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An elusive diagnosis: Scedosporium apiospermum infection after near-drowning

Malini Gopinath1, Ajith Cherian, Neeraj N Baheti

  • 1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Annals of Indian Academy of Neurology
|November 19, 2010
PubMed

Insights

Near-drowning can lead to insidious Scedosporium apiospermum infections of the central nervous system, causing ventriculitis and ring-enhancing lesions. Prompt voriconazole treatment is crucial for survival.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Near-drowning incidents can precipitate serious medical complications.
  • Fungal infections of the central nervous system (CNS) pose significant diagnostic and therapeutic challenges.

Observation:

  • A 51-year-old male developed ventriculitis and cerebral ring-enhancing lesions after a near-drowning event.
  • The patient experienced a fatal subarachnoid hemorrhage due to a ruptured mycotic aneurysm.
  • Scedosporium apiospermum was identified in the cerebrospinal fluid.

Findings:

  • Central nervous system invasion by Scedosporium apiospermum can present subtly in near-drowning survivors.
  • Cerebral ring-enhancing lesions and ventriculitis are key indicators of this infection.
  • Early initiation of antifungal therapy, even before definitive culture results, is critical.

Implications:

  • Neurologists and intensivists must maintain a high index of suspicion for Scedosporium apiospermum in near-drowning patients with CNS symptoms.
  • Prompt diagnosis and treatment with voriconazole can be life-saving.
  • This case highlights the potential for rare fungal pathogens to cause severe neurological sequelae.
Keywords:
Fungal meningitisPseudallescheria boydiiScedosporium apiospermumnear-drowning

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