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Treatment of Scedosporium infection

Sylvia F Costa, MD
Barbara D Alexander, MD, MHS
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


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 remain 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 (the asexual form of Pseudoallescheria boydii) 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, clinical manifestations, and diagnosis of Scedosporium infection".) Other emerging fungal infections are discussed elsewhere. (See "Epidemiology and clinical manifestations of Penicillium (Talaromyces) marneffei infection" and "Mycology, pathogenesis, and epidemiology of Fusarium infection".)


The Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) has approved a standard method (M38-A2) for antifungal susceptibility testing of filamentous fungi [5]. The M38-A2 method is applicable to Aspergillus, Fusarium, Scedosporium, and the Mucorales for testing amphotericin B and the azole antifungal agents. Minimum inhibitory concentration (MIC) reference ranges for amphotericin B, voriconazole, and posaconazole have been proposed for S. apiospermum [6]. However, interpretive breakpoints for MICs are not available. For echinocandins, inter-laboratory reproducibility for filamentous fungi using the M38-A method has not been established. Thus, caution should be exercised when attempting to interpret echinocandin susceptibility results [7].

Given the varying in vitro activity of antifungal agents against S. apiospermum and especially S. prolificans, we typically ask for susceptibility testing of isolates from patients with scedosporiosis.

Antifungal susceptibility testing is discussed in detail separately. (See "Antifungal susceptibility testing".)


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Literature review current through: Sep 2015. | This topic last updated: Jul 31, 2015.
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