immune cross-reactions between Scedosporium apiospermum and Aspergillus fumigatus. However, symptoms of allergic bronchopulmonary disease were observed in two patients chronically colonized by Scedosporium apiospermum. The results clearly demonstrate that the frequency of this fungus is largely underestimated and that it may trigger an inflammatory response, thus suggesting a pathogenic role in patients with cystic fibrosis.

Molecular Typing of AustralianScedosporiumIsolates Showing Genetic Variability and NumerousS. aurantiacum

“…aurantiacum S. apiospermum infections occur worldwide, ranging from localized mycetomas to deep-seated disease such as cerebral abscesses (6,7). This species also colonizes the respiratory tract of ≈10% of patients with cystic fi brosis and chronic suppurative lung disease (8)(9)(10). On the basis of genetic data, a new species, S. aurantiacum, was proposed for a subset of isolates previously identifi ed as S. apiospermum (11).…”

Typing of Scedosporium apiospermum by multilocus enzyme electrophoresis and random amplification of polymorphic DNA

“…More recently, attention has been paid to the particular occurrence of this fungus in patients with cystic ®brosis (CF), which is the most common recessively inherited genetic disease among the Caucasian population [5,6]. In these patients, mutations in the gene encoding the chloride channel transmembrane regulator result in an abnormal viscosity of the bronchial secretions, leading to colonisation of the bronchial tubes by various bacteria and the entrapment of some airborne mould spores in the viscous mucus.…”

“…In these patients, mutations in the gene encoding the chloride channel transmembrane regulator result in an abnormal viscosity of the bronchial secretions, leading to colonisation of the bronchial tubes by various bacteria and the entrapment of some airborne mould spores in the viscous mucus. In a prospective study including 128 CF patients from two different care units in France, S. apiospermum was isolated from bronchial secretions in 8.6% of the patients, ranking it the second most frequent ®lamen-tous fungus identi®ed [6]. In CF, previous alterations of the bronchopulmonary epithelial cells due to chronic bacterial infections and the host in¯ammatory response seem to be required for the establishment of S. apiospermum in the airways, the fungus being isolated usually from patients already infected by Pseudomonas aeruginosa and colonised by A. fumigatus [5].…”

Genotyping Study of Scedosporium apiospermum Isolates from Patients with Cystic Fibrosis

“…Besides Aspergillus fumigatus, which remains by far the most common species, other filamentous fungi may also be encountered. In a large prospective study encompassing 128 CF patients monitored during a 5-year period, Scedosporium apiospermum was isolated from bronchial secretions from 8.6% of the patients, ranking it as the second most frequently occurring filamentous fungus identified (3).…”