title: Susceptibility and diversity in the therapy-refractory genus scedosporium.
abstract: Scedosporium species show decreased susceptibility to the majority of systemic antifungal drugs. Acquired resistance is likely to disseminate differentially with the mode of exchange of genetic material between lineages. Inter- and intraspecific diversities of Scedosporium species were analyzed for three partitions (rDNA internal transcribed spacer gene [ITS], partial β-tubulin gene, and amplified fragment length polymorphism profiles), with the aim to establish distribution of resistance between species, populations, and strains. Heterogeneity of and recombination between lineages were determined, and distances between clusters were calculated using a centroid approach. Clinical, geographic, and antifungal data were plotted on diversity networks. Scedosporium minutisporum, Scedosporium desertorum, and Scedosporium aurantiacum were distinguished unambiguously in all partitions and had differential antifungal susceptibility profiles (ASP). Pseudallescheria fusoidea and Pseudallescheria ellipsoidea were indistinguishable from Scedosporium boydii. Pseudallescheria angusta took an intermediate position between Scedosporium apiospermum and S. boydii. Scedosporium boydii and S. apiospermum had identical ASP. Differences in (multi)resistance were linked to individual strains. S. apiospermum and S. boydii showed limited interbreeding and were recognized as valid, sympatric species. The S. apiospermum/S. boydii group, comprising the main clinically relevant Scedosporium species, consists of separate lineages and is interpreted as a complex undergoing sympatric evolution with incomplete lineage sorting. In routine diagnostics, the lineages in S. apiospermum/S. boydii are indicated with the umbrella descriptor "S. apiospermum complex"; individual species can be identified with rDNA ITS with 96.3% confidence. Voriconazole is recommended as the first-line treatment; resistance against this compound is rare.
authors: Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria.
authors: M
authors: M
authors: Lackner
authors: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors: F
authors: F
authors: Hagen
authors: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: J F
authors: JF
authors: Meis
authors: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.
authors: A H G
authors: AH
authors: Gerrits van den Ende
authors: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.
authors: D
authors: D
authors: Vu
authors: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.
authors: V
authors: V
authors: Robert
authors: Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
authors: J
authors: J
authors: Fritz
authors: Botany and Microbiology Department, Faculty of Science, Cairo University, Giza, Egypt Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
authors: T A A
authors: TA
authors: Moussa
authors: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China Sun Yat-Sen Memorial Hospital, Sun-Yat-Sen University, Guangzhou, China Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil de.hoog@cbs.knaw.nl.
authors: G S
authors: GS
authors: de Hoog
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D011541:Pseudallescheria / Q000187:drug effects; D021681:Scedosporium / Q000187:drug effects*; D065819:Voriconazole / Q000494:pharmacology
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole