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Murine Intrapulmonary Tracheal Transplantation: A Model for Investigating Obliterative Airway Disease After Lung Transplantation
Published on: November 10, 2023
Scedosporium apiospermum (Pseudoallescheria boydii) infection in lung transplant recipients
Hina Sahi1, Robin K Avery, Omar A Minai
1Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
Background:
Scedosporium apiospermum, the asexual counterpart of the teleomorph Pseudallescheria boydii, is increasingly recognized as an important opportunistic pathogen in transplant recipients. Infection is associated with a high rate of dissemination and poor outcome overall.
Methods:
A retrospective analysis of The Cleveland Clinic lung transplant database identified 5 patients with S. apiospermum isolated from respiratory tract specimens. Demographic data and lung transplant outcomes were obtained by review of medical records.
Results:
S. apiospermum was isolated from respiratory culture in 5 lung transplant recipients. Disseminated disease developed in 3 patients, whereas 2 appeared only to be colonized.
Conclusions:
Our experience and review of the literature highlights the importance of early diagnosis and differentiation from Aspergillus, since Scedosporium is inherently resistant to amphotericin B. Effective therapeutic approaches being explored include combinations of anti-fungals, because even the newer triazoles have a 50% response rate in clinical studies. Surgical débridement and immune recovery are associated with improved prognosis, favoring the use of agents that expedite immune reconstitution in these patients. Close monitoring of clinical improvement and frequent reevaluation of treatment is essential.
Insights
Scedosporium apiospermum is a dangerous fungus in lung transplant patients, often spreading and leading to poor outcomes. Early diagnosis and combination antifungal therapy are crucial for improving prognosis.
Area of Science:
- Mycology
- Infectious Diseases
- Transplant Medicine
Background:
- Scedosporium apiospermum, the asexual form of Pseudallescheria boydii, is an emerging opportunistic pathogen.
- Infections in transplant recipients are linked to high dissemination rates and adverse outcomes.
Observation:
- A retrospective analysis identified five lung transplant recipients with S. apiospermum isolated from respiratory samples.
- Three patients developed disseminated disease, while two showed only colonization.
Findings:
- Scedosporium apiospermum poses a significant risk in lung transplant recipients.
- The fungus exhibits inherent resistance to amphotericin B, necessitating alternative treatment strategies.
Implications:
- Early and accurate diagnosis, differentiating Scedosporium from Aspergillus, is critical.
- Combination antifungal therapies, surgical intervention, and expedited immune recovery are vital for improved patient prognosis.
- Close clinical monitoring and treatment reevaluation are essential for managing Scedosporium infections.
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