Nosocomial outbreak caused by Scedosporium prolificans (inflatum): four fatal cases in leukemic patients

Abstract

Four cases of fatal disseminated Scedosporium prolificans (inflatum) infection occurring in neutropenic patients are reported. Because of hospital renovation, the patients were cared for in a temporary hematologic facility. S. prolificans (inflatum) was isolated from blood cultures of these four patients, two of whom underwent full necropsy, and revealed abundant vegetative hyphae and ovoid conidia with truncate bases in many organs. In vitro susceptibility testing of fungal strains showed all isolates to be resistant to amphotericin B, flucytosine, miconazole, ketoconazole, fluconazole, and itraconazole, with MICs greater than 16 g/ml. The reported infections, two in each of two rooms, occurred over a period of 1 month, with very similar clinical outcomes. Circumstancial evidence suggested a nosocomial outbreak, but the environmental samples collected from the rooms, corridors, and adjacent areas did not yield S. prolificans (inflatum). Nevertheless, circumstantial evidence suggested a nosocomial outbreak of S. prolificans (inflatum) infection.

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

“…Although many of the published cases have come from Australia and Spain, cases have also been reported in other European countries and the Americas. A second series reported four cases of fatal infection occurring in patients with recently diagnosed leukaemia [6]. All four patients were neutropenic and had rapid development of respiratory symptoms in association with pulmonary in®ltrates on chest X-ray.…”

Identifying the emerging human pathogenScedosporium prolificansby using a species‐specific monoclonal antibody that binds to the melanin biosynthetic enzyme tetrahydroxynaphthalene reductase

“…Localized infections of immunocompetent individuals by S. prolificans are rare (Greig et al, 2001), but disseminated infections of immunocompromised patients are increasing in frequency and now account for approximately 25% of all non-Aspergillus mould infections in organ transplant recipients (Husain et al, 2003). The fungus causes debilitating diseases in a broad spectrum of patients at risk for invasive fungal infections including AIDS patients (Hopwood et al, 1995), allogeneic bone marrow and solid organ transplant recipients (Lionakis et al, 2004;Vagefi et al, 2005;Bouchara et al, 2009;Pihet et al, 2009a), and patients with neutropenia, acute lymphoblastic leukaemia and haematological malignancies (Alvarez et al, 1995;Maertens et al, 2000;Song et al, 2009). In neutropenic cancer patients and transplant recipients, disseminated infections are rapid (Alvarez et al, 1995;Husain et al, 2003;Marco de Lucas et al, 2006), with mortality rates of up to 75-80% (Rodriguez-Tudela et al, 2009).…”

“…The fungus causes debilitating diseases in a broad spectrum of patients at risk for invasive fungal infections including AIDS patients (Hopwood et al, 1995), allogeneic bone marrow and solid organ transplant recipients (Lionakis et al, 2004;Vagefi et al, 2005;Bouchara et al, 2009;Pihet et al, 2009a), and patients with neutropenia, acute lymphoblastic leukaemia and haematological malignancies (Alvarez et al, 1995;Maertens et al, 2000;Song et al, 2009). In neutropenic cancer patients and transplant recipients, disseminated infections are rapid (Alvarez et al, 1995;Husain et al, 2003;Marco de Lucas et al, 2006), with mortality rates of up to 75-80% (Rodriguez-Tudela et al, 2009). Along with the closely related fungi Pseudallescheria boydii and S. apiospermum, S. prolificans is recovered from the sputum samples of cystic fibrosis patients, but its involvement in disease aggravation has yet to be determined (Bouchara et al, 2009;Pihet et al, 2009a;Harun et al, 2010).…”

Preventing invasive fungal infection during hospital building works

“…6,27,28 A number of outbreak reports suggest that commencing antifungal prophylaxis during an outbreak may also be of benefit. 9,11,27,[29][30][31] However, most of these reports came from outbreaks that occurred before 1995 when antifungal prophylaxis for high-risk patient groups was not yet routine. We recommend lowering the threshold for antifungal prophylaxisusing a broader-spectrum antifungal agent or including patient groups other than those at 'high' risk -in the presence of ongoing building works.…”

“…have also been linked to building works. 1,11 A small, retrospective, case-control study revealed that IFI 'cases' confirmed at autopsy were more likely to have been hospitalized during hospital construction work (P < 0.02). 10 A separate clinico-epidemiological study found that rates of IFI rose from 1.2% pre-construction to 7.9% when construction was at its peak (P < 0.001).…”