Scedosporium apiospermum infection after near-drowning

Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece.
Mycoses (Impact Factor: 2.24). 10/2007; 50(5):412-21. DOI: 10.1111/j.1439-0507.2007.01388.x
Source: PubMed


Scedosporium apiospermum and its teleomorph (sexual form) Pseudallescheria boydii are ubiquitous saprophytic fungi, which under specific conditions, such as near-drowning, may cause therapy-refractory and life-threatening infections. We reviewed 22 cases (eight children and 14 adults) of S. apiospermum infection after near-drowning reported in the literature including an additional paediatric case from our institution. Scedosporiosis after near-drowning was associated with high mortality (16/23, 70%) even in immunocompetent hosts. It affected mainly young (mean age 24 years) and immunocompetent (83% with no apparent immune defect) males (male to female ratio 2.5 : 1). Scedosporiosis after near-drowning was a slow progressive disease (mean survival time 87 days) involving virtually all body organs. However, central nervous system (CNS) dissemination predominated (21/23, 91%) presenting mainly as multiple brain abscesses (15/23, 65%). All 23 patients showed preceding clinical and/or radiological evidence of lung disease indicating the mode of invasion. Diagnosis was delayed (median time to diagnosis 28 days) and was made by culture (16/23, 69.5%) or culture and tissue examination (7/23, 30.5%). The majority of the patients (20/23, 87%) received antifungal treatment and underwent neurosurgery. While the optimal treatment remains undefined, the most recent reports indicated voriconazole as a potentially effective option. Better knowledge of scedosporiosis after near-drowning could lead to improved intervention and ultimately to more favourable outcome.

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Available from: Aspasia Katragkou, Jan 11, 2015
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    • "S. apiospermum is well known to cause respiratory tract infection, which occurs via inhalation of spores, though this organism can disseminate and has a predilection for the central nervous system. It is notorious for causing meningitis after near drowning episodes [3], and this fungus can produce adventitial forms in tissue and release yeastlike forms into circulation, which likely allows for isolation in blood cultures [4]. It has rarely been shown to cause infective endocarditis. "
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    ABSTRACT: Scedosporium apiospermum is an increasingly appreciated pathogen in immunosuppressed patients. We present a case of S. apiospermum endocarditis in a 70-year-old male who had undergone orthotopic heart transplant. Echocardiogram demonstrated a 1.4 cm tricuspid valve vegetation. He underwent valve replacement, complicated by fatal massive post-operative haemorrhage. Valve cultures grew S. apiospermum. To our knowledge, our case is the first reported instance of endocarditis caused by S. apiospermum in a recipient of a cardiac transplant.
    Full-text · Article · Sep 2015 · Medical Mycology Case Reports
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    • "Sinusitis and pulmonary infections may also occur through inhalation of some airborne conidia, for example in patients with preexisting pulmonary cavities. Additionally, invasive diseases with central nervous system involvement and a high mortality rate are described as a consequence of near-drowning incidents (Panichpisal et al., 2006; Katragkou et al., 2007). Nevertheless, this fungus has gained attention in the past two decades mainly because of its worldwide recognition as a significant pathogen in patients with cystic fibrosis (CF). "
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    ABSTRACT: Species of the Pseudallescheria boydii / Scedosporium apiospermum complex (PSC) are emerging fungal pathogens able to chronically colonize the airways of patients with cystic fibrosis (CF). As P. boydii was found more frequently colonizing the lungs of CF patients in France than in other European countries in a previous report, the present study was conducted in order to clarify distribution of PSC species in our country and to characterize their natural habitat. The highest densities of PSC isolates were found in human-impacted areas, i.e. agricultural areas, fluids obtained from wastewater treatment plants, playgrounds and industrial areas. PSC was not detected from soil samples collected in forests. Most PSC culture-positive soil samples exhibited a pH range of 6 to 8. Scedosporium dehoogii, the most abundant species, was detected in all human-impacted area types except vineyards, whereas Scedosporium aurantiacum was mostly found in agricultural areas. Pseudallescheria boydii and S. apiospermum were predominantly isolated from seashores and playgrounds, respectively. Pseudallescheria minutispora was found only once from a playground. This study highlights potential sources of contamination of the patients, especially in the CF context.
    Full-text · Article · Mar 2014 · Environmental Microbiology
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    • "Because the detection of Scedosporium was confined to the BAL from the lung abscess, it was obviously too late for a successful antifungal therapy. Katragkou and colleagues [12] reported that the median 'time to diagnosis of Scedosporium infection' was 28 days. This could be attributed to the low sensitivity of routine culture methods. "
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    ABSTRACT: Scedosporium apiospermum is increasingly recognized as a cause of localized and disseminated mycotic infections in near-drowning victims. We report the case of a 59-year-old Japanese woman who was a survivor of a tsunami in northeastern Japan and who had lung and brain abscesses caused by S. apiospermum. Initially, an aspergillus infection was suspected, so she was treated with micafungin. However, computed tomography scans of her chest revealed lung abscesses, and magnetic resonance images demonstrated multiple abscesses in her brain. S. apiospermum was cultured from her bronchoalveolar lavage fluid, and antimycotic therapy with voriconazole was initiated. Since she developed an increase in the frequency of premature ventricular contractions, an adverse drug reaction to the voriconazole was suspected. She was started on a treatment of a combination of low-dose voriconazole and liposomal amphotericin B. After combination therapy, further computed tomography scans of the chest and magnetic resonance images of her brain showed a demarcation of abscesses. Voriconazole appeared to have a successful record in treating scedosporiosis after a near drowning but, owing to several adverse effects, may possibly not be recommended. Thus, a combination treatment of low-dose voriconazole and liposomal amphotericin B may be a safe and effective treatment for an S. apiospermum infection. Even though a diagnosis of scedosporiosis may be difficult, a fast and correct etiological diagnosis could improve the patient's chance of recovery in any case.
    Full-text · Article · Oct 2011 · Journal of Medical Case Reports
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