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1.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
2.
Medicine (Baltimore) ; 98(27): e16063, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277100

RESUMO

RATIONALE: Scedosporium species is rare pathogen of ocular infection. The accurate diagnosis is delaying in many cases and the clinical prognosis is poor due to its resistance to antifungal agents. This report describes a patient with infectious scleritis and corneal ulcer caused by Scedosporium auranticum infection who required enucleation to control the infection. PATIENT CONCERNS: A 70-year-old woman visited our clinic after experiencing ocular discomfort in her right eye for 4 days after minor ocular trauma, with soil exposure. DIAGNOSES: Scedosporium species was isolated from a culture of corneal tissue, Scedosporium aurantiacum was identified in a culture of necrotic tissue. INTERVENTIONS: She was started on treatment with antifungal agents, including topical amphotericin B and systemic fluconazole, but her ocular condition did not improve. Although the lesion showed temporary improvement, ocular pain and corneal ulcer recurred 3 months later. Evisceration was performed due to corneal perforation, and enucleation was also performed for dehiscence of the conjunctiva and scleral necrosis. OUTCOMES: After enucleation, postoperative systemic voriconazole treatment controlled the infection without recurrence. LESSONS: S aurantiacum keratitis is difficult to eradicate, even with several months of treatment with systemic and topical antifungal agents, and tends to progress to scleritis. The infection can be terminated by the orbital enucleation. Infection with this rare organism should be included in the differential diagnosis of patients with severe infectious keratitis.


Assuntos
Antifúngicos/uso terapêutico , Úlcera da Córnea , Enucleação Ocular , Infecções Oculares Fúngicas/terapia , Esclerite/microbiologia , Idoso , Úlcera da Córnea/etiologia , Úlcera da Córnea/microbiologia , Úlcera da Córnea/terapia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/patologia , Feminino , Humanos , Scedosporium/isolamento & purificação
4.
Microb Pathog ; 129: 168-175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30742949

RESUMO

In this present study, for the first time, we evaluated the cystic fibrosis (CF) patients for the Scedosporium species and their antifungal susceptibility against eight antifungal agents. During one-year period, 90 Sputum samples were collected from Iranian CF patients. All samples were evaluated by direct microscopic examination, culture onto four different media including Malt extract agar, Inhibitory mold agar, Brain Heart Infusion and Scedo-Select III. The mold isolated fungi were identified by PCR-Sequencing of ITS and ß-tubulin genes. In-vitro antifungal susceptibility was performed according to the Clinical & Laboratory Standards Institute (CLSI) M38-A2 guidelines. Out of 90 CF patients, 47 (52.2%) were male. The age of the patients ranged from 1 to 34 years (median of 15.84 ±â€¯7.41 years). Overall, 3 (3.3%) cases were positive for Scedosporium spp. of which two isolates were characterized as Scedosporium boydii and one isolate as S. ellipsoideum. Among Aspergillus genus, A. flavus (29.4%) was the most prevalent species followed by A. tubingensis (24.7%), A. niger (17.0%) and A. fumigatus (14.5%). The minimum effective concentration ranges of micafungin, anidulafungin, and caspofungin were 0.008-0.031 µg/mL, 0.0625-0.25 µg/mL, and 0.0625-0.25 µg/mL, respectively. All isolates of Scedosporium species showed high minimum inhibitory concentration to the triazoles tested, except voriconazole. Our results showed that A. flavus and Scedosporium species are the most prevalent molds isolated from CF patient populations in Iran. Our findings have also showed that Scedo-Select III can be used as a reliable culture media for isolation of Scedosporium spp. in clinical samples.


Assuntos
Fibrose Cística/complicações , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Scedosporium/isolamento & purificação , Adolescente , Adulto , Antifúngicos/farmacologia , Criança , Pré-Escolar , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Microscopia , Filogenia , Prevalência , Estudos Prospectivos , Scedosporium/classificação , Scedosporium/genética , Análise de Sequência de DNA , Tubulina (Proteína)/genética , Adulto Jovem
5.
Crit Rev Microbiol ; 45(1): 1-21, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30628529

RESUMO

Invasive Scedosporium spp. and Lomentospora prolificans infections are an emerging threat in immunocompromised and occasionally in healthy hosts. Scedosporium spp. is intrinsically resistant to most, L. prolificans to all the antifungal drugs currently approved, raising concerns about appropriate treatment decisions. High mortality rates of up to 90% underline the need for comprehensive diagnostic workup and even more for new, effective antifungal drugs to improve patient outcome. For a comprehensive analysis, we identified cases of severe Scedosporium spp. and L. prolificans infections from the literature diagnosed in 2000 or later and the FungiScope® registry. For 208 Scedosporium spp. infections solid organ transplantation (n = 58, 27.9%) and for 56 L. prolificans infection underlying malignancy (n = 28, 50.0%) were the most prevalent risk factors. L. prolificans infections frequently presented as fungemia (n = 26, 46.4% versus n = 12, 5.8% for Scedosporium spp.). Malignancy, fungemia, CNS and lung involvement predicted worse outcome for scedosporiosis and lomentosporiosis. Patients treated with voriconazole had a better overall outcome in both groups compared to treatment with amphotericin B formulations. This review discusses the epidemiology, prognostic factors, pathogen susceptibility to approved and investigational antifungals, and treatment strategies of severe infections caused by Scedosporium spp. and L. prolificans.


Assuntos
Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/patologia , Scedosporium/isolamento & purificação , Adulto , Idoso , Antifúngicos/uso terapêutico , Feminino , Humanos , Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Transplante de Órgãos/efeitos adversos , Prognóstico , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Voriconazol/uso terapêutico
6.
Ecotoxicol Environ Saf ; 171: 443-450, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-30639870

RESUMO

Viable and metabolically active fungi in toxic mixed liquors, treating landfill leachates and municipal wastewaters, were identified by culture depending methods. A selective culture medium consisting of wastewater and agar (WA) restrained fungi that could be randomly present (94% of the 51 taxa retrieved on WA were sample-specific), overcoming the problem of fast growing fungi or mycoparasite fungi. Moreover, WA allowed the isolation of fungi with a possible role in the degradation of pollutants typically present in the two wastewaters. Phoma medicaginis var. medicaginis, Chaetomium globosum, and Geotrichum candidum were mainly found in municipal wastewater, whereas Pseudallescheria boydii, Scedosporium apiospermum, Aspergillus pseudodeflectus, and Scopulariopsis brevicaulis were typical of landfill leachate.


Assuntos
Fungos/isolamento & purificação , Águas Residuárias/microbiologia , Poluentes Químicos da Água/análise , Ágar/química , Ascomicetos/isolamento & purificação , Aspergillus/isolamento & purificação , Chaetomium/isolamento & purificação , Contagem de Colônia Microbiana , Monitoramento Ambiental , Fungos/classificação , Geotrichum/isolamento & purificação , Concentração de Íons de Hidrogênio , Pseudallescheria/isolamento & purificação , Scedosporium/isolamento & purificação , Scopulariopsis/isolamento & purificação
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(2): 119-121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30528155

RESUMO

INTRODUCTION: Chronic invasive fungal rhinosinusitis (CIFR) is a rare entity generally observed in immunodepressed subjects. The pathogen most frequently identified is Aspergillus spp. Imaging generally reveals invasive pseudoneoplastic features. We report a case of Scedosporium apiospermum (S. apiospermum) CIFR with an atypical clinical and radiological presentation. CASE REPORT: A 72-year-old immunocompetent man presented with chronic headache, neck pain and bilateral limitation of lateral gaze. Imaging revealed an isolated left sphenoidal lesion with marked bone changes and an extradural abscess over the clivus. Large endoscopic sphenoidotomy with type II rhinopharyngectomy was performed and the diagnosis of S. apiospermum CIFR was based on histological examination and fungal culture. The patient refused all medical treatment and did not present any signs of recurrence after 1 year of follow-up. DISCUSSION: S. apiospermum is a fungal species rarely isolated in CIFR. The present case was revealed by an atypical clinical presentation including isolated sphenoidal infection complicated by bilateral abducens nerve paralysis and extradural abscess. Imaging was also unusual, revealing features of fibrous dysplasia or bacterial osteomyelitis rather than the typical pseudoneoplastic appearance. The patient was successfully treated by surgery alone, which may therefore be sufficient treatment in immunocompetent subjects.


Assuntos
Abscesso Epidural/microbiologia , Infecções Fúngicas Invasivas/microbiologia , Scedosporium , Sinusite Esfenoidal/microbiologia , Idoso , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/cirurgia , Humanos , Imunocompetência , Infecções Fúngicas Invasivas/diagnóstico por imagem , Infecções Fúngicas Invasivas/cirurgia , Masculino , Scedosporium/isolamento & purificação , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/cirurgia
8.
Pediatr Pulmonol ; 54(2): 133-140, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30549449

RESUMO

INTRODUCTION: Prevalence of fungi has been rising in the cystic fibrosis (CF) population. Scedosporium species (spp) is the second most common mold seen in the CF respiratory tract. However, the characteristics associated with Scedosporium isolation and its clinical implications are poorly understood. The goal of this study was to determine clinical factors associated with Scedosporium spp to better understand the mechanisms that may contribute to the emergence of filamentous fungi in CF. METHODS: We conducted a retrospective cohort study of subjects followed in the CF Foundation Patient Registry between January 1, 2010 and December 31, 2012. Patients under 6 years of age, history of solid organ transplantation, and insufficient respiratory culture data were excluded. We used a multivariable logistic regression model to determine demographic data and baseline disease characteristics, medications and co-infections associated with Scedosporium spp recovery in CF sputum. RESULTS: Among 19 023 subjects, prevalence of Scedosporium spp was 615 (3.2%). Older age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07, 1.26) and white race (OR 1.69, 95% CI 1.09, 2.63) were the demographic factors associated with Scedosporium spp isolation. Inhaled antibiotic use had a significant association with Scedosporium isolation (OR 2.01, 95% CI 1.61, 2.52). For every additional course of intravenous antibiotics, the odds of Scedosporium isolation increased by 8% (OR 1.08, 95% CI 1.03, 1.14). CONCLUSIONS: The association between inhaled antibiotics and Scedosporium informs us that chronic inhaled antibiotics may be playing a role in Scedosporium isolation. Further investigation to better characterize this relationship is necessary.


Assuntos
Antibacterianos/administração & dosagem , Fibrose Cística/tratamento farmacológico , Fibrose Cística/microbiologia , Scedosporium/isolamento & purificação , Administração por Inalação , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Razão de Chances , Prevalência , Sistema Respiratório/microbiologia , Estudos Retrospectivos , Fatores de Risco , Escarro/microbiologia , Adulto Jovem
9.
Med Mycol ; 57(2): 155-160, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29554296

RESUMO

Aspergillus fumigatus is commonly found in the airways of patients with cystic fibrosis (CF), and allergic bronchopulmonary aspergillosis (ABPA) is the most recognized associated clinical condition. However, accurate diagnosis remains challenging, and there is a paucity of clinical trials to guide clinical management of fungal disease. The aim of this survey was to assess the variability in current practice across the UK in diagnosis and management of fungal lung disease in CF patients. A 21 question anonymous online survey was sent to 94 paediatric and adult CF consultants in the UK. The response rate was 60.6% (32 adult physicians, 25 pediatricians) with 55 full and 2 partially completed surveys. For a first diagnosis of ABPA 20 (35.1%) treat with prednisolone alone, 38 (66.7%) use prednisolone with itraconazole and 2 (3.5%) choose voriconazole. Only 5 (8.8%) treat with prednisolone alone for a 1st relapse, 33 (58%) used prednisolone with itraconazole. To reduce treatment, 21 (36.8%) decrease steroids to zero over time and maintain azole therapy, 18 (31.6%) stop the azole and steroid after a fixed time, and 5 (8.8%) stop the azole after a fixed time and maintain a small steroid dose. Thirty-eight (66.7%) respondents believe Aspergillus colonization of the airway can cause clinical deterioration, and 37 (66.1%) would treat this. Scedosporium apiospermum infection has been diagnosed and treated by 35 (61.4%) of respondents. Results of this survey highlight the variance in clinical practice and the limited evidence available to guide management of fungal infection in CF.


Assuntos
Antifúngicos/administração & dosagem , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Fibrose Cística/complicações , Padrões de Prática Médica/estatística & dados numéricos , Aspergilose Broncopulmonar Alérgica/complicações , Aspergillus fumigatus/isolamento & purificação , Humanos , Scedosporium/isolamento & purificação , Inquéritos e Questionários , Reino Unido
10.
Vet Radiol Ultrasound ; 60(1): E6-E9, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28609568

RESUMO

A 5-year-old, spayed female, Basset Hound was referred for evaluation of a urinary bladder mass. Ultrasonographic images revealed a large, inhomogeneous, hypoechoic mass associated with the dorsal wall of the neck of the urinary bladder and left ureter. Partial cystectomy and left ureteral reimplantation were performed. Histopathology showed a severe inflammatory mass lesion forming multiple granulomas. A DNA sequencing test revealed Scedosporium apiospermum as the causative agent. Susceptibility tests on the isolated strain indicated susceptibility to voriconazole. To the authors' knowledge, this is the first report describing S. apiospermum as a cause of granulomas involving the canine ureterovesicular junction.


Assuntos
Doenças do Cão/diagnóstico por imagem , Granuloma/veterinária , Micoses/veterinária , Scedosporium/isolamento & purificação , Ureter/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Animais , Doenças do Cão/microbiologia , Doenças do Cão/patologia , Cães , Feminino , Granuloma/diagnóstico por imagem , Granuloma/microbiologia , Granuloma/patologia , Micoses/diagnóstico por imagem , Micoses/microbiologia , Micoses/patologia , Scedosporium/genética , Análise de Sequência de DNA/veterinária , Ultrassonografia/veterinária , Ureter/patologia , Bexiga Urinária/patologia
11.
Med Mycol ; 57(4): 429-433, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30124992

RESUMO

Isavuconazole is a new triazole with an expanded-spectrum and potent activity against moulds and yeasts. It has been authorized for use in adults for the treatment of invasive aspergillosis and for mucormycosis. The only commercially available isavuconazole susceptibility test is the minimum inhibitory concentration (MIC) strip isavuconazole test. The objective of this study was to assess the in vitro activity of isavuconazole using gradient concentration MIC strips, compared with the EUCAST broth microdilution reference method. A total of 147 clinically relevant fungal isolates comprising 120 Aspergillus sp. and 27 Scedosporium apiospermum complex were tested for susceptibility to isavuconazole using the EUCAST broth microdilution method and by the MIC strip isavuconazole test. The percent essential agreement between the two methods was calculated within a 1-fold dilution. The geometric means for the MICs using the EUCAST reference methods and the strip test were respectively: 0.60 mg/l and 0.65 mg/l for A. fumigatus, 0.70 mg/l and 0.77 mg/l for A. flavus, 1.50 mg/l and 1.25 mg/l for A. niger, 0.41 mg/l and 0.38 mg/l for A. terreus, 1.22 mg/l and 1.08 mg/l for S. apiospermum complex. The isavuconazole MIC strips showed good agreement with the EUCAST reference method. Isavuconazole MIC strips could be useful for susceptibility testing of Aspergillus sp. and S. apiospermum complex.


Assuntos
Antifúngicos/farmacologia , Aspergillus/efeitos dos fármacos , Testes de Sensibilidade Microbiana/métodos , Nitrilos/farmacologia , Piridinas/farmacologia , Scedosporium/efeitos dos fármacos , Triazóis/farmacologia , Aspergillus/isolamento & purificação , Humanos , Micoses/microbiologia , Scedosporium/isolamento & purificação
12.
Arch. Soc. Esp. Oftalmol ; 93(12): 613-616, dic. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-175157

RESUMO

Caso clínico: Un hombre de 51 años inmunocompetente nos fue remitido por presentar una gran úlcera corneal con hipopion en el ojo derecho. Inicialmente se le indicó anfotericina B, fluconazol y moxifloxacina tópicos e itraconazol por vía oral. Ante el reporte de estructuras micóticas en la tinción se administró natamicina tópica. El cultivo fue reportado dos semanas después indicando: Scedosporium apiospermum (S. apiospermum). Se añadió entonces voriconazol tópico. La respuesta al tratamiento fue muy lenta y solo hasta cinco semanas después de estar recibiendo el manejo típico triconjugado (natamicina, voriconazol y fluconazol) y de una dosis intraestromal de voriconazol, desapareció el hipopion. El resultado final fue exitoso, lográndose la cicatrización de la úlcera. El paciente está en espera de trasplante de córnea. Discusión: En pacientes en quienes se sospeche queratitis micótica es indispensable el estudio microbiológico. El manejo de elección ante S. apiospermum es el voriconazol, pero puede requerirse la combinación de diversos agentes antifúngicos


Clinical case: A 51 year-old immunocompetent male was referred due to presenting with a large corneal ulcer with hypopyon in the right eye. Topical amphotericin B, fluconazole and moxifloxacin, as well as oral itraconazole were initially indicated. Following the report of mycotic structures on staining, topical natamycin was started. The result of the culture was reported two weeks later as, Scedosporium apiospermum (S. apiospermum), and topical voriconazole was then added. The response to treatment was very slow, and took five weeks after receiving triple therapy (natamycin, voriconazole and fluconazole) and one dose of intrastromal voriconazole, for the hypopyon to disappear. The final outcome was successful, achieving healing of the ulcer. The patient is waiting for a corneal transplant. Discussion: A microbiological study is essential in patients in whom fungal keratitis is suspected. The treatment of choice against S. apiospermum is with voriconazole, but the combination of various antifungal agents may be required


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Scedosporium/isolamento & purificação , Ceratite/complicações , Ceratite/diagnóstico por imagem , Imunocompetência , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Reprodutibilidade dos Testes , Antifúngicos/uso terapêutico , Scedosporium , Cicatrização , Corpos Estranhos/complicações , Soluções Oftálmicas/uso terapêutico , Voriconazol/uso terapêutico , Administração Tópica
13.
Intern Med ; 57(23): 3485-3490, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30101932

RESUMO

Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred.


Assuntos
Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Nódulos Pulmonares Múltiplos/complicações , Nódulos Pulmonares Múltiplos/microbiologia , Scedosporium/isolamento & purificação , Idoso , Feminino , Humanos , Imunocompetência , Pneumopatias Fúngicas/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia
14.
Arch Soc Esp Oftalmol ; 93(12): 613-616, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30017419

RESUMO

CLINICAL CASE: A 51 year-old immunocompetent male was referred due to presenting with a large corneal ulcer with hypopyon in the right eye. Topical amphotericin B, fluconazole and moxifloxacin, as well as oral itraconazole were initially indicated. Following the report of mycotic structures on staining, topical natamycin was started. The result of the culture was reported two weeks later as, Scedosporium apiospermum (S. apiospermum), and topical voriconazole was then added. The response to treatment was very slow, and took five weeks after receiving triple therapy (natamycin, voriconazole and fluconazole) and one dose of intrastromal voriconazole, for the hypopyon to disappear. The final outcome was successful, achieving healing of the ulcer. The patient is waiting for a corneal transplant. DISCUSSION: A microbiological study is essential in patients in whom fungal keratitis is suspected. The treatment of choice against S. apiospermum is with voriconazole, but the combination of various antifungal agents may be required.


Assuntos
Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/microbiologia , Scedosporium/isolamento & purificação , Antifúngicos/uso terapêutico , Transplante de Córnea , Úlcera da Córnea/tratamento farmacológico , Quimioterapia Combinada , Infecções Oculares Fúngicas/tratamento farmacológico , Fluconazol/uso terapêutico , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Natamicina/uso terapêutico , Voriconazol/uso terapêutico
17.
Transpl Infect Dis ; 20(4): e12908, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29679424

RESUMO

Lomentospora prolificans is a filamentous fungus and an emerging pathogen in immunocompromised patients. It is encountered most commonly in Australia, Spain, and USA. We described the first case of Lomentospora prolificans fungemia in South America. The patient was a hematopoietic stem cell transplantation (HSCT) recipient who developed the infection 37 days after stem cells infusion. In addition, we performed a literature review of invasive lomentosporiosis in HSCT patients.


Assuntos
Fungemia/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospedeiro Imunocomprometido , Scedosporium/patogenicidade , Condicionamento Pré-Transplante/efeitos adversos , Adolescente , Antifúngicos/uso terapêutico , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , DNA Fúngico/isolamento & purificação , Fungemia/diagnóstico por imagem , Fungemia/tratamento farmacológico , Fungemia/imunologia , Doença Granulomatosa Crônica/cirurgia , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Radiografia , Scedosporium/genética , Scedosporium/isolamento & purificação , América do Sul , Condicionamento Pré-Transplante/métodos
19.
Arch Microbiol ; 200(3): 517-523, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29464281

RESUMO

Scedosporium species are opportunistic pathogens causing a great variety of infections in both immunocompetent and immunocompromised individuals. The Scedosporium genus ranks the second among the filamentous fungi colonizing the airways of patients with cystic fibrosis (CF), after Aspergillus fumigatus, and most species are capable to chronically colonize the respiratory tract of these patients. Nevertheless, few data are available regarding evasion of the inhaled conidia to the host immune response. Upon microbial infection, macrophages and neutrophils release reactive oxygen species (ROS). To colonize the respiratory tract, the conidia need to germinate despite the oxidative stress generated by phagocytic cells. Germination of spores from different clinical or environmental isolates of the major Scedosporium species was investigated in oxidative stress conditions. All tested species showed susceptibility to oxidative stress. However, when comparing clinical and environmental isolates, differences in germination capabilities under oxidative stress conditions were seen between species as well as within each species. Among environmental isolates, Scedosporium aurantiacum isolates were the most resistant to oxidative stress whereas Scedosporium dehoogii were the most susceptible. Overall, the differences observed between Scedosporium species in the capacity to germinate under oxidative stress conditions could explain their varying prevalence and pathogenicity.


Assuntos
Estresse Oxidativo , Scedosporium/crescimento & desenvolvimento , Esporos Fúngicos/crescimento & desenvolvimento , Fibrose Cística/microbiologia , Humanos , Oxidantes/farmacologia , Paraquat/farmacologia , Espécies Reativas de Oxigênio , Scedosporium/efeitos dos fármacos , Scedosporium/isolamento & purificação , Esporos Fúngicos/efeitos dos fármacos , Esporos Fúngicos/isolamento & purificação , Vitamina K 3/farmacologia
20.
BMC Ophthalmol ; 18(1): 40, 2018 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-29433463

RESUMO

BACKGROUND: Ubiquitous fungi of the Scedosporium apiospermum species complex (SASC) cause various opportunistic infections. Posterior subtenon triamcinolone acetonide (STTA) injection is a standard therapy for intraocular inflammation and macular edema. We report a case of Scedosporium apiospermum infectious scleritis after a posterior STTA injection. CASE PRESENTATION: A 75-year-old man received a posterior STTA injection to treat macular edema in his left eye. After 3 months, he complained of ocular pain and hyperemia in his left eye. Examination showed a subtenon abscess in the site corresponding with the STTA injection. After incising the abscess, the smear revealed numerous conidia-like structures. Although we suspected fungal infection and started topical voriconazole (VRCZ) and levofloxacin, the inflammation of the eye worsened. Fungal culture revealed filamentous fungus growth. Subsequently, we added systemic VRCZ and performed surgical debridement of the infected sclera and Tenon's capsule. Pathology of the sclera showed fungal hyphae. The antifungal susceptibility test revealed low minimum inhibitory concentrations for micafungin, VRCZ and miconazole (0.06, 0.25 and 0.5 µg/mL, respectively). After 2 months, the ciliary injection subsided and VRCZ therapy was stopped. However, subtenon abscess recurred 1 month after discontinuation of topical VRCZ. Surgical debridement and topical VRCZ were resumed, with the eye finally improving after 5 months of management. The fungal species was identified as Scedosporium apiospermum sensu stricto morphologically and by DNA sequencing. CONCLUSIONS: This case was successfully treated by topical and systemic VRCZ and repeated surgical debridement. Infectious scleritis caused by SASC rarely develops after posterior STTA. SASC can produce conidia in the enclosed subtenon space. Late-onset infectious scleritis after a posterior STTA injection suggests the presence of a fungal infection, including SASC, thereby requiring extensive and prolonged medical and surgical treatment.


Assuntos
Infecções Oculares Fúngicas/microbiologia , Imunossupressores/administração & dosagem , Micoses/microbiologia , Complicações Pós-Operatórias , Scedosporium/isolamento & purificação , Esclerite/microbiologia , Triancinolona Acetonida/administração & dosagem , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada , Desbridamento , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Humanos , Injeções Intraoculares , Edema Macular/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Testes de Sensibilidade Microbiana , Micoses/diagnóstico , Micoses/terapia , Esclerite/diagnóstico , Esclerite/terapia , Cápsula de Tenon/efeitos dos fármacos , Voriconazol/uso terapêutico
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