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[Infection and colonization by Scedosporium prolificans]
L López1, L Gaztelurrutia, M Cuenca-Estrella
1Servicio de Microbiología, Hospital de Cruces, Baracaldo, Vizcaya.
Background:
Scedosporium prolificans is a dematiaceous fungus that is known to cause a wide spectrum of infections in humans, bearing a severity and a prognosis that is relationed with the patients immune status.
Methods:
A retrospective review was made of the clinical charts of all patients who developed positive S. prolificans cultures in our centre from 1990 to 2000. Isolates were identified by colonial morphology and microscopic features. The in vitro susceptibility was evaluated using the microdilution method according to NCCLS.
Results:
S. prolificans was isolated in 15 patients. Eight were affected with cystic fibrosis and the isolation of S. prolificans in their airways did not worsen their clinical status. Among the remaining 7 cases there were five leukemic patients with neutropenia and two immunocompetent hosts with cutaneous infection and endocarditis. Four of five neutropenic patients died of sudden sepsis and S. prolificans was isolated from blood cultures made a few days before their death, and the fifth neutropenic case suffered a bilateral pneumonia with improving course probably due to recovery from neutropenia. As to the immunocompetent group the clinical course was good in the cutaneous infection case, but the endocarditis case died four days after the antifungical therapy was started. All the isolates tested were found to be resistant to amphotericin, 5 flucytosine, fluconazole, itraconazole, voriconazole, miconazole and terbinafine.
Conclusions:
Scedosporium prolificans is a fungal pathogen that colonizes the airways of patients affected with cystic fibrosis. It can also cause a wide variety of infections, whose severity and prognosis depends on the patients immune status. Due to the resistance of this fungus to antifungal drugs, the therapeutic options are limited. Only with the correction of neutropenia and surgery in local infections in immunocompetent hosts it has been possible to cure these infections.
Insights
Scedosporium prolificans causes severe infections, especially in immunocompromised patients. This fungus is resistant to most antifungals, limiting treatment options and highlighting the need for new therapeutic strategies.
Area of Science:
- Mycology
- Infectious Diseases
Background:
- Scedosporium prolificans is a fungus causing diverse human infections.
- Infection severity and prognosis depend on the patient's immune status.
Observation:
- A retrospective review of 15 patients with S. prolificans infections was conducted.
- Patients included those with cystic fibrosis, leukemia, and immunocompetent hosts.
Findings:
- S. prolificans colonization did not worsen cystic fibrosis patients' status.
- Neutropenic patients had high mortality rates from sepsis.
- Immunocompetent patients showed variable outcomes; one with endocarditis died despite therapy.
- All isolates demonstrated resistance to common antifungal drugs.
Implications:
- Limited therapeutic options exist for Scedosporium prolificans infections due to antifungal resistance.
- Correction of neutropenia and surgical intervention are crucial for managing infections in specific patient groups.