Scedosporiosis/lomentosporiosis observational study (SOS): Clinical significance of Scedosporium species identification.

Scedosporiosis/lomentosporiosis is a devastating emerging fungal infection. Our objective was to describe the clinical pattern and to analyze whether taxonomic grouping of the species involved was supported by differences in terms of clinical presentations or outcomes. We retrospectively studied cases of invasive scedosporiosis in France from 2005 through 2017 based on isolates characterized by polyphasic approach. We recorded 90 cases, mainly related to Scedosporium apiospermum (n = 48), S. boydii/S. ellipsoideum (n = 20), and Lomentospora prolificans (n = 14). One-third of infections were disseminated, with unexpectedly high rates of cerebral (41%) and cardiovascular (31%) involvement. In light of recent Scedosporium taxonomic revisions, we aimed to study the clinical significance of Scedosporium species identification and report for the first time contrasting clinical presentations between infections caused S. apiospermum, which were associated with malignancies and cutaneous involvement in disseminated infections, and infections caused by S. boydii, which were associated with solid organ transplantation, cerebral infections, fungemia, and early death. The clinical presentation of L. prolificans also differed from that of other species, involving more neutropenic patients, breakthrough infections, fungemia, and disseminated infections. Neutropenia, dissemination, and lack of antifungal prescription were all associated with 3-month mortality. Our data support the distinction between S. apiospermum and S. boydii and between L. prolificans and Scedosporium sp. Our results also underline the importance of the workup to assess dissemination, including cardiovascular system and brain.

Scedosporiosis/lomentosporiosis is a devastating emerging fungal infection. Our objective was to describe the clinical pattern and to analyze whether taxonomic grouping of the species involved was supported by differences in terms of clinical presentations or outcomes.

Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature.

BACKGROUND: Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation. CASE REPORT: We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed. CONCLUSIONS: Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.

El complejo Pseudallescheria/Scedosporium y taxas afines en la rutina del laboratorio micológico clínico / The Pseudallescheria/Scedoporium complex and related taxa in the routine of clinic mycological laboratory

El complejo Pseudallescheria/Scedosporium y taxas relacionados, pertenecientes a un grupo de microhongos con conidios viscosos e integrantes del orden Microascales, se presentan en diversos ambientes comunes asociados a las actividades humanas, ya sea en el suelo como en aguas contaminadas. Actualmente se consideran entre los mayores grupos de hongos filamentosos oportunistas causante de infecciones cutáneas y profundas en el hombre y otros mamíferos. El objetivo principal de este trabajo, consiste en reunir los datos primarios morfofisiológicos más relevantes, útiles para el micólogo médico en el laboratorio, con el aporte adicional de algunos aspectos, biológicos, ecológicos, taxonómicos y moleculares complementarios descritos en la literatura moderna.

The Pseudallescheria/Scedosporium complex and their related taxa are a group of fungus that conidia are presents in viscous mass and belong to the order Microascales. They are in several common enviroment related to human activities either in soil as in contaminated water. Nowadays they are considerated one of the most opportunistic group of filamentous fungus that may cause superficial and deep skin mycoses infections in man and other mammalian. The aim of this work is to gather the primary relevant morphophysiological aspects, usefull to the medical mycologist in the laboratory, plus the contribution of some of biological, ecological, taxonomical and moleculars complementary aspects that are describe in modern literature.

Disseminated Scedosporium/Pseudallescheria infection after double-lung transplantation in patients with cystic fibrosis.

We report a case of disseminated Scedosporium/Pseudallescheria infection due to Pseudallescheria boydii sensu stricto after lung transplantation in a patient with cystic fibrosis. Dissemination occurred under voriconazole. Despite surgery and combination therapy with voriconazole, caspofungin, and terbinafine, the patient died 8 months after transplantation. Previously reported cases are reviewed.

Heterothallism in Scedosporium apiospermum and description of its teleomorph Pseudallescheria apiosperma sp. nov.

Scedosporium apiospermum has traditionally been thought of as the anamorph of Pseudallescheria boydii (Microascaceae, Ascomycota), but recent molecular studies has demonstrated that they are different species. Since a teleomorph was not observed among isolates recently identified as S. apiospermum, we investigated whether this species could be heterothallic. In this study, 15 isolates of S. apiospermum were paired in all possible combinations, including self-pairings. Several combinations produced fertile ascomata typical of the genus Pseudallescheria, while all isolates were self-sterile. The isolates were grouped into two different mating types. Crosses among F1 progeny ascospores demonstrated a bi-allelic heterothallic mating system. The new species Pseudallescheria apiosperma, teleomorph of S. apiospermum, is proposed and described.

Ecology of Pseudallescheria and Scedosporium species in human-dominated and natural environments and their distribution in clinical samples.

This study aims to determine the occurrence of Pseudallescheria and Scedosporium species in natural and human-dominated environments. Habitats (136 sampling sites) in a transect with increasing human impact were investigated (natural areas, agricultural soils, urban playgrounds, industrial areas). Physico-chemical parameters were measured to characterize the different areas included in this investigation. Fungal identification was performed by morphology and sequence data analysis. Comparative description of virulence was largely based on the database of the ECMM/ISHAM Working Group on Pseudallescheria/Scedosporium Infections. Pseudallescheria and Scedosporium species were most abundant in industrial areas, followed by urban playgrounds and agricultural areas. None of the species were isolated from natural habitats. The abundance of Pseudallescheria and Scedosporium species could be correlated with increasing nitrogen concentrations (P<0.01) and decreasing pH (P<0.05) within a pH range of 6.1-7.5. In general, frequency of the different Pseudallescheria and Scedosporium species in the environment is strongly enhanced by human activities, and largely differs from species distribution in clinical settings, suggesting that these species have different degrees of virulence. Pseudallescheria boydii is relatively frequently found as agent of human disease, while Scedosporium dehoogii is found almost exclusively in the environment. Scedosporium apiospermum is responsible for the majority of infections and is found at comparable frequency in the environment; S. aurantiacum and P. minutispora showed similar spectra, but at much lower frequencies.

Molecular and phenotypic data supporting distinct species statuses for Scedosporium apiospermum and Pseudallescheria boydii and the proposed new species Scedosporium dehoogii.

Based on the morphological, physiologic, and molecular (beta-tubulin gene) study of 141 isolates of the Pseudallescheria boydii species complex (including several synonyms) and relatives, the new species Scedosporium dehoogii is proposed. Scedosporium apiospermum and P. boydii are considered two different species and the new name Scedosporium boydii is proposed for the anamorph of the latter species. A summary of the key morphological and physiological features for distinguishing the species of Pseudallescheria/Scedosporium is provided.

Polycytella hominis is a mutated form of Scedosporium apiospermum.

PCR amplification and sequencing of two separate regions of the nuclear ribosomal repeat region revealed that Polycytella hominis, a hyphomycete isolated from a human case of mycetoma, was genetically indistinguishable from Scedosporium apiospermum (the anamorph of Pseudallescheria boydii). These organisms also exhibited remarkably similar susceptibility profiles to common antifungal agents. P. hominis is thus likely to be a mutant of S. apiospermum showing abnormalities of sporulation, for which a possible mechanism is discussed. Polycytella hominis should thus be regarded as a synonym of Scedosporium apiospermum.