Infections caused by Scedosporium spp.
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):157-97. doi: 10.1128/CMR.00039-07.Infections caused by Scedosporium spp.1, , , , , , , , , , , , , , .1Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA.AbstractScedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.PMID:
[PubMed - indexed for MEDLINE] PMCID: PMC2223844 Pseudallescheria boydii in vitro, depicting a fully developed and ruptured cleistothecium, the hallmark of the sexual stage (teleomorph) of this fungus. Oblong ascospores are liberated in this culture. Magnification, ×100.Clin Microbiol Rev. ):157-197.(A) Scedosporium apiospermum conidiophore with annellation (arrowhead). Note the solitary oval to pyriform conidium. (B) Acute-angle branching septate hyaline hyphae. Note the septum (arrowhead) and lateral conidiation (arrow). A KOH preparation using differential interference contrast with polarized light photographic technique is shown, Magnification, ×1,000; bar, 10 μm.Clin Microbiol Rev. ):157-197.Synnemata (coremia) of the Graphium synanamorph of P. boydii bearing terminal conidia. Lactophenol cotton blue stain was used. Magnification, ×100.Clin Microbiol Rev. ):157-197.Scedosporium prolificans (formerly Scedosporium inflatum). (A) The arrowhead points to annellations. The arrows point to the inflated shape of the conidiophores. (B) The arrows point to the inflated conidiophores generating pyriform conidia. A KOH preparation using differential interference contrast with polarized light photographic technique is shown. Bar, 10 μm.Clin Microbiol Rev. ):157-197.Geographic distribution of cases which Scedosporium spp. were isolated in the United States from specimens submitted to the Fungus Testing Laboratory of the University of Texas Health Science System at San Antonio from January 2000 to May 2007. The white and gray tones represent the total incidences of Scedosporium cases reported by state. The numbers within each state indicate the incidence of Scedosporium prolificans/Scedosporium apiospermum and Pseudallescheria boydii/Scedosporium spp. (not further identified).Clin Microbiol Rev. ):157-197.Anatomical origins (sites of infection) of 370 isolates submitted to the Fungus Testing Laboratory at the University of Texas Health Science System at San Antonio from January 2000 to May 2007.Clin Microbiol Rev. ):157-197.Model of the host-pathogen interaction in pulmonary scedosporiosis. Pulmonary involvement begins with colonization of the respiratory tract. This colonization appears to be transient in immunocompetent hosts with anatomically normal respiratory tracts. However, colonization may become persistent in certain patient with anatomically altered respiratory tracts, leading to saprobic involvement. Such conditions occur in patients with cystic fibrosis, cavitary tuberculosis or sarcoidosis, and bronchiectasis. Conditions that alter the innate host defense mechanisms of a patient with colonization or saprobic involvement of the respiratory tract may lead to invasive disease manifesting as localized or disseminated infection. Conditions that may predispose to invasive pulmonary scedosporiosis include neutropenia, corticosteroid therapy, and CGD.Clin Microbiol Rev. ):157-197.Scedosporium apiospermum pedal mycetoma of 18 years of evolution. Several sinus tracts in different evolution stages on the left foot (A) and draining white yellow grains resembling fig seeds at the openings of three fistulae (B) are shown. A transversal section of a fistula shows several lobed pale grains and an inflammatory infiltrate on the fistula lumen (C). H&E magnification, ×400. (Reprinted from reference 345 with permission from Elsevier.)Clin Microbiol Rev. ):157-197.(A) Multifistulous right-lower-limb Scedosporium apiospermum mycetoma of 8 years of evolution. (B) MRI of the same patient, showing extensive inflammatory changes in the medial and lateral aspects of the lower leg and calcaneous osteomyelitis.Clin Microbiol Rev. ):157-197.Scedosporium apiospermum infection in human tissue. The main host response is a mixed neutrophilic and monocytic infiltrate. PAS staining of brain tissue in a patient with CNS scedosporiosis was performed. Magnification, ×100.Clin Microbiol Rev. ):157-197.Publication TypesMeSH TermsSubstancesFull Text SourcesOther Literature Sources
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2014 A20 Suppl 3:27-46. doi: 10.91.12465.ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others.1, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ; ; .1Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.AbstractMycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation. (C) 2014 The Authors Clinical Microbiology and Infection (C) 2014 European Society of Clinical Microbiology and Infectious Diseases.KEYWORDS: A F P S S hyalohyphomycosisPMID:
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):157-97. doi: 10.1128/CMR.00039-07.Infections caused by Scedosporium spp.1, , , , , , , , , , , , , , .1Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA.AbstractScedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.PMID:
[PubMed - indexed for MEDLINE] PMCID: PMC2223844 Pseudallescheria boydii in vitro, depicting a fully developed and ruptured cleistothecium, the hallmark of the sexual stage (teleomorph) of this fungus. Oblong ascospores are liberated in this culture. Magnification, ×100.Clin Microbiol Rev. ):157-197.(A) Scedosporium apiospermum conidiophore with annellation (arrowhead). Note the solitary oval to pyriform conidium. (B) Acute-angle branching septate hyaline hyphae. Note the septum (arrowhead) and lateral conidiation (arrow). A KOH preparation using differential interference contrast with polarized light photographic technique is shown, Magnification, ×1,000; bar, 10 μm.Clin Microbiol Rev. ):157-197.Synnemata (coremia) of the Graphium synanamorph of P. boydii bearing terminal conidia. Lactophenol cotton blue stain was used. Magnification, ×100.Clin Microbiol Rev. ):157-197.Scedosporium prolificans (formerly Scedosporium inflatum). (A) The arrowhead points to annellations. The arrows point to the inflated shape of the conidiophores. (B) The arrows point to the inflated conidiophores generating pyriform conidia. A KOH preparation using differential interference contrast with polarized light photographic technique is shown. Bar, 10 μm.Clin Microbiol Rev. ):157-197.Geographic distribution of cases which Scedosporium spp. were isolated in the United States from specimens submitted to the Fungus Testing Laboratory of the University of Texas Health Science System at San Antonio from January 2000 to May 2007. The white and gray tones represent the total incidences of Scedosporium cases reported by state. The numbers within each state indicate the incidence of Scedosporium prolificans/Scedosporium apiospermum and Pseudallescheria boydii/Scedosporium spp. (not further identified).Clin Microbiol Rev. ):157-197.Anatomical origins (sites of infection) of 370 isolates submitted to the Fungus Testing Laboratory at the University of Texas Health Science System at San Antonio from January 2000 to May 2007.Clin Microbiol Rev. ):157-197.Model of the host-pathogen interaction in pulmonary scedosporiosis. Pulmonary involvement begins with colonization of the respiratory tract. This colonization appears to be transient in immunocompetent hosts with anatomically normal respiratory tracts. However, colonization may become persistent in certain patient with anatomically altered respiratory tracts, leading to saprobic involvement. Such conditions occur in patients with cystic fibrosis, cavitary tuberculosis or sarcoidosis, and bronchiectasis. Conditions that alter the innate host defense mechanisms of a patient with colonization or saprobic involvement of the respiratory tract may lead to invasive disease manifesting as localized or disseminated infection. Conditions that may predispose to invasive pulmonary scedosporiosis include neutropenia, corticosteroid therapy, and CGD.Clin Microbiol Rev. ):157-197.Scedosporium apiospermum pedal mycetoma of 18 years of evolution. Several sinus tracts in different evolution stages on the left foot (A) and draining white yellow grains resembling fig seeds at the openings of three fistulae (B) are shown. A transversal section of a fistula shows several lobed pale grains and an inflammatory infiltrate on the fistula lumen (C). H&E magnification, ×400. (Reprinted from reference 345 with permission from Elsevier.)Clin Microbiol Rev. ):157-197.(A) Multifistulous right-lower-limb Scedosporium apiospermum mycetoma of 8 years of evolution. (B) MRI of the same patient, showing extensive inflammatory changes in the medial and lateral aspects of the lower leg and calcaneous osteomyelitis.Clin Microbiol Rev. ):157-197.Scedosporium apiospermum infection in human tissue. The main host response is a mixed neutrophilic and monocytic infiltrate. PAS staining of brain tissue in a patient with CNS scedosporiosis was performed. Magnification, ×100.Clin Microbiol Rev. ):157-197.Publication TypesMeSH TermsSubstancesFull Text SourcesOther Literature Sources
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