Scedosporium infection in lung transplant patients: a case report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SANG Ling , ZHOU Jing , CHEN Qiang , LI Yimin ,  LIU Xiaoqing

Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong 510120, P. R. China;

Corresponding?author：

LIU Xiaoqing, Email: lxq1118@126.com

Keywords：

Lung transplant; Scedosporium; Bronchoalveolar lavage fluid; Treatment

DOI：

10.7507/1671-6205.201903014

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Objective To investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.Methods A retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.Results The patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.Conclusions Scedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.

Citation： SANG Ling, ZHOU Jing, CHEN Qiang, LI Yimin, LIU Xiaoqing. Scedosporium infection in lung transplant patients: a case report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(1): 22-27. doi: 10.7507/1671-6205.201903014 Copy

1.	Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis, 2010, 50(8): 1101-1111.
2.	Patterson TF, Iii GRT, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e4-e60.
3.	Mitomo H, Sakurada A, Matsuda Y, et al. Endobronchial topical amphotericin B instillation for pulmonary chromomycosis after lung transplantation: a case report. Transplant Proc, 2018, 50(3): 939-942.
4.	Abela IA, Murer C, Schuurmans MM, et al. A cluster of scedosporiosis in lung transplant candidates and recipients: the Zurich experience and review of the literature. Transpl Infect Dis, 2018, 20(1): e12792.
5.	Bárbara B, Miriam A, Isabel S, et al. Scedosporium apiospermum and S. prolificansmixed disseminated infection in a lung transplant recipient: An unusual case of long-term survival with combined systemic and local antifungal therapy in intensive care unit. Med Mycol Case Rep, 2016, 11(1): 53-56.
6.	Campa-Thompson MM, West JA, Guileyardo JM, et al. Clinical and morphologic findings in disseminated Scedosporium apiospermum infections in immunocompromised patients. Proc (Bayl Univ Med Cent), 2014, 27(3): 253-256.
7.	Cobo F, Lara-Oya A, Rodríguez-Granger J, et al. Infections caused by Scedosporium/Lomentospora species: clinical and microbiological findings in 21 cases. Med Mycol, 2018, 56(8): 917-925.
8.	Denton EJ, Smibert O, Gooi J, et al. Invasive scedosporium, sternal osteomyelitis following lung transplant: cured. Med Mycol Case Rep, 2016, 12(1): 14-16.
9.	Hirschi S, Letscherbru V, Pottecher J, et al. Disseminated trichosporon mycotoxinivorans, aspergillus fumigatus, and scedosporium apiospermum coinfection after lung and liver transplantation in a cystic fibrosis patient. J Clin Microbiol, 2012, 50(12): 4168-4170.
10.	Miraldi F, Anile M, Ruberto F, et al. Scedosporium apiospermum atrial mycetomas after lung transplantation for cystic fibrosis. Transpl Infect Dis, 2012, 14(2): 188-191.
11.	Morales P, Galan GE. Intrabronchial instillation of amphotericin B lipid complex: a case report. Transplant Proc, 2009, 41(6): 2223-2224.
12.	Morio F, Horeaulanglard D, Gayandrieu F, et al. Disseminated Scedosporium/Pseudallescheria infection after double-lung transplantation in patients with cystic fibrosis. J Clin Microbiol, 2010, 48(5): 1978-1982.
13.	Musk M, Chambers D, Weng C, et al. Successful treatment of disseminated scedosporium, infection in 2 lung transplant recipients: review of the literature and recommendations for management. J Heart Lung Transplant, 2006, 25(10): 1268-1272.
14.	Peghin M, Monforte V, Martingomez MT, et al. Epidemiology of invasive respiratory disease caused by emerging non-aspergillus molds in lung transplant recipients. Transplant Infect Dis, 2015, 18(1): 70-78.
15.	Sayah DM, Schwartz BS, Kukreja J, et al. Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis. Transplant Infect Dis, 2013, 15(2): 70-74.
16.	Scott M, Wanat K, Pappas-Taffer L. Sporotrichoid eruption in a patient after lung transplantation. Scedosporium apiospermum fungal thrombophlebitis and sporotrichoid nodules. JAMA Dermatol, 2014, 150(1): 83-84.
17.	Shinohara MM, George E. Scedosporium apiospermum: an emerging opportunistic pathogen that must be distinguished from aspergillus and other hyalohyphomycetes. J Cutan Pathol, 2009, 36(1): 39-41.
18.	Solé A, Garcíarobles AA, Jordá C, et al. Salvage therapy with topical posaconazole in lung transplant recipients with invasive scedosporium infection. Am J Transplant, 2017, 18(2): 504-509.
19.	Thomson S, Alibhai K, Winkelaar G, et al. Case report of vertebral osteomyelitis and mycotic abdominal aortic aneurysm caused by scedosporium apiospermum in a lung transplant patient with cystic fibrosis. Transplant Proc, 2015, 47(1): 204-209.
20.	Sheu R, Bricker AO, Sahi H, et al. Pseudallescheria boydii (Scedosporium species) in 3 lung transplant recipients: computed tomography findings and literature review. J Comput Assist Tomogr, 2009, 33(2): 247-252.
21.	Tamm M, Malouf M, Glanville A. Pulmonary scedosporium infection following lung transplantation. Transplant Infect Dis, 2001, 3(4): 189-194.
22.	Sahi H, Avery RK, Minai OA, et al. Scedosporium apiospermum (pseudoallescheria boydii) infection in lung transplant recipients. J Heart Lung Transplant, 2007, 26(4): 350-356.
23.	Cortez KJ, Roilides E, Quiroz-Telles F, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev, 2008, 21(1): 157-197.
24.	Johnson LS, Shields RK, Clancy CJ. Epidemiology, clinical manifestations, and outcomes of scedosporium infections among solid organ transplant recipients. Transpl Infect Dis, 2014, 16(4): 578-587.
25.	Cimon B, Carrere J, Vinatier JF, et al. Clinical significance of scedosporium apiospermum in patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2000, 19(1): 53-56.
26.	Husain S, Munoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis, 2005, 40(1): 89-99.
27.	Sabatelli F, Patel R, Mann PA, et al. In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother, 2006, 50(6): 2009-2015.
28.	Gonzalez GM, Tijerina R, Najvar LK, et al. Activity of posaconazole against Pseudallescheria boydii: in vitro and in vivo assays. Antimicrob Agents Chemother, 2003, 47(4): 1436-1438.
29.	Howden BP, Slavin MA, Schwarer AP, et al. Successful control of disseminated scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis, 2003, 22(2): 111-113.
30.	Meletiadis J, Mouton JW, Meis JF, et al. In vitro drug interaction modeling of combinations of azoles with terbinafine against clinical Scedosporium prolificans isolates. Antimicrob Agents Chemother, 2003, 47(1): 106-117.

1. Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis, 2010, 50(8): 1101-1111.
2. Patterson TF, Iii GRT, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e4-e60.
3. Mitomo H, Sakurada A, Matsuda Y, et al. Endobronchial topical amphotericin B instillation for pulmonary chromomycosis after lung transplantation: a case report. Transplant Proc, 2018, 50(3): 939-942.
4. Abela IA, Murer C, Schuurmans MM, et al. A cluster of scedosporiosis in lung transplant candidates and recipients: the Zurich experience and review of the literature. Transpl Infect Dis, 2018, 20(1): e12792.
5. Bárbara B, Miriam A, Isabel S, et al. Scedosporium apiospermum and S. prolificansmixed disseminated infection in a lung transplant recipient: An unusual case of long-term survival with combined systemic and local antifungal therapy in intensive care unit. Med Mycol Case Rep, 2016, 11(1): 53-56.
6. Campa-Thompson MM, West JA, Guileyardo JM, et al. Clinical and morphologic findings in disseminated Scedosporium apiospermum infections in immunocompromised patients. Proc (Bayl Univ Med Cent), 2014, 27(3): 253-256.
7. Cobo F, Lara-Oya A, Rodríguez-Granger J, et al. Infections caused by Scedosporium/Lomentospora species: clinical and microbiological findings in 21 cases. Med Mycol, 2018, 56(8): 917-925.
8. Denton EJ, Smibert O, Gooi J, et al. Invasive scedosporium, sternal osteomyelitis following lung transplant: cured. Med Mycol Case Rep, 2016, 12(1): 14-16.
9. Hirschi S, Letscherbru V, Pottecher J, et al. Disseminated trichosporon mycotoxinivorans, aspergillus fumigatus, and scedosporium apiospermum coinfection after lung and liver transplantation in a cystic fibrosis patient. J Clin Microbiol, 2012, 50(12): 4168-4170.
10. Miraldi F, Anile M, Ruberto F, et al. Scedosporium apiospermum atrial mycetomas after lung transplantation for cystic fibrosis. Transpl Infect Dis, 2012, 14(2): 188-191.
11. Morales P, Galan GE. Intrabronchial instillation of amphotericin B lipid complex: a case report. Transplant Proc, 2009, 41(6): 2223-2224.
12. Morio F, Horeaulanglard D, Gayandrieu F, et al. Disseminated Scedosporium/Pseudallescheria infection after double-lung transplantation in patients with cystic fibrosis. J Clin Microbiol, 2010, 48(5): 1978-1982.
13. Musk M, Chambers D, Weng C, et al. Successful treatment of disseminated scedosporium, infection in 2 lung transplant recipients: review of the literature and recommendations for management. J Heart Lung Transplant, 2006, 25(10): 1268-1272.
14. Peghin M, Monforte V, Martingomez MT, et al. Epidemiology of invasive respiratory disease caused by emerging non-aspergillus molds in lung transplant recipients. Transplant Infect Dis, 2015, 18(1): 70-78.
15. Sayah DM, Schwartz BS, Kukreja J, et al. Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis. Transplant Infect Dis, 2013, 15(2): 70-74.
16. Scott M, Wanat K, Pappas-Taffer L. Sporotrichoid eruption in a patient after lung transplantation. Scedosporium apiospermum fungal thrombophlebitis and sporotrichoid nodules. JAMA Dermatol, 2014, 150(1): 83-84.
17. Shinohara MM, George E. Scedosporium apiospermum: an emerging opportunistic pathogen that must be distinguished from aspergillus and other hyalohyphomycetes. J Cutan Pathol, 2009, 36(1): 39-41.
18. Solé A, Garcíarobles AA, Jordá C, et al. Salvage therapy with topical posaconazole in lung transplant recipients with invasive scedosporium infection. Am J Transplant, 2017, 18(2): 504-509.
19. Thomson S, Alibhai K, Winkelaar G, et al. Case report of vertebral osteomyelitis and mycotic abdominal aortic aneurysm caused by scedosporium apiospermum in a lung transplant patient with cystic fibrosis. Transplant Proc, 2015, 47(1): 204-209.
20. Sheu R, Bricker AO, Sahi H, et al. Pseudallescheria boydii (Scedosporium species) in 3 lung transplant recipients: computed tomography findings and literature review. J Comput Assist Tomogr, 2009, 33(2): 247-252.
21. Tamm M, Malouf M, Glanville A. Pulmonary scedosporium infection following lung transplantation. Transplant Infect Dis, 2001, 3(4): 189-194.
22. Sahi H, Avery RK, Minai OA, et al. Scedosporium apiospermum (pseudoallescheria boydii) infection in lung transplant recipients. J Heart Lung Transplant, 2007, 26(4): 350-356.
23. Cortez KJ, Roilides E, Quiroz-Telles F, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev, 2008, 21(1): 157-197.
24. Johnson LS, Shields RK, Clancy CJ. Epidemiology, clinical manifestations, and outcomes of scedosporium infections among solid organ transplant recipients. Transpl Infect Dis, 2014, 16(4): 578-587.
25. Cimon B, Carrere J, Vinatier JF, et al. Clinical significance of scedosporium apiospermum in patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2000, 19(1): 53-56.
26. Husain S, Munoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis, 2005, 40(1): 89-99.
27. Sabatelli F, Patel R, Mann PA, et al. In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother, 2006, 50(6): 2009-2015.
28. Gonzalez GM, Tijerina R, Najvar LK, et al. Activity of posaconazole against Pseudallescheria boydii: in vitro and in vivo assays. Antimicrob Agents Chemother, 2003, 47(4): 1436-1438.
29. Howden BP, Slavin MA, Schwarer AP, et al. Successful control of disseminated scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis, 2003, 22(2): 111-113.
30. Meletiadis J, Mouton JW, Meis JF, et al. In vitro drug interaction modeling of combinations of azoles with terbinafine against clinical Scedosporium prolificans isolates. Antimicrob Agents Chemother, 2003, 47(1): 106-117.

Chinese Journal of Respiratory and Critical Care Medicine

Scedosporium infection in lung transplant patients: a case report and literature review

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