Scedosporium apiospermum infection after near-drowning.
Scedosporium apiospermum and its teleomorph (sexual form) Pseudallescheria boydii are ubiquitous saprophytic fungi, which under specific conditions, such as near-drowning, may cause therapy-refractory and life-threatening infections. We reviewed 22 cases (eight children and 14 adults) of S. apiospermum infection after near-drowning reported in the literature including an additional paediatric case from our institution. Scedosporiosis after near-drowning was associated with high mortality (16/23, 70%) even in immunocompetent hosts. It affected mainly young (mean age 24 years) and immunocompetent (83% with no apparent immune defect) males (male to female ratio 2.5 : 1). Scedosporiosis after near-drowning was a slow progressive disease (mean survival time 87 days) involving virtually all body organs. However, central nervous system (CNS) dissemination predominated (21/23, 91%) presenting mainly as multiple brain abscesses (15/23, 65%). All 23 patients showed preceding clinical and/or radiological evidence of lung disease indicating the mode of invasion. Diagnosis was delayed (median time to diagnosis 28 days) and was made by culture (16/23, 69.5%) or culture and tissue examination (7/23, 30.5%). The majority of the patients (20/23, 87%) received antifungal treatment and underwent neurosurgery. While the optimal treatment remains undefined, the most recent reports indicated voriconazole as a potentially effective option. Better knowledge of scedosporiosis after near-drowning could lead to improved intervention and ultimately to more favourable outcome.
Katragkou
Aspasia
A
Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece.
Dotis
John
J
Kotsiou
Maria
M
Tamiolaki
Maria
M
Roilides
Emmanuel
E
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008169:Lung Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D015701:Near Drowning / Q000150:complications*; D011743:Pyrimidines / Q000627:therapeutic use; D011859:Radiography; D035583:Rare Diseases; D021681:Scedosporium / Q000187:drug effects; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole