Scedosporium apiospermum brain abscesses in a patient after near-drowning – a case report with 10-year follow-up and a review of the literature

Signore, Sandra C.; Dohm, Christoph P.; Schütze, Gunther; Bähr, Mathias; Kermer, Pawel

doi:10.1016/j.mmcr.2017.06.001

Cited by 14 publications

(18 citation statements)

References 19 publications

(41 reference statements)

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“…The most common cause of CNS infection is contact with contaminated water [ 101 , 102 , 104 ]. A few cases of CNS infection with S. apiospermum after near-drowning have been described in the world literature [ 105 , 106 ]. In addition, endophthalmitis due to S. prolificans (syn.…”

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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BackgroundFungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences.MethodsOne hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: “fungi and CNS mycoses”, CNS fungal infections”, “fungal brain infections”, " fungal cerebritis”, fungal meningitis”, “diagnostics of fungal infections”, and “treatment of CNS fungal infections”. All were published in English with the majority in the period 2000–2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS.ResultsThe FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS.ConclusionAlthough the number of fungal species causing CNS mycosis is increasing, only som...

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Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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“…Most CNS infections due to S. apiospermum occur in immunocompetent patients, typically associated with near drowning, motor vehicle accidents, or direct inoculation (neurosurgery, CSF drainage devices, shunts, etc.) [56,57,58]. Cerebral scedosporiosis due to L. proliferans has been described in immunocompromised patients, is typically due to rapid hematogenous dissemination, and is invariably fatal [55,59].…”

Section: Other Hyaline Moldsmentioning

confidence: 99%

Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds

Miceli

2019

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Central nervous system infections due to Aspergillus spp and other hyaline molds such as Fusarium and Scedosporium spp are rare but fatal conditions. Invasion of the central nervous system (CNS) tends to occur as a result of hematogenous dissemination among immunocompromised patients, and by local extension or direct inoculation secondary to trauma in immunocompetent hosts. Efforts should be directed to confirm the diagnosis by image-guided stereotactic brain biopsy when feasible. Non-culture methods could be useful to support the diagnosis, but they have not been validated to be performed in cerebral spinal fluid. Treatment of these infections is challenging given the variable susceptibility profile of these pathogens and the penetration of antifungal agents into the brain.

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“…One of the most serious fungal infections of the lungs and brain that may afflict patients follows exposure by near–drowning events due to inhalation of contaminated water [47,48]. The most common fungi associated with near-drowning syndrome belong to the Scedosporium apiospermum complex (Microascaceae), including fungi Pseudallescheria and its anamorph Scedosporium [21].…”

Section: Water-related Filamentous Fungi As Causative Agents Of Opmentioning

confidence: 99%

“…The most common fungi associated with near-drowning syndrome belong to the Scedosporium apiospermum complex (Microascaceae), including fungi Pseudallescheria and its anamorph Scedosporium [21]. The disease develops slowly, and only after several weeks or months do cerebral abscesses or pulmonary infection appear, often with a fatal outcome [47,48]. Fungi from Scedosporium apiospermum complex were also related to otitis, subcutaneous, and disseminated infections (Table 2) [8].…”

Section: Water-related Filamentous Fungi As Causative Agents Of Opmentioning

confidence: 99%

Opportunistic Water-Borne Human Pathogenic Filamentous Fungi Unreported from Food

et al. 2018

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Clean drinking water and sanitation are fundamental human rights recognized by the United Nations (UN) General Assembly and the Human Rights Council in 2010 (Resolution 64/292). In modern societies, water is not related only to drinking, it is also widely used for personal and home hygiene, and leisure. Ongoing human population and subsequent environmental stressors challenge the current standards on safe drinking and recreational water, requiring regular updating. Also, a changing Earth and its increasingly frequent extreme weather events and climatic changes underpin the necessity to adjust regulation to a risk-based approach. Although fungi were never introduced to water quality regulations, the incidence of fungal infections worldwide is growing, and changes in antimicrobial resistance patterns are taking place. The presence of fungi in different types of water has been thoroughly investigated during the past 30 years only in Europe, and more than 400 different species were reported from ground-, surface-, and tap-water. The most frequently reported fungi, however, were not waterborne, but are frequently related to soil, air, and food. This review focuses on waterborne filamentous fungi, unreported from food, that offer a pathogenic potential.

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Scedosporium apiospermum brain abscesses in a patient after near-drowning – a case report with 10-year follow-up and a review of the literature

Cited by 14 publications

References 19 publications

Neuroinfections caused by fungi

Neuroinfections caused by fungi

Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds

Opportunistic Water-Borne Human Pathogenic Filamentous Fungi Unreported from Food

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