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Scedosporium inflatum: clinical spectrum of a newly recognized pathogen
C M Wilson1, E J O'Rourke, M R McGinnis
1Division of Infectious Diseases, The Children's Hospital, Boston, MA 02115.
Abstract:
The clinical course of 11 patients is reported: a newly-described species, Scedosporium inflatum, was isolated from each. Infections were primarily focally invasive and involved musculoskeletal tissues. All but one followed penetrating trauma, often minor, or surgery. Two cases, one fatal, occurred in immunosuppressed patients. In only one case was there presumptive hematogenous spread. In three cases colonization with S. inflatum could not reliably be distinguished from infection. In vitro susceptibility testing of isolates from all patients showed that all were resistant to amphotericin B, miconazole, and ketoconazole and most were resistant to fluconazole and itraconazole. The optimum management of S. inflatum infection is not apparent: Although several patients recovered without antifungal therapy, progressive unremitting infection occurred in an immunocompromised patient and in a previously healthy child despite aggressive antifungal chemotherapy and surgical debridement.
Insights
Scedosporium inflatum infections primarily affect musculoskeletal tissues following trauma or surgery. Many isolates show antifungal resistance, complicating treatment and patient outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- A newly described fungal species, Scedosporium inflatum, has emerged as a cause of human infection.
- Understanding its clinical presentation and treatment is crucial for patient management.
Observation:
- Eleven cases of Scedosporium inflatum infection are reported, predominantly affecting musculoskeletal tissues.
- Most infections followed penetrating trauma or surgery, with two cases occurring in immunosuppressed individuals.
- Distinguishing colonization from infection was challenging in some instances.
Findings:
- Scedosporium inflatum isolates demonstrated resistance to multiple antifungal agents, including amphotericin B, miconazole, ketoconazole, fluconazole, and itraconazole.
- Treatment outcomes were variable, with some patients recovering without antifungals, while others experienced progressive disease despite aggressive therapy.
- Optimal management strategies for Scedosporium inflatum infections remain unclear.
Implications:
- The antifungal resistance profile of Scedosporium inflatum poses significant therapeutic challenges.
- Further research is needed to establish effective treatment protocols for these infections.
- Clinicians should consider Scedosporium inflatum in cases of invasive fungal infections, particularly after trauma or in immunocompromised patients.