A fatal invasive Scedosporium apiospermum pulmonary infection in an adult patient with malignant lung adenocarcinoma

Document Type : Case report

Authors

1 Department of Mycology, Kayseri City Hospital, Kayseri, Turkey

2 Department of Mycology, Eskisehir City Hospital, Eskisehir, Turkey

3 Department of Infectious Diseases and Clinical Microbiology, Kayseri City Hospital, Kayseri, Turkey

Abstract

Background and Purpose: Scedosporium apiospermum complex as a ubiquitous environmental mold is increasingly reported to cause an invasive fungal infection in immunosuppressive hosts. Herein, we present the case of an immunosuppressive 54-year-old man who developed S. apiospermum complex lung infection and pulmonary adenocarcinoma.
Case report: The patient had some complaints of dyspnea and cough during a neutropenic episode. The computed tomography (CT) scan of the patient revealed pleural effusion. After culturing the pleural fluid sample, the fungus was identified by microscopic examination and ITS sequencing. In addition, antifungal susceptibility testing was performed using the M38-A2 microdilution method. The minimum inhibitory concentrations of amphotericin B, voriconazole, posaconazole, and caspofungin were obtained as > 64, 0.06, 0.06, and 0.03 μg/mL, respectively. Voriconazole (administered in two doses of 6 mg/kg and a maximum of 250 mg) was preferred for treatment. The patient received antifungal treatment for 2 months; however, he was lost to follow-up.
Conclusion: Scedosporium apiospermum complex should be considered a cause of systemic fungal infections in neutropenic patients. Furthermore, the determination of the in vitro antifungal susceptibilities of clinical strains may contribute to the development of therapeutic approaches.
 

Keywords

References

1. Webb BJ, Ferraro JP, Rea S, Kaufusi S, Goodman BE Spalding J. Epidemiology and clinical features of invasive fungal infection in a US health care network. Open Forum Infect Dis. 2018; 5(8):ofy187.
2. Low CY, Rotstein C. Emerging fungal infections in immunocompromised patients. F1000 Med Rep. 2011; 3:14.
3. Vanzzini-Zago V, Corredor-Casas S, Rodríguez-Reyes A, Hernández-Hernández F, Manzano-Gayosso P, Martínez RL, et al. Endophthalmitis of probable endogenous origin caused by Scedosporium boydii: a case report. Rev Iberoam Micol. 2016; 33(2):122-5.
4. Uenotsuchi T, Moroi Y, Urabe K, Tsuji G, Koga T, Matsuda T, et al. Cutaneous Scedosporium apiospermum infection in an immunocompromised patient and a review of the literature. Acta Derm Venereol. 2005; 85(2):156-9.
5. Steinbach WJ, Schell WA, Miller JL, Perfect JR. Scedosporium prolificans osteomyelitis in an immunocompetent child treated with voriconazole and caspofungin, as well as locally applied polyhexamethylene biguanide. J Clin Microbiol. 2003; 41(8): 3981-5.
6. Howden BP, Slavin MA, Schwarer AP, Mijch AM. Successful control of disseminated Scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis. 2003; 22(2):111-3.
7. Tortorano AM, Richardson M, Roilides E, van Diepeningen A, Caira M, Munoz P, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp.,Scedosporium spp. and others. Clin Microbiol Infect. 2014; 20(Suppl 3):27-46.
8. Cuenca-Estrella M, Gomez-Lopez A, Mellado E, Buitrago MJ, Monzon A, Rodriguez-Tudela JL. Head-to-head comparison of the activities of currently available antifungal agents against 3,378 Spanish clinical isolates of yeasts and filamentous fungi. Antimicrob Agents Chemother. 2006; 50(3):917-21.
9. Muñoz P, Marín M, Tornero P, Martín Rabadán P, Rodríguez-Creixéms M, Bouza E. Successful outcome of Scedosporium apiospermum disseminated infection treated with voriconazole in a patient receiving corticosteroid therapy. Clin Infect Dis. 2000; 31(6):1499-501.
10. Stripeli F, Pasparakis D, Velegraki A, Lebessi E, Arsenis G, Kafetzis D, et al. Scedosporium apiospermum skeletal infection in an immunocompetent child. Med Mycol. 2009; 47(4):441-4.
11. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008; 46(12):1813-21.
12. Schoch CL, Seifert KA, Huhndorf S, Robert V, Spouge JL, Levesque CA, et al. Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for Fungi. Proc Natl Acad Sci U S A. 2012; 109(16):6241-6.
13. National Committee for Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard-second edition. CLSI Document M38-A2. Wane, PA, USA: National Committee for Clinical Laboratory Standards; 2008.
14. Rodriguez-Tudela JL, Berenguer J, Guarro J, Kantarcioglu AS, Horre R, de Hoog GS, et al. Epidemiology and outcome of Scedosporium prolificans infection, a review of 162 cases. Med Mycol. 2009; 47(4):359-70.
15. Cortez KJ, Roilides E, Quiroz-Telles F, Antachopoulos C, Knudsen T, Buchanan W, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev. 2008; 21(1):157-97.
16. Rynga D, Capoor MR, Varshney S, Naik M, Gupta V. Scedosporium apiospermum, an emerging pathogen in India: case series and review of literature. Indian J Pathol Microbiol. 2007; 60(4):550-5.
Current Medical Mycology
Volume 6, Issue 3
September 2020
Pages 61-64

Files

Share

How to cite

Statistics