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Crit Rev Microbiol. 2019 Jan 10:1-21. doi: 10.1080/1040841X.2018.1514366. [Epub ahead of print]

Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope®.

Author information

1
a Department I of Internal Medicine , University Hospital of Cologne , Cologne , Germany.
2
b Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) , University of Cologne , Cologne , Germany.
3
c Department of Hospital Hygiene and Infection Control , University Hospital Cologne , Cologne , Germany.
4
d Division of Hygiene and Medical Microbiology , Medical University of Innsbruck (MUI) , Innsbruck , Austria.
5
e Department of Immunology and Hygiene, Institute for Medical Microbiology , University of Cologne , Cologne , Germany.
6
f Partner site Bonn - Cologne , German Centre for Infection Research (DZIF) , Cologne , Germany.
7
g Division of Infectious Diseases and Department of Medical Microbiology , McGill University Health Centre , Montreal , Canada.
8
h Hôpitaux Universitaires, Department of Parasitology and Mycology, Plateau Technique de Microbiologie, FMTS , Université de Strasbourg , Strasbourg , France.
9
i Oncology and Hematology Department , University Hospital of Strasbourg and INSERM U1113 , Strasbourg , France.
10
j Department of Microbiology , Government Medical College Hospital , Chandigarh , India.
11
k Infectious Diseases , Falk Medical Building , Pittsburgh , PA , USA.
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l Infectious Diseases Department , Hospital Universitari Vall d'Hebron , Barcelona , Spain.
13
m University of Melbourne , Melbourne, Australia, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre , Melbourne , Australia.
14
n Department of Biomedical Sciences and Human Oncology , University of Bari Aldo Moro , Bari , Italy.
15
o Laboratory of Antimicrobial Chemotherapy , Ion Ionescu de la Brad University , Iași , Romania.
16
p Medical Clinic II - Infectious Diseases , University Hospital Giessen/Marburg , Giessen , Germany.
17
q Laboratory Dr. Wisplinghoff , Cologne , Germany.
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r Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty , University of Cologne , Cologne , Germany.
19
s Hospital Universitario Puerta de Hierro Majadahonda , Madrid , Spain.
20
t Institute for Virology and Clinical Microbiology , Witten/Herdecke University , Witten , Germany.
21
u Clinical Trials Centre Cologne (ZKS Köln) , University of Cologne , Cologne , Germany.
22
v Center for Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany.
23
w Department of Ophthalmology , University Hospital of Cologne , Cologne , Germany.
24
x Department of Internal Medicine III , University of Rostock , Rostock , Germany.
25
y Department of Hematology , University Hospital Giessen , Giessen , Germany.
26
z Department of Medical Microbiology , Postgraduate Institute of Medical Education & Research , Chandigarh , India.
27
aa Department of Stem Cell Transplantation , University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
28
ab Department of Pathology and Microbiology , Aga Khan University Hospital , Karachi , Pakistan.
29
ac Department of Cardiothoracic Surgery , University Hospital of Cologne , Cologne , Germany.
30
ad Pediatric Infectious Diseases and Immunodeficiencies Unit , University Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain.
31
ae Department of Internal Medicine IV , Hospital of the Justus-Liebig-University , Giessen , Germany.
32
af Medical Clinic 2 , University Hospital Frankfurt , Frankfurt , Germany.
33
ag Department of Microbiology, Sri Ramachandra Medical College and Research Institute , Sri Ramachandra University , Chennai , India.
34
ah Department of Clinical Mycology, Allergology and Immunology , North Western State Medical University , St. Petersburg , Russia.
35
ai Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria.
36
aj Department of Anaesthesia and Surgical Intensive Care-Liver ICU, AP-HP Henri Mondor Hospital , Université Paris Est - UPEC , Creteil , France.
37
ak Mycotic Diseases Branch , Centers for Disease Control and Prevention , Atlanta , GA , USA.
38
al Medical Microbiology and Clinical Infectiology, Institute of Clinical Hygiene , Paracelsus Medical University , Nuremberg , Germany.
39
am Department of Medicine and Experimental Hematology, Policlinico Sant'Orsola-Malpighi, Institute of Hematology Lorenzo e Ariosto Seràgnoli , University of Bologna , Bologna , Italy.
40
an Institute of Pathology , University Hospital of Cologne , Cologne , Germany.
41
ao University Hospital Vall d'Hebron , Microbiology Department , Universitat Autònoma de Barcelona , Barcelona , Spain.
42
ap Department of Medical Microbiology , Canisius-Wilhelmina Ziekenhuis , Nijmegen , the Netherlands.
43
aq Infectious Diseases Department , Turku University Hospital and Turku University , Turku , Finland.
44
ar Institute of Hematology , Catholic University of Sacred Heart , Rome , Italy.
45
as Division of Plastic, Aesthetic, and Reconstructive Surgery , Medical University of Graz , Graz , Austria.
46
at Department of Microbiology and Immunology , Catholic University Leuven , Leuven , Belgium.

Abstract

Invasive Scedosporium spp. and Lomentospora prolificans infections are an emerging threat in immunocompromised and occasionally in healthy hosts. Scedosporium spp. is intrinsically resistant to most, L. prolificans to all the antifungal drugs currently approved, raising concerns about appropriate treatment decisions. High mortality rates of up to 90% underline the need for comprehensive diagnostic workup and even more for new, effective antifungal drugs to improve patient outcome. For a comprehensive analysis, we identified cases of severe Scedosporium spp. and L. prolificans infections from the literature diagnosed in 2000 or later and the FungiScope® registry. For 208 Scedosporium spp. infections solid organ transplantation (n = 58, 27.9%) and for 56 L. prolificans infection underlying malignancy (n = 28, 50.0%) were the most prevalent risk factors. L. prolificans infections frequently presented as fungemia (n = 26, 46.4% versus n = 12, 5.8% for Scedosporium spp.). Malignancy, fungemia, CNS and lung involvement predicted worse outcome for scedosporiosis and lomentosporiosis. Patients treated with voriconazole had a better overall outcome in both groups compared to treatment with amphotericin B formulations. This review discusses the epidemiology, prognostic factors, pathogen susceptibility to approved and investigational antifungals, and treatment strategies of severe infections caused by Scedosporium spp. and L. prolificans.

KEYWORDS:

Scedosporiosis; antifungal treatment; invasive fungal disease; lomentosporiosis; surgery

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