Scedosporium infection in immunocompromised patients: successful use of liposomal amphotericin B and itraconazole.
BACKGROUND
Invasive fungal disease is a major cause of death in immunocompromised patients. The filamentous fungus Scedosporium consists of two species, S. prolificans and S. apiospermum, which can cause infections in immunocompromised patients that are often fatal. A significant feature of this pathogen is its broad resistance to many antifungal agents, including amphotericin B.


RESULTS
Five cases of infection with Scedosporium spp. occurred in patients with haematologic malignancies over a 10-month period. Three patients with S. prolificans were severely immunosuppressed and neutropenic; two were in relapse and another was early post-matched unrelated bone marrow transplant. All three died despite treatment with various combinations of amphotericin B and itraconazole. Two patients who were less immunosuppressed and had a normal neutrophil count developed S. apiospermum infection. Both were successfully treated with liposomal amphotericin B and itraconazole.


CONCLUSIONS
Disseminated infection in immunocompromised hosts with Scedosporium spp. is often fatal. However, in patients with a lesser degree of immunocompromise and particularly in those infected with the less virulent S. apiospermum, intensive antifungal therapy with liposomal amphotericin B and itraconazole may be associated with complete eradication of infection. Med Pediatr Oncol 2001;37:122-125.
Barbaric
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Oncology Unit, the Children's Hospital at Westmead (Royal Alexandra Hospital for Children), Sydney, NSW 2145, Australia. DragaB@nch.edu.au
Shaw
P J
PJ
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use*; D007938:Leukemia / Q000188:drug therapy; D008081:Liposomes; D008297:Male; D008271:Mycetoma / Q000188:drug therapy / Q000473:pathology*; D021681:Scedosporium / Q000302:isolation & purification / Q000472:pathogenicity*
D000935:Antifungal Agents; D008081:Liposomes; D017964:Itraconazole; D000666:Amphotericin B