Scedosporiosis in patients with acute leukemia: a retrospective multicenter report

Abstract

We retrospectively analyzed 542 proven/probable mould infections registered, in the course of 2 studies, in 8,633 patients with acute leukemia, focusing on scedosporiosis. We aimed to define scedosporiosis incidence and mortality rate over a 15-year period. Only 5 cases of scedosporiosis were identified, all of them involving patients with acute myeloid leukemia (AML). We also reviewed all cases of Scedosporium spp. infections in acute leukemia reported to date in the international literature. The 52 cases analyzed confirmed that acute myeloid leukemia is the category with the highest risk of scedosporiosis. Clinical features of scedosporiosis were extremely variable and closely related to patient immune status. Infection disseminated to multiple sites in a very high percentage of patients and outcome was confirmed to be very poor. In our surveys all patients died, in spite of Amphotericin B compounds or voriconazole administration. Our review of literature found scedosporiosis attributable mortality rate (AMR) to be 77%. In conclusion, scedosporiosis, although extremely rare, represents a big problem for clinicians because of its aggressive clinical presentation and the lack of an effective therapy. New drugs with in vitro activity against Scedosporium spp (voriconazole, posaconazole) should be considered. However, their clinical activity should be more widely demonstrated.

Isolation of Scedosporium apiospermum (Teleomorph: Pseudallescheria apiosperma) from an Acute Myeloid Leukemia Patient

“…İlk hastaların tanımlanmasından günümüze kadar geçen sürede, yeni antifungal ilaçların kullanıma girmesine rağmen, skedosporyoz tedavisinde önemli bir başarı sağlanamamıştır. AML hastalarındaki uzun süreli immünsüpresyon, hızlı ve etkili antifungal tedaviyi gerektirmektedir 5 . Yaygın skedosporyozda etkin bir tedavi bulunmamaktadır.…”

“…AML hastalarında kültürle varlığı gösterilen skedosporyoz insidansı %0.08 olarak rapor edilmiştir 5 . AML hastalarında görülen skedosporyozun klinik tablosu, daha sık enfeksiyon etkeni olan diğer filamentöz mantar enfeksiyonlarını taklit edebilmektedir.…”

Deep Skin Infection of Scedosporium apiospermum in a Patient with Refractory Idiopathic Thrombocytopenic Purpura

“…Concerning the incidence of scedosporiosis among a certain disease status, Caira et al (11) reported the incidence of Scedosporium infections in patients with acute leukemia in Italy. They collected a total of 542 proven/probable mold infections among 8,633 patients with acute leukemia.…”

Aspectos actuales de las enfermedades invasivas por hongos filamentosos

“…La patogenia y la epidemiología de estas micosis emergentes es peor conocida, y su diagnóstico, más complicado, ya que no tienen unas características clínicas y radiológicas específicas y muchos de estos hongos poseen propiedades fisiológicas y relacionadas con el cultivo poco conocidas, lo que plantea dificultades para su identificación en el laboratorio 1,[7][8][9]39 .…”

“…Posaconazol es una alternativa terapéutica en los casos en los que no es efectivo el tratamiento anterior (tabla 3). Lomentospora prolificans (Scedosporium prolificans) es un hongo multirresistente a los antifúngicos habituales y para su tratamiento se requiere la combinación de voriconazol con otros fármacos (terbinafina, una candina, miltefosina, colistina o interferón-␥), sin que pueda garantizarse un resultado satisfactorio 8,9,39 .…”