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Fungal infections in lung transplantation
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Overall, Scedosporium infection accounts for 27% of cases of mold infection in lung transplant recipients and occurs at a median of 12 months after lung transplantation.3Scedosporium is associated with various conditions, such as colonization, mycetoma, sinopulmonary disease, and disseminated disease with CNS involvement.67 Approximately 50% of cases of scedosporiosis in SOT recipients are disseminated.68 The clinical symptoms, radiologic findings, and histopathologic features of Scedosporium infection are indistinguishable from those characterizing Aspergillus, but unlike Aspergillus, Scedosporium is resistant to many anti-fungal agents and is thus associated with high rates of therapeutic failure and relapses.67
Epidemiology of fungal infections: What, where, and when
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Frederic Lamoth, Sylvia F. Costa, Barbara D. Alexander
It is important to note that both S. apiospermum complex and L. prolificans may simply colonize body sites without overt disease, or they may produce a variety of clinical syndromes in a wide range of hosts. For example, S. apiospermum has been isolated as a colonizer from the airways of CF patients, and S. prolificans has been reported to colonize airways and external auditory canals [116,117,125–129]. Patients in these reports had the organism isolated from culture on multiple occasions; however, they did not appear to have clinical disease, nor did they receive systemic antifungal therapy. On the other hand, both organisms may cause severe infection of the eye, lung, skin and soft tissues, bone, CNS, and bloodstream. In fact, disseminated infection is the most commonly reported presentation of S. prolificans, and blood cultures are frequently positive (in 75%–100% of cases) in the setting of disseminated disease [113,115,117,123,130–135]. The high rate of bloodstream infection may be one feature distinctive of infection with S. prolificans when compared with S. apiospermum infection. In one large review of transplant recipients with scedosporiosis, fungemia occurred in 40% of cases with S. prolificans infection versus 4.7% of cases with S. apiospermum infection [122]. The overall mortality rate among transplant recipients with scedosporiosis was 58%. Among the HSCT recipients, overall mortality rate was 68% (77.8% for S. prolificans and 61.5% for S. apiospermum) whereas the mortality for SOT recipients was 54% (77.8% for S. prolificans and 54.5% for S. apiospermum).
Surface properties, adhesion and biofilm formation on different surfaces by Scedosporium spp. and Lomentospora prolificans
Published in Biofouling, 2018
Thaís P. Mello, Simone S. C. Oliveira, Susana Frasés, Marta H. Branquinha, André L. S. Santos
Their (multi)resistance profile against commonly used, clinical antifungal drugs is a hallmark of Scedosporium/Lomentospora species and, consequently, an eminent concern during the treatment of patients with scedosporiosis/lomentosporiosis in hospitals worldwide (Lackner et al. 2012). Aggravating this scenario is the ability of these fungi to adhere to the surfaces of medical devices and subsequently to form biofilms (robust structures that confer resistance to many physico-chemical stressor agents such as drugs, radiation, shear forces, and host immune attack) (Okshevsky et al. 2015). The establishment of biofilms has recently been reported for S. apiospermum, S. boydii, S. minutisporum, S. aurantiacum, and L. prolificans (Mello et al. 2016a; Rollin-Pinheiro et al. 2017). Corroborating these findings, Mello et al. (2016a) reported that the MIC values measured for the biofilms formed on a polystyrene surface by Scedosporium/Lomentospora species were significantly higher than for planktonic cells. It is relevant to highlight that a few clinical cases of scedosporiosis have already been attributed to biofilm formation on catheter surfaces (Jeong et al. 2011; Eldin et al. 2012).
Evolution of antifungals for invasive mold infections in immunocompromised hosts, then and now
Published in Expert Review of Anti-infective Therapy, 2023
Zoe Freeman Weiss, Jessica Little, Sarah Hammond
Scedosporiosis is associated with significant mortality (between 50 and 90%), with highest mortality in stem cell transplant recipients [102,103]. Voriconazole or voriconazole-based regimens are considered the drug of choice for scedosporiosis [104,105] due to extensive clinical experience with this agent [102] and some evidence of improved outcomes when compared to other agents. In one study of 80 patients with scedosporiosis (including patients with both S. apiospermum complex and L. prolificans) between 1985 and 2003, a logistic regression model comparing voriconazole to amphotericin, voriconazole was associated with a trend toward better survival [OR], 10.40; P = .08 as compared to amphotericin [106].
Advances in understanding and managing Scedosporium respiratory infections in patients with cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2020
Jean-Philippe Bouchara, Yohann Le Govic, Samar Kabbara, Bernard Cimon, Rachid Zouhair, Monzer Hamze, Nicolas Papon, Gilles Nevez
In non-transplanted patients, documented cases of scedosporiosis remain rare. In a patient that was chronically colonized with Scedosporium, a pulmonary mycetoma has developed; however, a cerebral involvement complicated the situation which rapidly led to the patient’s death [33]. Similarly, spondylodiscitis was reported in a CF patient colonized by Scedosporium and the unique risk factor that was identified for hematogenous spread was a corticosteroid-induced diabetes [34].