Peptidorhamnomannan negatively modulates the immune response in a scedosporiosis murine model.

In this study, we analyzed the impact of immunization with the peptidorhamnomannan (PRM) from the cell wall of the fungus Scedosporium (Lomentospora) prolificans in a murine model of invasive scedosporiosis. Immunization with PRM decreased the survival of mice infected with S. prolificans. Immunization of mice with PRM led to decreased secretion of pro-inflammatory cytokines and chemokines but did not affect the secretion of IL-10. Mice immunized with PRM showed an increase in IgG1 secretion, which is an immunoglobulin linked to a nonprotective response. Splenocytes isolated from mice infected with S. prolificans and immunized with PRM showed no differences in the percentages of Th17 cells and no increase in the frequency of the CD4(+)CD62L(Low) T cell population. PRM-immunized mice showed a significant increase in the percentage of Treg cells. In summary, our results indicated that immunization with PRM did not assist or improve the immunological response against S. prolificans infection. PRM exacerbated the infection process by reducing the inflammatory response, thereby facilitating colonization, virulence and dissemination by the fungus.

Fungal meningitis caused by Lomentospora prolificans after allogeneic hematopoietic stem cell transplantation.

Central nervous system lomentosporiosis is a rare pathological condition in immunocompromised patients. We describe a fatal case of meningitis caused by Lomentospora prolificans (which was previously named Scedosporium prolificans), after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). To our knowledge, no cases of Lomentospora meningitis following allo-HSCT have been reported previously. Particularly in neutropenic patients, it is important to consider L. prolificans when a fungal infection is suspected and antifungal agents are ineffective.

Infective endocarditis and meningitis due to Scedosporium prolificans in a renal transplant recipient.

Scedosporium prolificans is a ubiquitous filamentous fungi that may cause disseminated diseases in neutropenic patients with hematological malignancies. We report a fatal case of renal transplant recipient who developed both infective endocarditis and meningitis due to S. prolificans during treatment with micafungin and itraconazole for chronic necrotizing aspergillosis. Breakthrough Scedosporium infection should be considered among differential diagnosis of invasive fungal diseases in patients with renal transplant recipients receiving antifungal agents.

Disseminated Scedosporium prolificans infection in an 'extensive metaboliser': navigating the minefield of drug interactions and pharmacogenomics.

We report a case of non-fatal disseminated Scedosporium prolificans infection, including central nervous system disease and endophthalmitis, in a relapsed acute myeloid leukaemia patient with extensive CYP2C19 metabolism. Successful treatment required aggressive surgical debridement, three times daily voriconazole dosing and cimetidine CYP2C19 inhibition. In addition, the unique use of miltefosine was employed due to azole-chemotherapeutic drug interactions. Prolonged survival following disseminated S. prolificans, adjunctive miltefosine and augmentation of voriconazole exposure with cimetidine CYP2C19 inhibition has not been reported.

Successful use of locally applied polyhexamethylene biguanide as an adjunct to the treatment of fungal osteomyelitis.

Fungal osteomyelitis is rare in immunocompetent patients and is often difficult to cure, even with optimal medical and surgical management. The authors present two cases of fungal osteomyelitis in which the common swimming pool cleaner, polyhexamethylene biguanide, was used successfully as an adjunct to standard surgical and medical treatment. Also presented is a literature review on the use of polyhexamethylene biguanide for this indication. The authors recommend that this safe and well-tolerated compound be considered as part of the treatment for fungal osteomyelitis.

L'ostéomyélite fongique, rare chez les patients immunocompétents, est souvent difficile à guérir, malgré une prise en charge médicale et chirurgicale optimale. Les auteurs présentent deux cas d'ostéomyélite fongique dans lesquels le polyhexaméthylène biguanide, un nettoyeur pour piscine courant, a été utilisé avec succès en plus du traitement chirurgical et médical. Ils présentent également une analyse bibliographique de l'utilisation de polyhexaméthylène biguanide pour cette indication. Les auteurs recommandent d'envisager d'utiliser ce composant sécuritaire et bien toléré dans le cadre du traitement de l'ostéomyélite fongique.

Successful Treatment of Cutaneous Scedosporium prolificans: An Emerging and Treatment-Resistant Fungal Pathogen.

Scedosporium prolificans (S. prolificans) is an increasingly prevalent and treatment-resistant opportunistic fungus. The pathogen is known to cause a variety of clinical manifestations ranging from localized cutaneous disease to disseminated systemic infection. Herein we present an otherwise healthy 41-year-old male with biopsy-proven S. prolificans cutaneous infection. The patient experienced drastic clinical improvement on two months of a combination of oral itraconazole and oral minocycline. S. prolificans exhibits resistance to many antifungal agents, thus, single-agent antifungal therapy has a high failure rate and often results in the need for surgical excision or debridement. Recent accounts suggest that minocycline in combination with azole antifungals has a synergistic effect in treating S. prolificans. This case highlights the excellent response to combination oral therapies with minocycline and itraconazole. Prompt and efficacious treatment reduces the risk of destructive or disseminated disease and may avoid the need for surgical intervention.

Investigation of a Lomentospora prolificans case cluster with whole genome sequencing.

Lomentospora prolificans has caused outbreaks in immunocompromised patients. We performed whole genome sequencing (WGS) on 4 L. prolificans isolates from infections occurring during an 8-month period in the haematology unit at Hospital 1., and 2 isolates from unrelated infections at Hospital 2., showing a high number of mutational differences (>10,000 single nucleotide polymorphisms) between L. prolificans isolates from Hospital 1. Novel typing of isolates by WGS did not demonstrate a single causative strain.

Successful Treatment of Scedosporium Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management.

BACKGROUND: Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation. OBJECTIVES: To identify and evaluate treatment options. METHODS: This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases. RESULTS: Two lung transplant patients had a positive culture for Scedosporium. The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months. CONCLUSIONS: Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.

The Effective Treatment of Lung Infection Due to Scedosporium prolificans with Voriconazole and Surgery.

Scedosporium prolificans is a fungus that has demonstrated resistance against most currently available antifungal agents and which causes a rapidly disseminating and potentially fatal infection. A 68-year-old woman presented with a fever and consolidation in the lung field. Her symptoms and inflammatory reaction did not improve despite treatment with tazobactam/piperacillin, meropenem, and micafungin. Scedosporium prolificans was detected from the patient's bronchial lavage fluid, and we initiated treatment with voriconazole. Voriconazole was effective in shrinking the consolidation and suppressing the inflammatory reaction. The residual lesion was surgically resected because of the risk of systemic dissemination. The patient is currently alive without relapse or dissemination.

Scedosporium prolificans fungemia.

Fungemia due to Scedosporium prolificans is described in a young woman with a relapse of acute lymphoblastic leukemia. Several days after starting reinduction chemotherapy, the patient presented with fever, neutropenia and blood cultures showing fungi on Gram stain. The patient died despite therapy with antifungal agents, including fluconazole and amphotericin B. Fungi grew from blood cultures, and was subsequently identified as Scedosporium prolificans.

Scedosporium prolificans osteomyelitis following penetrating injury: A case report.

Scedosporium prolificans are opportunistic moulds that can cause mycetoma following penetrating injuries. This fungus is more virulent than other species and treatment options are limited. Here we describe the first known case in the UK of S. prolificans osteomyelitis, in a 4 year old following penetrating injury. Successful outcome with limb salvage and foot function is achieved after repeated surgical debridement, and combination chemotherapy with voriconazole/terbinafine.

Locally extensive angio-invasive Scedosporium prolificans infection following resection for squamous cell lung carcinoma.

We report a case of Scedosporium prolificans infection in a patient following surgery for squamous cell lung carcinoma. Combination therapy with voriconazole and terbinafine was commenced for intrathoracic infection and mycotic vasculitis. In spite of antifungal treatment, he developed culture-positive sternal and rib osteomyelitis four months later. Scedosporiosis is not commonly reported in patients with solid organ malignancies, and this case highlights its aggressive nature and propensity for direct local invasion.

Scedosporium prolificans fungaemia in a patient with acute lymphoblastic leukaemia.

Aggressive chemotherapy and immunosuppressive treatment may prolong patients' life, but influence the risk of severe, life-threatening infections. Here, we report the case of a 21-year-old caucasian female who developed a disseminated infection of Scedosporium prolificans after allogenic stem cell transplantation performed for treatment of relapsed acute lymphoblastic leukaemia. The pathogen was isolated from the blood and identified on the basis of its macroscopic and microscopic morphological features. The empirical treatment with amphotericin B provided no improvement. However, introduction of intravenous voriconazole resulted in amelioration of fever. Unfortunately, the patient died due to progression of underlying disease and multiorgan failure. However, this case report indicates a possible relevance of voriconazole-based treatment regimens in invasive S. prolificans infections.

Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a tsunami in Japan.

Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.

A Case of Fatal Scedosporium prolificans Fungemia in a Patient with Acute Myeloid Leukemia / 대한임상미생물학회지

Scedosporium prolificans is a saprophytic fungus widespread in the environment. It has become an emerging pathogen in recent years causing disseminated infections, especially in profoundly neutropenic immunocompromised patients. We report a case of fatal Scedosporium fungemia in a 45 year old female with acute myeloid leukemia in relapse. She received salvage chemotherapy and antibiotic treatment, and was neutropenic with relapsing fever. S. prolificans was isolated repeatedly from the aerobic bottles on the second day of two successive blood cultures. Amphotercin B was started; however, the patient expired the next day.

Scedosporium prolificansInfection by Laceration with a Broken Piece of Flowerpot: A Case Report / 대한정형외과학회잡지

Scedosporium prolificans is a fungus that can be found in soil or polluted water. It is mandatory to evaluate Scedosporium prolificans infection in case of injury by soil- contaminated materials. Musculoskeletal infections by Scedosporium prolificans are extremely rare and the clinical manifestations are similar to other bacterial infections. So it is difficult to detect Scedosporium prolificans infection. We report a neglected case with bone and joint infection by Scedosporium prolificans after joint laceration with a broken piece of flowerpot in a 10-year-old boy.