Non-Aspergillus Hyaline Molds: Emerging Causes of Sino-Pulmonary Fungal Infections and Other Invasive Mycoses

Abstract

Hyaline molds, widely distributed in nature, are an important and increasing cause of invasive fungal infections in humans, likely due to an expanding population of immunosuppressed hosts, increases in antifungal resistance, and improvements in laboratory diagnostics. Sinopulmonary disease and disseminated infection are common manifestations in neutropenic patients and transplant recipients, whereas, catheter-related and localized soft tissue infections predominate in immunocompetent hosts. These organisms are not reliably differentiated based on their morphology in tissue; rather, efforts should be made to establish a microbiologic diagnosis via culture or molecular-based methods to guide antifungal management and inform prognosis. Herein, we review the epidemiology, clinical manifestations, diagnosis, and management of these opportunistic pathogens known to cause hyalohyphomycoses: Scedosporium spp., Lomentospora prolificans, Fusarium spp., Scopulariopsis spp., Arthrographis kalrae, Trichoderma spp., Acremonium spp., Paecilomyces variotii, Purpureocillium lilacinum, and Penicillium species.

Species Identification and In Vitro Antifungal Susceptibility of Paecilomyces/Purpureocillium Species Isolated from Clinical Respiratory Samples: A Multicenter Study

“…In recent years, we have observed the emergence of fungal infections in humans and animals caused by environmental moulds [ 2 , 12 , 22 ]. Among these moulds, Paecilomyces spp.…”

Novel antifungal agents in clinical trials

“…Fosmanogepix also exerted potent antifungal activity against Scedosporium apiospermum (MEC 90 0.12 µ g/ml), Scedosporium aurantiacum (MEC 50 0.06 µg/ml), and Scedosporium (Lomentospora) prolificans (MEC 90 0.12 µ g/ml), as well as Fusarium solani (MEC 90 0.06 µ g/ml) and Fusarium oxysporum (MEC 90 0.25 µ g/ml) 10 . These organisms pose formidable therapeutic challenges, particularly in immunocompromised patients 11 . In immunocompromised mouse models of invasive pulmonary aspergillosis, hematogenously disseminated fusariosis, and pulmonary scedosporiosis, fosmanogepix demonstrated improved survival and tissue clearance versus placebo; whereas, comparable outcomes were observed between mice treated with fosmanogepix and posaconazole ( Aspergillus- infected mice) or high dose liposomal amphotericin B ( Fusarium- and Scedosporium- infected mice) 12 , 13 .…”

Novel antifungal agents in clinical trials

“…Amongst moulds, fosmanogepix has in vitro activity against a range of hyaline moulds including Aspergillus spp., Fusarium spp., Scedosporium spp., Lomentospora prolificans, and Purpureocillium lilacinum 2,3,10 . These organisms pose formidable therapeutic challenges, particularly in immunocompromised patients 11 . In immunocompromised mouse models of invasive pulmonary aspergillosis, hematogenously disseminated fusariosis, and pulmonary scedosporiosis, fosmanogepix demonstrated improved survival and tissue clearance versus placebo; whereas, comparable outcomes were observed between mice treated with fosmanogepix and posaconazole (Aspergillus-infected mice) or high dose liposomal amphotericin B (Fusarium-and Scedosporium-infected mice) 12,13 .…”