Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20-year experience from a single center in Spain.

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Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20-year experience from a single center in Spain.

Mycoses. 2020 Aug 04;:

Authors: Álvarez-Uría A, Guinea J, Escribano P, Gómez-Castellá J, Valerio M, Galar A, Vena A, Bouza E, Muñoz P

Abstract
BACKGROUND: non-Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long-term incidence.
OBJECTIVES: to analyse the epidemiology, risk factors, clinical features, and incidence of patients with proven and probable infections.
PATIENTS/METHODS: patients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection.
RESULTS: one or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were hematologic malignancy (25%), solid organ transplantation (25%), and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter-species susceptibility variability to triazoles was observed for most isolates.
CONCLUSIONS: in contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.

PMID: 32749009 [PubMed – as supplied by publisher]

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