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Published on: December 7, 2021
Cluster analysis of Scedosporium boydii infections in a single hospital
Anne Bernhardt1, Michael Seibold1, Volker Rickerts1
1Robert Koch Institute, Division 16: Mycotic and Parasitic Agents and Mycobacteria, Consultant laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, Berlin, Germany.
Abstract:
Scedosporiosis is a rare, but often fatal mycotic infection occurring in immunosuppressed as well as in immunocompetent patients. Over a period of 14 months, Scedosporium boydii isolates were sent to our reference laboratory from six immunocompetent patients treated at a single hospital in Germany. In analogy to the EORTC/MSG criteria, four patients were classified as proven invasive scedosporiosis cases, and two patients as probable or possible cases. Of note, in five patients scedosporiosis was diagnosed between 1 and 14 months (median 5.0 months) after cardiac surgery. Despite antimycotic treatment two patients died, and three were lost for long-term follow-up. All clinical S. boydii isolates were characterized by molecular analysis using multilocus sequence typing (MLST). An identical MLST type was found in five patients who had been treated in the surgery unit, suggesting a link between these infections. The source of S. boydii has not been identified. Within an observation period of 2 years before and after this cluster of infections no further cases of scedosporiosis were reported from this hospital.
Insights
A cluster of rare Scedosporium boydii infections occurred in immunocompetent patients post-cardiac surgery. Molecular typing suggested a common source, highlighting the need for vigilance against this fatal fungal infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health
Background:
- Scedosporiosis is a rare but frequently fatal fungal infection.
- It affects both immunocompromised and immunocompetent individuals.
- Invasive Scedosporium boydii infections pose a significant clinical challenge.
Purpose of the Study:
- To investigate a cluster of Scedosporium boydii infections in immunocompetent patients.
- To characterize the clinical features and molecular epidemiology of these cases.
- To identify potential sources and transmission routes of S. boydii.
Main Methods:
- Isolates from six immunocompetent patients were analyzed.
- Clinical data were reviewed, and cases were classified using EORTC/MSG criteria.
- Multilocus sequence typing (MLST) was used for molecular characterization of S. boydii isolates.
Main Results:
- Four proven and two probable/possible invasive scedosporiosis cases were identified.
- Five infections occurred after cardiac surgery, with a median onset of 5 months post-operation.
- Identical MLST types were found in five patients from the surgery unit, suggesting a common source.
- Two patients died, and three were lost to follow-up despite treatment.
Conclusions:
- A nosocomial outbreak of Scedosporium boydii infection occurred in immunocompetent patients following cardiac surgery.
- Molecular data suggest a common source linked to the surgery unit.
- The unidentified source of S. boydii necessitates enhanced infection control measures.
