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Published on: March 29, 2012
A review of German Scedosporium prolificans cases from 1993 to 2007
K Tintelnot1, G Just-Nübling, R Horré
1Division of Mycology, Robert Koch-Institut, Nordufer 20, Berlin, Germany. tintelnotk@rki.de
Abstract:
Scedosporium prolificans is one of the most life-threatening fungal opportunistic pathogens due to its high resistance to common systemic antifungal agents. While a close relative of Pseudallescheria boydii, S. prolificans has a more limited geographic range being primarily found in Australia, USA and Spain. Infections have also been reported from several other European countries and from Chile. Twenty patients with Scedosporium prolificans infection or colonization from August 1993 to May 2007 were retrospectively reviewed in Germany. They had all been identified at or reported to the Reference Laboratory for Pseudallescheria/Scedosporium spp. in Berlin. Twelve of 13 patients with haematological disorders and/or on immunosuppressive therapy developed a fatal invasive scedosporiosis. Colonization of the respiratory tract was reported for one patient after heart-lung-transplantation, all six patients with cystic fibrosis and one with chronic sinusitis. Molecular studies of the S. prolificans isolates confirmed that parts of the 18S, the Internal Transcribed Spacer (ITS) regions and the D1/D2 domain of the 28S region of rDNA are monomorphic. However, sequencing of parts of the translation elongation factor EF1-alpha (EF-1alpha) and the chitin synthase (CHS-1) genes revealed the presence of three and two distinct genotypes, respectively. Two informative mutations were found in EF-1alpha and a single nucleotide exchange in the CHS-1 gene.
Insights
Scedosporium prolificans, a resistant fungal pathogen, caused fatal invasive infections in 12 of 13 immunocompromised patients. Molecular analysis revealed genetic diversity within S. prolificans strains.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Molecular Biology
Background:
- Scedosporium prolificans is a highly resistant fungal opportunistic pathogen.
- It is geographically limited, primarily found in Australia, USA, and Spain, with reported cases elsewhere.
- Infections pose a significant threat, especially to immunocompromised individuals.
Purpose of the Study:
- To retrospectively review Scedosporium prolificans infections and colonization in Germany.
- To investigate the genetic diversity of S. prolificans isolates using molecular methods.
Main Methods:
- Retrospective review of 20 patients identified between August 1993 and May 2007.
- Molecular analysis of ribosomal DNA (rDNA) regions (18S, ITS, 28S D1/D2).
- Sequencing of translation elongation factor EF1-alpha (EF-1alpha) and chitin synthase (CHS-1) genes.
Main Results:
- Twelve of 13 patients with hematological disorders or immunosuppressive therapy experienced fatal invasive scedosporiosis.
- Respiratory tract colonization was observed in transplant recipients, cystic fibrosis patients, and individuals with sinusitis.
- rDNA regions were monomorphic, but EF-1alpha and CHS-1 genes showed genotypic variations (3 and 2 genotypes, respectively).
Conclusions:
- Scedosporium prolificans poses a severe threat, particularly to immunocompromised patients, often leading to fatal outcomes.
- Genetic analysis using EF-1alpha and CHS-1 genes is valuable for differentiating S. prolificans strains.
- Further research into S. prolificans epidemiology and treatment is warranted.
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