Successful outcome of Scedosporium apiospermum disseminated infection treated with voriconazole in a patient receiving corticosteroid therapy.
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A disseminated Scedosporium apiospermum infection was diagnosed in a woman with severe asthma and treated with corticosteroids. This fungi is resistant to fluconazole and amphotericin B. The infection was refractory to itraconazole, but responded successfully to voriconazole. A review of the literature is provided. (+info)
Molecular epidemiology of Scedosporium apiospermum infection determined by PCR amplification of ribosomal intergenic spacer sequences in patients with chronic lung disease.
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Respiratory tract colonization with Scedosporium apiospermum in patients with chronic suppurative lung disease is a significant concern for lung transplantation candidates, since Scedosporium infections occurring posttransplantation are usually untreatable. Up to 10% of patients with cystic fibrosis attending our respiratory medicine unit have had Scedosporium organisms isolated from sputum samples. We therefore developed a molecular typing method to examine these isolates. Typing by PCR amplification of ribosomal intergenic spacer sequences demonstrated 20 different types from 52 isolates collected from the respiratory medicine unit and elsewhere in Australia. A single common type was isolated from 11 respiratory medicine unit inpatients. Two other types were isolated from more than one source: one from two respiratory medicine unit inpatients and one from two epidemiologically linked nonhuman sources. Multiple isolates were obtained from nine patients. This method demonstrated persistent carriage of isolates of the same type in one patient for 7 months. Two patients showed carriage of isolates with multiple typing patterns within a 3-month period. The high rate of isolation and the predominance of isolates with a single typing pattern from respiratory medicine unit patients may suggest transmission to patients from a source in the unit. There was no epidemiological evidence of direct patient-to-patient spread, and Scedosporium organisms were not isolated from dust, soil, or air samples from the unit. The source and route of transmission have yet to be determined. (+info)
Analysis of growth characteristics of filamentous fungi in different nutrient media.
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A microbroth kinetic model based on turbidity measurements was developed in order to analyze the growth characteristics of three species of filamentous fungi (Rhizopus microsporus, Aspergillus fumigatus, and Scedosporium prolificans) characterized by different growth rates in five nutrient media (antibiotic medium 3, yeast nitrogen base medium, Sabouraud broth, RPMI 1640 alone, and RPMI 1640 with 2% glucose). In general, five distinct phases in the growth of filamentous fungi could be distinguished, namely, the lag phase, the first transition period, the log phase, the second transition period, and the stationary phase. The growth curves were smooth and were characterized by the presence of long transition periods. Among the different growth phases distinguished, the smallest variability in growth rates among the strains of each species was found during the log phase in all nutrient media. The different growth phases of filamentous fungi were barely distinguishable in RPMI 1640, in which the poorest growth was observed for all fungi even when the medium was supplemented with 2% glucose. R. microsporus and A. fumigatus grew better in Sabouraud and yeast nitrogen base medium than in RPMI 1640, with growth rates three to four times higher. None of the media provided optimal growth of S. prolificans. The germination of Rhizopus spores and Aspergillus and Scedosporium conidia commenced after 2 and 5 h of incubation, respectively. The elongation rates ranged from 39.6 to 26.7, 25.4 to 20.2, and 16.9 to 9.9 microm/h for Rhizopus, Aspergillus, and Scedoporium hyphae, respectively. The germination of conidia and spores and the elongation rates of hyphae were enhanced in antibiotic medium 3 and delayed in yeast nitrogen base medium. In conclusion, the growth curves provide a useful tool to gain insight into the growth characteristics of filamentous fungi in different nutrient media and may help to optimize the methodology for antifungal susceptibility testing. (+info)
Lymphadenitis caused by Scedosporium apiospermum in an immunocompetent patient.
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A case of lymphadenitis caused by Scedosporium apiospermum in a 25-year-old immunocompetent woman had been misdiagnosed as tuberculous lymphadenitis. Clinical response to itraconazole therapy was obtained in 6 months; to our knowledge, this is the first report of lymphadenitis caused by S. apiospermum in humans. (+info)
Inoculum standardization for antifungal susceptibility testing of filamentous fungi pathogenic for humans.
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Two methods of inoculum preparation for filamentous fungi were compared: counting with a hematocytometer and spectrophotometric adjustment. One hundred eighty-two filamentous fungi pathogenic for humans were used. Colony counts were done for all inoculum preparations. The agreement between the hematocytometer counts and the colony counts (CFU per milliliter) was 97.2%. The reproducibility between the hematocytometer counts and the colony counts by means of an intraclass correlation coefficient was 0.70. Pearson's correlation index for hematocytometer counts versus colony counts was 0.56, whereas that for optical density versus colony counts was 0.008. Both methods can be used for inoculum size adjustment. However, the use of the spectrophotometric method requires that each species be standardized separately. (+info)
Invasive mold infections in allogeneic bone marrow transplant recipients.
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Invasive mold infections (IMIs) are an important cause of morbidity and mortality in patients who are undergoing bone marrow transplantation (BMT). To examine the epidemiology, risk factors, and outcome of IMIs in allogeneic BMT recipients, all cases of mold infection among 94 adult patients who underwent allogeneic BMT at this institution from 1 January 1997 through 31 December 1998 were reviewed retrospectively. Fifteen cases of IMI were identified; infection occurred a median of 102 days after BMT. Aspergillus species was the most common cause of disease, and species other than Aspergillus fumigatus were present in 53% of patients. By multivariate analysis, the variable associated with infection risk was systemic glucocorticosteroid use. Prophylactic antifungal therapy that was targeted to high-risk patients had little effect on disease incidence. These observations suggest that early identification of high-risk patients and better approaches to prevention should be explored, to reduce incidence and severity of disease in this population. (+info)
Disseminated infection and colonization by Scedosporium prolificans: a review of 18 cases, 1990-1999.
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Scedosporium prolificans infection was analyzed in 18 patients from whom the fungus was isolated during the period 1990-1999. Of these 18 patients, 12 had some predisposing factor and either unconfirmed infection or colonization, and 6 patients had confirmed disseminated infection: 4 patients with leukemia died, 1 patient with breast cancer who underwent autologous bone marrow transplantation survived, and 1 patient with advanced acquired immunodeficiency syndrome died, although the fungal infection did not seem to affect his clinical symptoms. (+info)
In vitro activities of four novel triazoles against Scedosporium spp.
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In order to develop new approaches to the treatment of the severe and usually fatal infections caused by Scedosporium spp., the in vitro antifungal activities of four novel triazoles (posaconazole, ravuconazole, voriconazole, and UR-9825) and some current antifungals (amphotericin B, ketoconazole, itraconazole, and nystatin) were determined. The latter group was clearly ineffective against the two species tested. The four new antifungals showed activity against Scedosporium apiospermum, and UR-9825 and voriconazole were active against S. prolificans. (+info)