<i>Scedosporium</i> infection in immunocompromised patients: Successful use of liposomal amphotericin B and itraconazole

Barbaric, Draga; Shaw, Peter J.

doi:10.1002/mpo.1180

Cited by 33 publications

(27 citation statements)

References 9 publications

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“…In another series of five patients with S. prolificans who were treated with liposomal amphotericin B in addition to itraconazole, three patients were persistently neutropenic and all three died; the other two were not neutropenic and survived the infection (25). In neutropenic patients, disseminated Scedosporium prolificans is rapidly fatal (265).…”

Section: Immunotherapymentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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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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Section: Immunotherapymentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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“…The most common isolate was S. prolificans, accounting for over a third of cases. Since that review, S. prolificans remains the most frequent cause of disseminated disease, almost exclusively in immunocompromised patients (33,62,96,151,304,358,364,368,434,697,709,747,750,796). E. dermatitidis, in contrast, is commonly seen in immunocompetent patients, particularly from Asia (13,349,565).…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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“…Itraconazole has also been used for S. apiospermum soft tissue infections, with some case reports demonstrating successful outcomes (Table 1). There are fewer published reports describing successful outcomes with itraconazole for the treatment of disseminated S. apiospermum infection in immunocompromised hosts (2,37).…”

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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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Scedosporium infection in immunocompromised patients: Successful use of liposomal amphotericin B and itraconazole

Cited by 33 publications

References 9 publications

Infections Caused byScedosporiumspp

Infections Caused byScedosporiumspp

Melanized Fungi in Human Disease

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

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