Scedosporium and Lomentospora: an updated overview of underrated opportunists.

Species of Scedosporium and Lomentospora are considered as emerging opportunists, affecting immunosuppressed and otherwise debilitated patients, although classically they are known from causing trauma-associated infections in healthy individuals. Clinical manifestations range from local infection to pulmonary colonization and severe invasive disease, in which mortality rates may be over 80%. These unacceptably high rates are due to the clinical status of patients, diagnostic difficulties, and to intrinsic antifungal resistance of these fungi. In consequence, several consortia have been founded to increase research efforts on these orphan fungi. The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxonomy, environmental distribution, epidemiology, pathology, virulence factors, immunology, diagnostic methods, and therapeutic strategies.

Primer caso de fungemia asociada a catéter por Candida nivariensis en la Península Ibérica / First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula

Antecedentes. En los últimos años estamos asistiendo a un aumento en la incidencia de la candidemia causada por especies de Candida no Candida albicans. Dentro del complejo Candida glabrata se han descrito 2 especies crípticas, Candida nivariensis y Candida bracarensis, que pueden presentar problemas en la identificación de los aislamientos en el laboratorio y una mayor resistencia a fluconazol. Objetivos. Se describe el primer aislamiento en la Península Ibérica de C. nivariensis en un paciente con fungemia asociada a catéter. Caso clínico. Varón de 81 años que ingresó en nuestro hospital con una fístula intestinal y en estado de malnutrición. En los hemocultivos y en la punta del catéter venoso central se aisló una levadura que crecía formando colonias blancas en medio BD CHROMagar Candida® y que no pudo ser identificada por la metodología convencional. A pesar del tratamiento intravenoso con fluconazol, los hemocultivos persistían positivos después de 5 días de tratamiento. Las CMI obtenidas fueron: 1μg/ml para anfotericina B, 0,015μg/ml para anidulafungina, 0,125μg/ml para caspofungina, 0,015μg/ml para micafungina, 4μg/ml para fluconazol, 0,25μg/ml para itraconazol, 0,25μg/ml para posaconazol, y 0,03μg/ml para voriconazol. Se sustituyó el fluconazol por caspofungina, que se mantuvo durante 2 semanas. El paciente fue intervenido y dado de alta tras un postoperatorio sin complicaciones. Finalmente, el aislamiento fue identificado como C. nivariensis mediante secuenciación de las regiones ITS del rARN. Conclusiones. C. nivariensis es una levadura emergente cuya identificación debe basarse en pruebas de biología molecular. En el caso clínico que presentamos el tratamiento con caspofungina fue eficaz(AU)

Background. In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole. Aims. To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia. Case report. An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida® medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1μg/ml for amphotericin B, 0.015μg/ml for anidulafungin, 0.125μg/ml for caspofungin, 0.015μg/ml for micafungin, 4μg/ml for fluconazole, 0.25μg/ml for itraconazole, 0.25μg/ml for posaconazole, and 0.03μg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA. Conclusions. C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin(AU)

[First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula]. / Primer caso de fungemia asociada a catéter por Candida nivariensis en la Península Ibérica.

BACKGROUND: In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole. AIMS: To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia. CASE REPORT: An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida(®) medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1 µg/ml for amphotericin B, 0.015 µg/ml for anidulafungin, 0.125 µg/ml for caspofungin, 0.015 µg/ml for micafungin, 4 µg/ml for fluconazole, 0.25 µg/ml for itraconazole, 0.25 µg/ml for posaconazole, and 0.03 µg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA. CONCLUSIONS: C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin.

Enfermedad fúngica invasora: ¿Diagnóstico micológico convencional o molecular? / Invasive Fungal Disease: Conventional or molecular mycological diagnosis?

El diagnóstico de las micosis invasoras es un reto difícil por la baja sensibilidad de los métodos tradicionales y conlleva retrasos diagnósticos y terapéuticos. Los objetivos de este trabajo de revisión han sido resumir el estado actual de las técnicas de diagnóstico molecular de las enfermedades fúngicas invasoras y aclarar el papel real que desempeñan en la práctica clínica. Los métodos microbiológicos convencionales pueden ser complementados con técnicas moleculares que permitan una identificación más rápida y certera de los aislamientos clínicos. La detección de biomarcadores (..)(AU)

Diagnosis of invasive mycoses is a difficult challenge due to the limitations and low sensitivity of traditional microbiology methods which lead to diagnostic and therapeutic delays. The aim of this review is to summarise the state of the art of the molecular diagnosis of invasive fungal disease and to clarify its current role in the clinical practice. Conventional microbiological methods could be complemented with molecular methods in the rapid and definitive identification of fungal isolates. Biomarkers ( -glucan, galactomannan) are very useful in immunocompromised patients and have been included as probable invasive mycoses by the EORTC/MSG. Nucleic acid detection is currently used as a complementary tool for diagnosis. However, PCR can be very useful in mould invasive mycoses. Finally, the combined detection using biomarkers can improve the diagnosis. However, their applicability in the microbiology laboratoryis not so easy and further studies are required for the appropriate evaluation of its clinical usefulness (AU)

[Invasive fungal disease: conventional or molecular mycological diagnosis?]. / Enfermedad fúngica invasora: ¿Diagnóstico micológico convencional o molecular?

Diagnosis of invasive mycoses is a difficult challenge due to the limitations and low sensitivity of traditional microbiology methods which lead to diagnostic and therapeutic delays. The aim of this review is to summarise the state of the art of the molecular diagnosis of invasive fungal disease and to clarify its current role in the clinical practice. Conventional microbiological methods could be complemented with molecular methods in the rapid and definitive identification of fungal isolates. Biomarkers (ß-glucan, galactomannan) are very useful in immunocompromised patients and have been included as probable invasive mycoses by the EORTC/MSG. Nucleic acid detection is currently used as a complementary tool for diagnosis. However, PCR can be very useful in mould invasive mycoses. Finally, the combined detection using biomarkers can improve the diagnosis. However, their applicability in the microbiology laboratory is not so easy and further studies are required for the appropriate evaluation of its clinical usefulness.