title: Epidemiology and outcome of Scedosporium prolificans infection, a review of 162 cases.
abstract: Scedosporium prolificans is a truly emerging fungal pathogen. It has only been recognized as a human pathogen for 22 years and has been related with numerous infections in immunocompromised and immunocompetent patients. A search for cases in the literature was performed and a database was constructed. Cases were reviewed in order to analyse the epidemiology and outcome of infection. A total of 162 cases were included. The median age of patients was 45 years (ranging from a few months to 81 years), and 102 (63%) infections were diagnosed in males. Risk factors for scedosporiosis were malignancy, 74/162 (45.7%), cystic fibrosis, 19/172 (11.7%), and solid organ transplantation 14/162 (8.6%). The most common clinical presentations were disseminated infection, 72/162 cases (44.4%), pulmonary mycosis, 47/162 (29%), and bone and joint infections, 17/162 (10.4%). All disseminated infections afflicted patents with underlying diseases, primarily haematological malignancies (57/72 [80%]). Blood cultures were positive in 70% of patients suffering from disseminated mycosis. Neutropenia, fever and cerebral symptoms were independently related to the development of disseminated infection whereas recovery from aplasia was associated with a reduced risk. The overall mortality was 46.9% but mortality rate was 87.5% in patients with disseminated disease. Survival was independently associated with surgical excision and recovery from aplasia. Antifungal treatments were not related to a reduced risk of death. Infections caused by S. prolificans are life threatening in susceptible patients, and can be considered a truly emerging disease. Infections are difficult to treat since it is a multi-resistant species. Multicenter studies are essential with the aim of developing and disseminating appropriate techniques and protocols to treat this mycosis.
authors.affiliation: Servicio de Micologa, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. jlrtudela@isciii.es
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Rodriguez-Tudela
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Josep
authors.initials: J
authors.lastname: Guarro
authors.forename: A Serda
authors.initials: AS
authors.lastname: Kantarcioglu
authors.forename: Regine
authors.initials: R
authors.lastname: Horre
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D021681:Scedosporium / Q000187:drug effects / Q000302:isolation & purification*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents