Fatal pulmonary Scedosporium aurantiacum infection in a patient after near-drowning: A case report

Document Type : Case report

Authors

1 Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

2 Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran

3 Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

4 Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran

5 Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

6 Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

7 Infectious Diseases Section, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece

10.18502/cmm.7.4.8410

Abstract

Background and Purpose: Scedosporium spp. is a saprophytic fungus that may cause invasive pulmonary infection due to the aspiration of contaminated water in both immunosuppressed and immunocompetent hosts.
Case report: Herein, we report a fatal case of pulmonary infection caused by Scedosporium species associated with a car crash and near-drowning in a sewage canal.Scedosporium aurantiacum isolated from bronchoalveolar lavage was identified by PCR-sequencing of β-tubulin genes. The minimum inhibitory concentration values for amphotericin B, itraconazole, posaconazole, isavuconazole were >16 µg/ml, and >8 µg/ml for anidulafungin, micafungin, and caspofungin. Voriconazole was found to be the most active agent with a MIC of 1 µg/ml.
Conclusion: This report, as the first case of pulmonary scedosporiosis after near-drowning
in Iran, highlights the importance of high suspicion in near-drowning victims, prompt
identification of Scedosporium spp., and early initiation of appropriate antifungal therapy.
 

Keywords


 1. Steinbach WJ. Perfect JR. Scedosporium species infections and
treatments. J Chemother. 2003; 15 Suppl 2:16-27.
2. He XH, et al.,
Scedosporium apiospermum Infection after Neardrowning. Chin Med J (Engl). 2015; 128(15):2119-23.
3. Ramirez-Garcia A, Hua He X, Wu JY, Wu CJ, Halm-Lutterodt
NV, Zhang J, Li CS, et al.
Scedosporium and Lomentospora: an
updated overview of underrated opportunists. Med Mycol. 2018;
56(suppl_1):102-125.
4. Lackner M, de Hoog GS, Yang L,Moreno LF, Ahmad SA,
Andreas F, et al. Proposed nomenclature for
Pseudallescheria,
Scedosporium and related genera. Fungal Diversity. 2014;
67(1):1–10.
5. Guarro J, Kantarcioglu AS, Horre R, Rodreguez tudela JL,
Strella MC,Berenguer J, et al.
Scedosporium apiospermum:
changing clinical spectrum of a therapy-refractory opportunist.
Med Mycol. 2006; 44(4):295-327.
6. Troke P, Aguirrebengoa K, Arteaga C, Ellis D, Heath C, Lutsar
I, et al. Treatment of scedosporiosis with voriconazole: clinical
experience with 107 patients. Antimicrob Agents Chemother.
2008; 52(5):1743-50.
7. Katragkou A, Dotis J, Kotsiou M, Tamiolaki M, et al.
Scedosporium apiospermum infection after near-drowning.
Mycoses. 2007; 50(5):412-21.
8. Gilgado F, Cano J, Gene J, Guarro J, et al. Molecular phylogeny
of the
Pseudallescheria boydii species complex: proposal of two
new species. J Clin Microbiol. 2005; 43(10):4930-42.
9. Gilgado F, Cerena C, Cano J, Gene J,Guarro J, et al. Antifungal
susceptibilities of the species of the
Pseudallescheria boydii
complex. Antimicrob Agents Chemother. 2006; 50(12):4211-3.
10. Hedayati MT, Tavakoli M, Maleki M,Heidari S,Mortezaee
V,Gheisari M, et al. Fungal epidemiology in cystic fibrosis
patients with a special focus on
Scedosporium species complex.
Microb Pathog. 2019; 129:168-175.
11. Rüchel R. False-positive reaction of a Cryptococcus antigen test
owing to
Pseudallescheria mycosis. Mycoses. 1994; 37(3-4):69.
12. Rainer J,De hoog GS, Wedde M, Graser Y,Gilges S. Molecular
variability of
Pseudallescheria boydii, a neurotropic opportunist.
J Clin Microbiol. 2000; 38(9):3267-73.
13. Nakamura Y,Suzuki N, Nakajima Y, Utsumi Y, Murata O,
Nagashima H, et al.
Scedosporium aurantiacum brain abscess
after near-drowning in a survivor of a tsunami in Japan. Respir
Investig. 2013; 51(4):207-11.
14. Wang H, Wan Z, Ruoyu Li, Jin YU. Molecular identification
and susceptibility of clinically relevant
Scedosporium spp. in
China. Biomed Res Int. 2015;2015:109656.
15. de Mello TP, Aor ACe, Branquinha, Souza dos S. Insights into
the interaction of
Scedosporium apiospermum, Scedosporium
aurantiacum
, Scedosporium minutisporum, and Lomentospora
prolificans
with lung epithelial cells. Braz J Microbiol. 2020;
51(2):427-436.
16. Dworzack DL, Clarck R, Galant M, Borkowski W, Smith DL,
Dykstra, et al.
Pseudallescheria boydii brain abscess: association
with near-drowning and efficacy of high-dose, prolonged
miconazole therapy in patients with multiple abscesses.
Medicine (Baltimore). 1989; 68(4):218-24.
17. Lackner M, Dehoog GS, Horre R, Graf B, Sobottka I, Seibold
M, et al.Verweije PE, Najafzadeh MJ, et al., Species-specific
antifungal susceptibility patterns of
Scedosporium and
Pseudallescheria species. Antimicrob Agents Chemother. 2012;
56(5):2635-42.
18. Tintelnot K, NublingG, Horre R, Graf B, et al. A review of
German
Scedosporium prolificans cases from 1993 to 2007.
Med Mycol. 2009; 47(4):351-8.
19. Agatha D, Krishnan KU Dillirani VA, Selvi R, et al., Invasive
lung infection by
Scedosporium apiospermum in an
immunocompetent individual. Indian J Pathol Microbiol. 2014;
57(4):635-7.
20. Jannik Stemler, Michaela Lackner, Sharon C -A Chen, Martin
Hoenigl, Oliver A Cornely, EQUAL Score Scedosporiosis/
Lomentosporiosis 2021: a European Confederation of Medical
Mycology (ECMM) tool to quantify guideline adherence, J
Antimicrob Chemother. 2021; dkab355.
 
Volume 7, Issue 4
December 2021
Pages 38-42
  • Receive Date: 21 September 2021
  • Revise Date: 27 November 2021
  • Accept Date: 27 November 2021
  • First Publish Date: 30 November 2021
  • Publish Date: 01 December 2021