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Diagnosis and treatment of Scedosporium infection

INTRODUCTION

During the past few decades, opportunistic fungal pathogens have become increasingly recognized as a cause of infection in severely ill or immunocompromised patients [1,2]. Although Aspergillus species remains the most common mold to cause invasive infection, other pathogens, such as Scedosporium, are becoming more common [1-3]. Two members of this genus, Scedosporium apiospermum and Scedosporium prolificans, are considered major human pathogens [4].

This topic will discuss the diagnosis and treatment of Scedosporium infections. The epidemiology, mycology, and clinical manifestations of Scedosporium infections are discussed elsewhere. (See "Epidemiology and clinical manifestations of Scedosporium infection".) Other emerging fungal infections are discussed elsewhere. (See "Epidemiology and clinical manifestations of Penicillium marneffei infection" and "Mycology, pathogenesis, and epidemiology of Fusarium infection".)

DIAGNOSIS

Invasive fungal infection has been defined in accordance with certain criteria proposed by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (NIAID/MSG) [1]. Proven mold infection is defined as:

Histopathologic examination revealing tissue invasion and a culture result positive for mold.

OR

                              

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Literature review current through: Nov 2014. | This topic last updated: Nov 7, 2013.
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References
Top
  1. Ascioglu S, Rex JH, de Pauw B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34:7.
  2. Tarrand JJ, Lichterfeld M, Warraich I, et al. Diagnosis of invasive septate mold infections. A correlation of microbiological culture and histologic or cytologic examination. Am J Clin Pathol 2003; 119:854.
  3. Walsh TJ, Groll A, Hiemenz J, et al. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 Suppl 1:48.
  4. Perfect JR, Schell WA. The new fungal opportunists are coming. Clin Infect Dis 1996; 22 Suppl 2:S112.
  5. Nulens E, Eggink C, Rijs AJ, et al. Keratitis caused by Scedosporium apiospermum successfully treated with a cornea transplant and voriconazole. J Clin Microbiol 2003; 41:2261.
  6. Castiglioni B, Sutton DA, Rinaldi MG, et al. Pseudallescheria boydii (Anamorph Scedosporium apiospermum). Infection in solid organ transplant recipients in a tertiary medical center and review of the literature. Medicine (Baltimore) 2002; 81:333.
  7. Montejo M, Muñiz ML, Zárraga S, et al. Case Reports. Infection due to Scedosporium apiospermum in renal transplant recipients: a report of two cases and literature review of central nervous system and cutaneous infections by Pseudallescheria boydii/Sc. apiospermum. Mycoses 2002; 45:418.
  8. Schaenman JM, DiGiulio DB, Mirels LF, et al. Scedosporium apiospermum soft tissue infection successfully treated with voriconazole: potential pitfalls in the transition from intravenous to oral therapy. J Clin Microbiol 2005; 43:973.
  9. Wilson CM, O'Rourke EJ, McGinnis MR, Salkin IF. Scedosporium inflatum: clinical spectrum of a newly recognized pathogen. J Infect Dis 1990; 161:102.
  10. Steinbach WJ, Schell WA, Miller JL, Perfect JR. Scedosporium prolificans osteomyelitis in an immunocompetent child treated with voriconazole and caspofungin, as well as locally applied polyhexamethylene biguanide. J Clin Microbiol 2003; 41:3981.
  11. Howden BP, Slavin MA, Schwarer AP, Mijch AM. Successful control of disseminated Scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis 2003; 22:111.
  12. Wood GM, McCormack JG, Muir DB, et al. Clinical features of human infection with Scedosporium inflatum. Clin Infect Dis 1992; 14:1027.
  13. Rüchel R, Wilichowski E. Cerebral Pseudallescheria mycosis after near-drowning. Mycoses 1995; 38:473.
  14. Chakraborty A, Workman MR, Bullock PR. Scedosporium apiospermum brain abscess treated with surgery and voriconazole. Case report. J Neurosurg 2005; 103:83.
  15. Cimon B, Carrère J, Vinatier JF, et al. Clinical significance of Scedosporium apiospermum in patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis 2000; 19:53.
  16. Symoens F, Knoop C, Schrooyen M, et al. Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation. J Heart Lung Transplant 2006; 25:603.
  17. Defontaine A, Zouhair R, Cimon B, et al. Genotyping study of Scedosporium apiospermum isolates from patients with cystic fibrosis. J Clin Microbiol 2002; 40:2108.
  18. Idigoras P, Pérez-Trallero E, Piñeiro L, et al. Disseminated infection and colonization by Scedosporium prolificans: a review of 18 cases, 1990-1999. Clin Infect Dis 2001; 32:E158.
  19. Tamm M, Malouf M, Glanville A. Pulmonary scedosporium infection following lung transplantation. Transpl Infect Dis 2001; 3:189.
  20. Husain S, Muñoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis 2005; 40:89.
  21. Jabado N, Casanova JL, Haddad E, et al. Invasive pulmonary infection due to Scedosporium apiospermum in two children with chronic granulomatous disease. Clin Infect Dis 1998; 27:1437.
  22. García-Arata MI, Otero MJ, Zomeño M, et al. Scedosporium apiospermum pneumonia after autologous bone marrow transplantation. Eur J Clin Microbiol Infect Dis 1996; 15:600.
  23. Klopfenstein KJ, Rosselet R, Termuhlen A, Powell D. Successful treatment of Scedosporium pneumonia with voriconazole during AML therapy and bone marrow transplantation. Med Pediatr Oncol 2003; 41:494.
  24. Nomdedéu J, Brunet S, Martino R, et al. Successful treatment of pneumonia due to Scedosporium apiospermum with itraconazole: case report. Clin Infect Dis 1993; 16:731.
  25. Goldberg SL, Geha DJ, Marshall WF, et al. Successful treatment of simultaneous pulmonary Pseudallescheria boydii and Aspergillus terreus infection with oral itraconazole. Clin Infect Dis 1993; 16:803.
  26. Perlroth MG, Miller J. Pseudoallescheria boydii pneumonia and empyema: a rare complication of heart transplantation cured with voriconazole. J Heart Lung Transplant 2004; 23:647.
  27. Pryce TM, Palladino S, Price DM, et al. Rapid identification of fungal pathogens in BacT/ALERT, BACTEC, and BBL MGIT media using polymerase chain reaction and DNA sequencing of the internal transcribed spacer regions. Diagn Microbiol Infect Dis 2006; 54:289.
  28. Lionakis MS, Bodey GP, Tarrand JJ, et al. The significance of blood cultures positive for emerging saprophytic moulds in cancer patients. Clin Microbiol Infect 2004; 10:922.
  29. Williamson EC, Speers D, Arthur IH, et al. Molecular epidemiology of Scedosporium apiospermum infection determined by PCR amplification of ribosomal intergenic spacer sequences in patients with chronic lung disease. J Clin Microbiol 2001; 39:47.
  30. de Aguirre L, Hurst SF, Choi JS, et al. Rapid differentiation of Aspergillus species from other medically important opportunistic molds and yeasts by PCR-enzyme immunoassay. J Clin Microbiol 2004; 42:3495.
  31. Ruiz-Díez B, Martín-Díez F, Rodríguez-Tudela JL, et al. Use of random amplification of polymorphic DNA (RAPD) and PCR-fingerprinting for genotyping a Scedosporium prolificans (inflatum) outbreak in four leukemic patients. Curr Microbiol 1997; 35:186.
  32. Guerrero A, Torres P, Duran MT, et al. Airborne outbreak of nosocomial Scedosporium prolificans infection. Lancet 2001; 357:1267.
  33. Odabasi Z, Paetznick VL, Rodriguez JR, et al. Differences in beta-glucan levels in culture supernatants of a variety of fungi. Med Mycol 2006; 44:267.
  34. Odabasi Z, Mattiuzzi G, Estey E, et al. Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis 2004; 39:199.
  35. Ostrosky-Zeichner L, Alexander BD, Kett DH, et al. Multicenter clinical evaluation of the (1-->3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 2005; 41:654.
  36. Pazos C, Pontón J, Del Palacio A. Contribution of (1->3)-beta-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients: a comparison with serial screening for circulating galactomannan. J Clin Microbiol 2005; 43:299.
  37. Yoshida M, Obayashi T, Iwama A, et al. Detection of plasma (1 --> 3)-beta-D-glucan in patients with Fusarium, Trichosporon, Saccharomyces and Acremonium fungaemias. J Med Vet Mycol 1997; 35:371.
  38. Liu K, Howell DN, Perfect JR, Schell WA. Morphologic criteria for the preliminary identification of Fusarium, Paecilomyces, and Acremonium species by histopathology. Am J Clin Pathol 1998; 109:45.
  39. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi; Approved Standard. NCCLS document M38-A. First Edition ed. Wayne, PA: NCCLS, 2002.
  40. Espinel-Ingroff A, Fothergill A, Ghannoum M, et al. Quality control and reference guidelines for CLSI broth microdilution susceptibility method (M 38-A document) for amphotericin B, itraconazole, posaconazole, and voriconazole. J Clin Microbiol 2005; 43:5243.
  41. Cuenca-Estrella M, Gomez-Lopez A, Mellado E, et al. Head-to-head comparison of the activities of currently available antifungal agents against 3,378 Spanish clinical isolates of yeasts and filamentous fungi. Antimicrob Agents Chemother 2006; 50:917.
  42. Cuenca-Estrella M, Ruiz-Díez B, Martínez-Suárez JV, et al. Comparative in-vitro activity of voriconazole (UK-109,496) and six other antifungal agents against clinical isolates of Scedosporium prolificans and Scedosporium apiospermum. J Antimicrob Chemother 1999; 43:149.
  43. Johnson EM, Szekely A, Warnock DW. In-vitro activity of voriconazole, itraconazole and amphotericin B against filamentous fungi. J Antimicrob Chemother 1998; 42:741.
  44. Meletiadis J, Meis JF, Mouton JW, et al. In vitro activities of new and conventional antifungal agents against clinical Scedosporium isolates. Antimicrob Agents Chemother 2002; 46:62.
  45. Cortez KJ, Roilides E, Quiroz-Telles F, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev 2008; 21:157.
  46. Garcia-Effron G, Gomez-Lopez A, Mellado E, et al. In vitro activity of terbinafine against medically important non-dermatophyte species of filamentous fungi. J Antimicrob Chemother 2004; 53:1086.
  47. Alexander BD, Pfaller MA. Contemporary Tools for the Diagnosis and Management of Invasive Mycoses. Clin Infect Dis 2006; 43 Suppl 1:S15.
  48. Cuenca-Estrella M, Gomez-Lopez A, Mellado E, et al. In vitro activity of ravuconazole against 923 clinical isolates of nondermatophyte filamentous fungi. Antimicrob Agents Chemother 2005; 49:5136.
  49. Carrillo AJ, Guarro J. In vitro activities of four novel triazoles against Scedosporium spp. Antimicrob Agents Chemother 2001; 45:2151.
  50. Afeltra J, Dannaoui E, Meis JF, et al. In vitro synergistic interaction between amphotericin B and pentamidine against Scedosporium prolificans. Antimicrob Agents Chemother 2002; 46:3323.
  51. Meletiadis J, Mouton JW, Rodriguez-Tudela JL, et al. In vitro interaction of terbinafine with itraconazole against clinical isolates of Scedosporium prolificans. Antimicrob Agents Chemother 2000; 44:470.
  52. Meletiadis J, Mouton JW, Meis JF, Verweij PE. In vitro drug interaction modeling of combinations of azoles with terbinafine against clinical Scedosporium prolificans isolates. Antimicrob Agents Chemother 2003; 47:106.
  53. Heyn K, Tredup A, Salvenmoser S, Müller FM. Effect of voriconazole combined with micafungin against Candida, Aspergillus, and Scedosporium spp. and Fusarium solani. Antimicrob Agents Chemother 2005; 49:5157.
  54. Capilla J, Serena C, Pastor FJ, et al. Efficacy of voriconazole in treatment of systemic scedosporiosis in neutropenic mice. Antimicrob Agents Chemother 2003; 47:3976.
  55. Capilla J, Guarro J. Correlation between in vitro susceptibility of Scedosporium apiospermum to voriconazole and in vivo outcome of scedosporiosis in guinea pigs. Antimicrob Agents Chemother 2004; 48:4009.
  56. González GM, Tijerina R, Najvar LK, et al. Activity of posaconazole against Pseudallescheria boydii: in vitro and in vivo assays. Antimicrob Agents Chemother 2003; 47:1436.
  57. Capilla J, Mayayo E, Serena C, et al. A novel murine model of cerebral scedosporiosis: lack of efficacy of amphotericin B. J Antimicrob Chemother 2004; 54:1092.
  58. Bocanegra R, Najvar LK, Hernandez S, et al. Caspofungin and liposomal amphotericin B therapy of experimental murine scedosporiosis. Antimicrob Agents Chemother 2005; 49:5139.
  59. Capilla J, Yustes C, Mayayo E, et al. Efficacy of albaconazole (UR-9825) in treatment of disseminated Scedosporium prolificans infection in rabbits. Antimicrob Agents Chemother 2003; 47:1948.
  60. Husain S, Alexander BD, Munoz P, et al. Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi. Clin Infect Dis 2003; 37:221.
  61. Marr KA, Carter RA, Crippa F, et al. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002; 34:909.
  62. Troke P, Aguirrebengoa K, Arteaga C, et al. Treatment of scedosporiosis with voriconazole: clinical experience with 107 patients. Antimicrob Agents Chemother 2008; 52:1743.
  63. Girmenia C, Luzi G, Monaco M, Martino P. Use of voriconazole in treatment of Scedosporium apiospermum infection: case report. J Clin Microbiol 1998; 36:1436.
  64. Muñoz P, Marín M, Tornero P, et al. Successful outcome of Scedosporium apiospermum disseminated infection treated with voriconazole in a patient receiving corticosteroid therapy. Clin Infect Dis 2000; 31:1499.
  65. Perfect JR, Marr KA, Walsh TJ, et al. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis 2003; 36:1122.
  66. Johnson LB, Kauffman CA. Voriconazole: a new triazole antifungal agent. Clin Infect Dis 2003; 36:630.
  67. Dodds Ashley ES, Lewis R, Lewis JS, et al. Pharmacology of Systemic Antifungal Agents. Clin Infect Dis 2006; 43 Suppl 1:S28.
  68. Perfect JR. Treatment of non-Aspergillus moulds in immunocompromised patients, with amphotericin B lipid complex. Clin Infect Dis 2005; 40 Suppl 6:S401.
  69. Wu Z, Ying H, Yiu S, et al. Fungal keratitis caused by Scedosporium apiospermum: report of two cases and review of treatment. Cornea 2002; 21:519.
  70. Díaz-Valle D, Benitez del Castillo JM, Amor E, et al. Severe keratomycosis secondary to Scedosporium apiospermum. Cornea 2002; 21:516.
  71. del Palacio A, Perez-Blazquez E, Cuétara MS, et al. Keratomycosis due to Scedosporium apiospermum. Mycoses 1991; 34:483.
  72. Hernández Prats C, Llinares Tello F, Burgos San José A, et al. Voriconazole in fungal keratitis caused by Scedosporium apiospermum. Ann Pharmacother 2004; 38:414.
  73. Larocco A Jr, Barron JB. Endogenous scedosporium apiospermum endophthalmitis. Retina 2005; 25:1090.
  74. McKelvie PA, Wong EY, Chow LP, Hall AJ. Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis. Clin Experiment Ophthalmol 2001; 29:330.
  75. Fortún J, Martín-Dávila P, Sánchez MA, et al. Voriconazole in the treatment of invasive mold infections in transplant recipients. Eur J Clin Microbiol Infect Dis 2003; 22:408.
  76. Talbot TR, Hatcher J, Davis SF, et al. Scedosporium apiospermum pneumonia and sternal wound infection in a heart transplant recipient. Transplantation 2002; 74:1645.
  77. German JW, Kellie SM, Pai MP, Turner PT. Treatment of a chronic Scedosporium apiospermum vertebral osteomyelitis. Case report. Neurosurg Focus 2004; 17:E9.
  78. O'Doherty M, Hannan M, Fulcher T. Voriconazole in the treatment of fungal osteomyelitis of the orbit in the immunocompromised host. Orbit 2005; 24:285.
  79. Karaarslan A, Arikan S, Karaarslan F, Cetin ES. Skin infection caused by Scedosporium apiospermum. Mycoses 2003; 46:524.
  80. Mellinghoff IK, Winston DJ, Mukwaya G, Schiller GJ. Treatment of Scedosporium apiospermum brain abscesses with posaconazole. Clin Infect Dis 2002; 34:1648.
  81. Berenguer J, Rodríguez-Tudela JL, Richard C, et al. Deep infections caused by Scedosporium prolificans. A report on 16 cases in Spain and a review of the literature. Scedosporium Prolificans Spanish Study Group. Medicine (Baltimore) 1997; 76:256.
  82. Madrigal V, Alonso J, Bureo E, et al. Fatal meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a child with lymphoblastic leukemia. Eur J Clin Microbiol Infect Dis 1995; 14:601.
  83. Salesa R, Burgos A, Ondiviela R, et al. Fatal disseminated infection by Scedosporium inflatum after bone marrow transplantation. Scand J Infect Dis 1993; 25:389.
  84. de Batlle J, Motjé M, Balanzà R, et al. Disseminated infection caused by Scedosporium prolificans in a patient with acute multilineal leukemia. J Clin Microbiol 2000; 38:1694.
  85. Rabodonirina M, Paulus S, Thevenet F, et al. Disseminated Scedosporium prolificans (S. inflatum) infection after single-lung transplantation. Clin Infect Dis 1994; 19:138.
  86. Spielberger RT, Tegtmeier BR, O'Donnell MR, Ito JI. Fatal Scedosporium prolificans (S. inflatum) fungemia following allogeneic bone marrow transplantation: report of a case in the United States. Clin Infect Dis 1995; 21:1067.
  87. Sullivan LJ, Snibson G, Joseph C, Taylor HR. Scedosporium prolificans sclerokeratitis. Aust N Z J Ophthalmol 1994; 22:207.
  88. Taylor A, Wiffen SJ, Kennedy CJ. Post-traumatic Scedosporium inflatum endophthalmitis. Clin Experiment Ophthalmol 2002; 30:47.
  89. Vagefi MR, Kim ET, Alvarado RG, et al. Bilateral endogenous Scedosporium prolificans endophthalmitis after lung transplantation. Am J Ophthalmol 2005; 139:370.
  90. Pickles RW, Pacey DE, Muir DB, Merrell WH. Experience with infection by Scedosporium prolificans including apparent cure with fluconazole therapy. J Infect 1996; 33:193.
  91. Gosbell IB, Toumasatos V, Yong J, et al. Cure of orthopaedic infection with Scedosporium prolificans, using voriconazole plus terbinafine, without the need for radical surgery. Mycoses 2003; 46:233.
  92. Pfizer. Package insert VFEND (Voriconazole).New York, NY 10017: Pfizer Inc., 2006:1-42.
  93. Casadevall A, Pirofski LA. Adjunctive immune therapy for fungal infections. Clin Infect Dis 2001; 33:1048.
  94. Pappas PG. Immunotherapy for invasive fungal infections: from bench to bedside. Drug Resist Updat 2004; 7:3.
  95. Gil-Lamaignere C, Roilides E, Lyman CA, et al. Human phagocytic cell responses to Scedosporium apiospermum (Pseudallescheria boydii): variable susceptibility to oxidative injury. Infect Immun 2003; 71:6472.
  96. Gil-Lamaignere C, Maloukou A, Rodriguez-Tudela JL, Roilides E. Human phagocytic cell responses to Scedosporium prolificans. Med Mycol 2001; 39:169.
  97. Gil-Lamaignere C, Winn RM, Simitsopoulou M, et al. Inteferon gamma and granulocyte-macrophage colony-stimulating factor augment the antifungal activity of human polymorphonuclear leukocytes against Scedosporium spp.: comparison with Aspergillus spp. Med Mycol 2005; 43:253.
  98. Gil-Lamaignere C, Roilides E, Maloukou A, et al. Amphotericin B lipid complex exerts additive antifungal activity in combination with polymorphonuclear leucocytes against Scedosporium prolificans and Scedosporium apiospermum. J Antimicrob Chemother 2002; 50:1027.
  99. Gil-Lamaignere C, Roilides E, Mosquera J, et al. Antifungal triazoles and polymorphonuclear leukocytes synergize to cause increased hyphal damage to Scedosporium prolificans and Scedosporium apiospermum. Antimicrob Agents Chemother 2002; 46:2234.
  100. Ortoneda M, Capilla J, Pastor FJ, et al. Interaction of granulocyte colony-stimulating factor and high doses of liposomal amphotericin B in the treatment of systemic murine scedosporiosis. Diagn Microbiol Infect Dis 2004; 50:247.
  101. Simitsopoulou M, Gil-Lamaignere C, Avramidis N, et al. Antifungal activities of posaconazole and granulocyte-macrophage colony-stimulating factor ex vivo and in mice with disseminated infection due to Scedosporium prolificans. Antimicrob Agents Chemother 2004; 48:3801.
  102. Bouza E, Muñoz P, Vega L, et al. Clinical resolution of Scedosporium prolificans fungemia associated with reversal of neutropenia following administration of granulocyte colony-stimulating factor. Clin Infect Dis 1996; 23:192.
  103. Mursch K, Trnovec S, Ratz H, et al. Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode. Childs Nerv Syst 2006; 22:189.
  104. Nesky MA, McDougal EC, Peacock Jr JE. Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis. Clin Infect Dis 2000; 31:673.