title: Cure of orthopaedic infection with Scedosporium prolificans, using voriconazole plus terbinafine, without the need for radical surgery.
abstract: Scedosporium prolificans infections of normal hosts usually require extensive debridement and sometimes amputation to effect cure, due to the intrinsic resistance of this species to available antifungal agents. Newer agents have not tested favourably. Variable results are obtained with voriconazole, and 100% resistance is described with echinocandins. Itraconazole and terbinafine has offered synergy against various moulds including S. prolificans. In vivo success is reported with the azole/terbinafine combination in S. apiospermum pulmonary infection and Pythium insidiosum periorbital cellulitis. We report a case of orthopaedic infection in a non-immunocompromised host with S. prolificans, in which the combinations of itraconazole/terbinafine and voriconazole/terbinafine showed synergy in vitro, and success was achieved without radical surgery, using voriconazole and terbinafine.
authors.affiliation: Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool. i.gosbell@unsw.edu.au
authors.forename: I B
authors.initials: IB
authors.lastname: Gosbell
authors.forename: V
authors.initials: V
authors.lastname: Toumasatos
authors.forename: J
authors.initials: J
authors.lastname: Yong
authors.forename: R S
authors.initials: RS
authors.lastname: Kuo
authors.forename: D H
authors.initials: DH
authors.lastname: Ellis
authors.forename: R C
authors.initials: RC
authors.lastname: Perrie
mesh_terms: D000368:Aged; D016512:Ankle Injuries / Q000188:drug therapy* / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use*; D003646:Debridement; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008271:Mycetoma / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D009281:Naphthalenes / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D021681:Scedosporium / Q000187:drug effects; D000077291:Terbinafine; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D011743:Pyrimidines; D014230:Triazoles; D000077291:Terbinafine; D065819:Voriconazole