title: Infections due to Pseudallescheria/Scedosporium species in patients with advanced HIV disease--a diagnostic and therapeutic challenge.
abstract: OBJECTIVE
  The aim of this study is to highlight the importance of infections caused by members of the genera Pseudallescheria/Scedosporium in HIV-positive patients.
  
  
  METHODS
  We describe a case of a fatal scedosporiosis in a treatment-naïve HIV patient and review all previously reported cases of pseudallescheriosis/scedosporiosis from a search of the PubMed and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) databases, applying the terms 'Pseudallescheria', 'Scedosporium', 'Allescheria', 'Monosporium', 'Petriellidium', 'boydii', 'prolificans', 'inflatum', cross-referenced with 'HIV' and 'AIDS'.
  
  
  RESULTS
  Detection of Scedosporium and Pseudallescheria species has been reported in 22 HIV-positive patients. Fourteen isolates belonged to the Pseudallescheria boydii complex and eight to Scedosporium prolificans. Invasive scedosporiosis (IS) was proven in 54.5% of the patients. Among them dissemination was observed in 66.7%. Pseudallescheria/Scedosporium species were mainly isolated from male individuals. Patients with proven IS showed CD4+ cell counts <100/μl and a higher co-infection rate as compared to colonized patients. Patients with central nervous system (CNS) manifestations showed CD4+ cell counts <50/μl. The mortality rate for patients with proven IS was 75% and was 100% for patients with dissemination/CNS manifestations. The fatality rate for patients treated with antifungal drugs plus surgery was lower compared to patients treated with antimycotic agents alone.
  
  
  CONCLUSIONS
  IS only occurred in HIV-positive patients with a strongly impaired immune system. The survival rates of patients with advanced HIV disease and invasive scedosporiosis can be improved by rapid diagnosis by biopsy and requires complex therapy with a combination of active antifungal drugs, surgery and supportive immune augmentation.
authors.affiliation: Institute of Medical Microbiology, Otto-von-Guericke University, Leipziger Str. 44, 39 120 Magdeburg, Germany. ina.tammer@med.ovgu.de
authors.forename: Ina
authors.initials: I
authors.lastname: Tammer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Tintelnot
authors.forename: Rüdiger C
authors.initials: RC
authors.lastname: Braun-Dullaeus
authors.forename: Christian
authors.initials: C
authors.lastname: Mawrin
authors.forename: Cordula
authors.initials: C
authors.lastname: Scherlach
authors.forename: Dirk
authors.initials: D
authors.lastname: Schlüter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: König
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008271:Mycetoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011541:Pseudallescheria / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D011859:Radiography; D021681:Scedosporium / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: D000935:Antifungal Agents