title: Scedosporium prolificans osteomyelitis in an immunocompetent child treated with voriconazole and caspofungin, as well as locally applied polyhexamethylene biguanide.
abstract: Scedosporium species are increasingly isolated from immunocompromised and immunocompetent patients. Unfortunately, Scedosporium infections are generally resistant to amphotericin B, and Scedosporium prolificans strains are particularly resistant to the antifungal agents now in use. We report here on an immunocompetent child with S. prolificans-associated osteomyelitis successfully treated with debridement, local irrigation with polyhexamethylene biguanide, and the systemic administration of voriconazole and caspofungin despite poor in vitro activity of voriconazole alone against the isolate. We also review the treatments and outcomes of 28 reported cases of osteomyelitis or septic arthritis caused by Scedosporium species in immunocompetent patients.
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina 27710, USA. stein022@mc.duke.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.forename: Wiley A
authors.initials: WA
authors.lastname: Schell
authors.forename: Jackie L
authors.initials: JL
authors.lastname: Miller
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001645:Biguanides / Q000008:administration & dosage / Q000627:therapeutic use*; D000077336:Caspofungin; D002675:Child, Preschool; D004202:Disinfectants / Q000008:administration & dosage / Q000627:therapeutic use; D054714:Echinocandins; D006801:Humans; D055666:Lipopeptides; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy*; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D010455:Peptides; D010456:Peptides, Cyclic; D011743:Pyrimidines / Q000627:therapeutic use*; D021681:Scedosporium / Q000302:isolation & purification*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D001645:Biguanides; D004202:Disinfectants; D054714:Echinocandins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; C031233:polihexanide; D000077336:Caspofungin; D065819:Voriconazole