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Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France
Abstract:
Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.
Insights
Scedosporium and Lomentospora can cause dangerous arterial infections, particularly in transplant recipients. Early vascular imaging is crucial for managing these invasive fungal diseases and improving patient outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Vascular Surgery
Background:
- Scedosporium spp. and Lomentospora prolificans are increasingly recognized as significant opportunistic fungal pathogens.
- Previous studies highlighted frequent vascular involvement in scedosporiosis and lomentosporiosis, including aortitis and peripheral arteritis.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of Scedosporium spp. and Lomentospora prolificans arteritis.
- To emphasize the vascular tropism of these fungi and the importance of appropriate diagnostic imaging.
Main Methods:
- A review of 20 cases of Scedosporium spp. and Lomentospora prolificans arteritis, including 7 from a prior observational study and 13 from published literature.
- Analysis of patient demographics, underlying conditions, infection sites, treatment, and outcomes.
Main Results:
- The majority of patients (70%) had underlying immunosuppression, often related to solid organ transplantation (10/14).
- Osteoarticular involvement was common (50%), frequently contiguous with vascular infection sites (7/10).
- Aneurysms were prevalent in both aortitis (8/11) and peripheral arteritis (6/10) cases, with a high mortality rate (67%).
Conclusions:
- Scedosporium spp. and Lomentospora prolificans exhibit significant vascular tropism, leading to potentially fatal arteritis.
- Vascular imaging, such as computed tomography angiography, is essential for diagnosing and managing these infections, especially when associated with osteoarticular sites.
