Infección ocular invasora por Scedosporium apioespermum en un paciente inmunocomprometido / Invasive ocular fungal infection by Scedosporium apiospermum in an immunocompromised patient

Resumen Presentamos el caso clínico de una infección fúngica invasora con una conjuntivitis necrosante, escleritis y panuveitis unilateral por Scedosporium apiospermum en una mujer de 78 años con artritis reumatoidea con neutropenia secundaria a fármacos. El diagnóstico etiológico fue confirmado por cultivo micológico de secreción ocular con apoyo de MALDI-TOF-TOF e histopatología. El tratamiento incluyó aseos quirúrgicos asociado a terapia tópica y sistémica con voriconazol y corticoesteroides, con una evolución favorable a los dos meses de tratamiento. Una recaída obligó a un segundo curso terapéutico por 12 meses adicionales con mejoría y erradicación del agente. La conjuntivitis fúngica por S. apiospermum es un evento infrecuente asociado a pacientes inmunocomprometidos. Su tratamiento involucra desbridamientos quirúrgicos y terapia antifúngica prolongada.

Abstract We report a case of invasive fungal infection with necrotizing conjunctivitis, scleritis and unilateral panuveitis caused by Scedosporium apiospermum in a 78-year-old woman that developed neutropenia by drugs indicated for rheumatoid arthritis. The etiological diagnosis was confirmed by mycological culture of an ocular secretion with the support of MALDI-TOF-TOF analysis and histopathological findings. The treatment involved surgical debridements together with topical solution and systemic therapy with voriconazole and steroids with a favorable evolution after 2 months of treatment. A relapse required a second therapeutic course for an additional 12 months with improvement and eradication of the agent. Fungal conjunctivitis due to S. apiospermum is a rare event associated with immunosuppressed patients. Its treatment involves surgical debridements and prolonged antifungal therapy.

Ocular infections caused by Scedosporium apiospermum: A case series

The aim of our retrospective study is to report a case series of ocular infections caused by a rare fungus, Scedosporium apiospermum, in a South Indian population. Thirteen cases of culture-positive S. apiospermum infections diagnosed between January 2011 and March 2016 were included in this study. The parameters evaluated were predisposing factors, treatment and final clinical outcome. The most common mode of presentation was keratitis (84.6%) followed by sclerokeratitis (15.3%). The predisposing factors involved were unspecified foreign body injury (30.7%), organic matter injury (15.3%), uncontrolled diabetes (7.6%), and recent manual small-incision cataract surgery (7.6%). Five cases (38.46%) had no predisposing factor. Of the 11 keratitis cases, nine (69.2%) responded well to combination medical therapy while one case (7.6%) required therapeutic keratoplasty. One case was lost to follow-up. Both cases which presented with sclerokeratitis showed no response to medico-surgical treatment progressing to panophthalmitis and evisceration.

Ultrastructural viewpoints on the interaction events of Scedosporium apiospermum conidia with lung and macrophage cells

BACKGROUND Scedosporium apiospermum is a ubiquitous, emerging and multidrug-resistant fungal pathogen with still rather unknown virulence mechanisms. OBJECTIVES/METHODS The cellular basis of the in vitro interaction between fungi and host cells/tissues is the determinant factor for the development of a successful in vivo infection. Herein, we evaluated the interaction of S. apiospermum conidia with lung epithelial (A549), lung fibroblast (MRC-5) and RAW 264.7 macrophages by light and scanning/transmission electron microscopy. FINDINGS After 4 h of fungi-host cell contact, the percentage of infected mammalian cells and the number of fungi per infected cell was measured by light microscopy, and the following association indexes were calculated for A549, MRC-5 and macrophage cells: 73.2 ± 25.9, 69.7 ± 22.5 and 59.7 ± 11.1, respectively. Both conidia and germinated conidia were regularly observed interacting with the evaluated cells, with a higher prevalence of non-germinated conidia. Interestingly, nests of germinated conidia were evidenced at the surface of lung cells by scanning electron microscopy. Some germination projections and hyphae were seen penetrating/evading the mammalian cells. Furthermore, internalised conidia were seen within vacuoles as visualised by transmission electron microscopy. MAIN CONCLUSIONS The present study contributes to a better understanding of S. apiospermum pathogenesis by demonstrating the first steps of the infection process of this opportunistic fungus.

Invasive lung infection by Scedosporium apiospermum in an immunocompetent individual.

Scedosporium apiospermum previously known as Monospermum apiospermum is a ubiquitous fungus found in soil, polluted water and sewage. It causes broad spectrum of diseases, including soft tissue infections, septic arthritis, osteomyelitis, ophthalmic infections, sinusitis, pneumonia, meningitis, brain abscesses, endocarditis and disseminated infection. In recent years, it has been shown to be pathogenic for both immunocompetent and immunosuppressed patients. It is a signifi cant opportunist with very high levels of antifungal resistance. We report here a case of invasive lung infection due to S. apiospermum in an immunocompetent patient who responded to antifungal therapy and surgical treatment.

A Case of Localized Skin Infection Due to Scedosporium apiospermum Diagnosed by DNA Sequencing of the Internal Transcribed Spacer Region / 대한의진균학회지

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.

A Case of Fungal Keratitis Scedosporium apiospermum

PURPOSE: To report a case of fungal keratitis caused by Scedosporium apiospermum. CASE SUMMARY: A 70-year-old man visited our clinic with complaints of redness and decreased visual acuity in his right eye caused by a soil gotten into an eye while gardening 10 days ago. The patient had previously been treated in a local clinic but did not show significant clinical improvement. Bacterial and fungal staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Scedosporium apiospermum. The patient was treated with topical moxifloxacin antibiotics, fluconazole, amphotericin B antifungal agents. However, the lesion was not improved, so antifungal therapy was switched to topical voriconazole. After two months of treatment, the infection was resolved with mild scarring. CONCLUSIONS: Although it is a rare pathogen, Scedosporium apiospermum should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil, polluted water, or spoiled plant contact. And we suggest that topical application of voriconazole may be a good alternative treatment for patient with fungal keratitis in which no improvement despite a conventional antifungal agent, fluconazole.

A Case of Cutaneous Scedosporium apiospermum Infection Successfully Treated with Voriconazole / 대한피부과학회지

Scedosporium apiospermum, an asexual state of Pseudallescheria boydii, is a widely distributed mould that can be found in the soil, manure, stagnant water and decaying vegetation. It has become an emerging pathogen among immunosuppressed patients but it can also cause infections in immunocompetent patients by penetrating trauma. This fungus is a classical cause of mycetoma and the localized skin infections caused by this mould are much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection in a 79-year-old woman. She had erythematous plaque with crust and violaceous supprative nodules on the right forearm. The culture from pus showed typical white to gray colored cottony colonies of S. apiospermum. Treatment was started with voriconazole effectively. Skin lesions completely cured with no reccurence. Thus, voriconazole shows to be an effective treatment for Scedosporium infection.

Localized Cutaneous Infection due to Scedosporium apiospermum / 대한의진균학회지

Scedosporium(S) apiospermum is the asexual stage of Pseudallescheria boydii. The organism has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. This ubiquitous fungus causes not only mycetoma, but also infections of variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. Infection may occur via direct inoculation and usually affects the extremities. We report a case of localized cutaneous infection due to S. apiospermum which occurred in a 79-year old female. She presented multiple erythematous papulopustules on the right wrist. Culture isolation for definitive diagnosis showed S. apiospermum. The patient was treated successfully with oral itraconazole 200 mg daily for 4 weeks.

Primary Cutaneous Infection with Scedosporium apiospermum Successfully Treated with Intravenouse Itraconazole / 대한의진균학회지

Scedosporium apiospermum is a rising opportunistic fungus that may infect immunocompetent individuals and may cause often fatal disease among the increasing immunosuppressed patient population. This pathogen is typically difficult to treat because of its particular resistance to commonly used antimycotic drugs. We describe an 83-year-old male patient with a history of long-term corticosteroid treatment for chronic prurigo simplex, who developed multiple suppurative nodules on a erythematous plaque at the right forearm. Histological examinations revealed granulomatous infiltration with hyphae and spores in dermis and fungal cultured isolation for definitive diagnosis showed S. apiospermum. Treatment was started with oral fluconazole, but skin lesions were getting worse. Then patient was treated with 200 mg of intravenouse itraconazole daily. Skin lesions showed a marked improvement after 1 week, and completely healing after 3 weeks.

A Case of Scedosporium Apiospermum Pneumonia in an Immunocompetent Patient / 대한내과학회지

Scedosporium apiospermum, an asexual form of Pseudallescheria boydii, is a saprophytic mold with a worldwide distribution. It may cause severe pulmonary or disseminated infections in immunocompromised patients who have undergone organ transplantation, have hematological malignancies, or have received corticosteroid therapy. However, in immunocompetent patients, it usually produces localized infection and has been reported to cause pneumonia after near-drowning in polluted water. We present here the case of an immunocompetent 72-year-old woman with pneumonia caused by S. apiospermum.

Identification of Peudallescheria boydii/Scedosporium apiospermum dinical isolates by sequence differences of ITS and TUB / 中华检验医学杂志

ObjectiveTore-identifyfifteenclinical Pseudallescheriaboydii/Scedosporium apiospermum isolates by the sequence difference of ITS rDNA and partial β-tubulin gene (TUB) and thus understand thepathogenicstrain typesfor guiding theclinicaltreatment.MethodsMorphological appearances,D-ribose assimilation and sequencing of ITS and TUB were used to re-identify the fifteen clinical strains of Pseudallescheria boydii/Scedosporium apiospermum.The sequences of ITS and TUB were analyzed with Clustal X and MEGA 4 software.Results No difference of morphological appearances was found in the fifteen strains.Cleistothecium was observed in one isolate.All the strains were D-ribose assimilation positive.The clinical strains were re-identified as P.boydii species complex by the CBS database (http://www.cbs.knaw.nl).ElevenstrainswereP.boydiiandfourstrainswereS.apiospermum respectively.Conclusions P.boydii and S.apiospermum cannot be identified correcdy by the time-consuming conventional morphological method and biochemical characteristics.The study recommend that the clinical isolates of P.boydii and S.apiospermum should be identified utilizing a combination of traditional phenotype method and molecular biotechnology.

Thyroid abscess due to Scedosporium apiospermum.

We report a case of thyroid abscess caused by Scedosporium apiospermum in a patient with cirrhosis of liver and autoimmune haemolytic anaemia. To date, there are no reports of isolation of this fungus from thyroid abscess.

Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente / Scedosporium apiospermum rhinosinusal infection in an immunocompetent host

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.

Pulmonary Fungal Ball of Pseudallescheria boydiiIdentified by LSU rDNA D2 Region Sequencing / 대한임상미생물학회지

We report a case of pulmonary fungal ball of Pseudallescheria boydii (Scedosporium apiospermum, the anamorph) and the result of LSU rDNA D2 region sequencing of the clinical isolate. An immunocompetent 58-year-old female suffered 2-year history of hemoptysis. Her symptom persisted despite the administration of oral itraconazole, even though the clinical, radiological, and histological findings suggested Aspergilloma. In the fungal culture, the typical morphology of S. apiospermum was observed. Even though the sequencing using LSU rDNA D2 region identified the organism as Pseudallescheria ellipsoidea, one of the P. boydii complex, the further investigation of ours suggested that the species in P. boydii complex could not be differentiated from each other by the sequencing of LSU rDNA D2 region.

Fungal keratitis caused by Pseudallescheria boydii(Scedosporium apiospermum) / 国际眼科杂志(Guoji Yanke Zazhi)

· We report successful treatment of a case of fungal keratitis caused by Pseudallescheria boydii with minimal corneal scar. A 71-year-old woman with history of pain, redness and foreign body sensation presented to our tertiary eye center. Initial corneal scraping revealed fungal elements. After two days fungal culture became positive, and after five days it was shown to be growth of Pseudallescheria boydii. The patient achieved clinical cures with medical therapy alone with minimal corneal scar and good visual outcome of 3/10.

A Case of Skin Infection due to Scedosporium apiospermum Treated with Voriconazole / 대한의진균학회지

Scedosporium(S.) apiospermum has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. The localized skin infection due to S. apiospermum is rare and usually results from traumatic implantation of contaminated material due to a penetrating injury. We report a case of skin infection due to S. apiospermum in a 78-year-old female. She had multiple nodules, pustules and exudative ulcerative lesions at the right forearm. Cultured isolation for definitive diagnosis showed typical S. apiospermum. Treatment was started with itraconazole effectively, but skin lesions were recurred after 4 months, and then cured with voriconazole with no recurrence.

A Case of Scedosporium apiospermum Keratitis Confirmed by a Molecular Genetic Method / 대한진단검사의학회지

A 54-yr-old male, who was treated by chemotherapy for gastric cancer 15 months ago, presented to Yongdong Severance Hospital, Seoul, with complaints of pain in his right eye caused by a foreign body from the ground in the previous week. He had been treated with topical and oral antibacterial in addition to antifungal agents, but did not show significant clinical improvement. After a positive corneal culture with mold, topical amphotericin B was added to the initial regimen. The mold was identified as Scedosporium apiospermum by macroscopic and microscopic morphologies and the nucleotide sequences of a fungal PCR product showing 99% homology with those of S. apiospermum (EF151349). He recovered with good results at 25 days after corneal epithelial debridement. The early diagnosis of S. apiospermum keratitis is very important for proper treatment. It is recommended that molecular diagnostic methods such as fungal PCR and sequencing be done with conventional cultures whenever a fungal infection is suspected.

A Case of Localized Skin Infection Due to Scedosporium apiospermum / 대한피부과학회지

Scedosporium(S.) apiospermum is the asexual stage of Pseudallescheria boydii. It has been isolated from soil, plant debris, polluted water and sewage. It is an opportunistic organism with low virulence. Infection may occur via direct inoculation. This ubiquitous fungus causes not only mycetoma, but also infections of a variety of body sites including the skin. Localized skin infection without granule or grain production due to this organism is much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection which occurred in a 69-year-old woman. The lesion was manifested by a 5.0 x 4.0 cm-sized, scaly erythematous plaque on the dorsum of the right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored floccose colonies of S. apiospermum. The patient was treated with 200 mg of itraconazole daily for 3 months. Skin lesions were completely cured and recurrence has not been observed to date.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.