Journal Article

Infections Due to <i>Scedosporium apiospermum</i> and <i>Scedosporium prolificans</i> in Transplant Recipients: Clinical Characteristics and Impact of Antifungal Agent Therapy on Outcome

Shahid Husain, Patricia Muñoz, Graeme Forrest, Barbara D. Alexander, Jyoti Somani, Kathleen Brennan, Marilyn M. Wagener and Nina Singh

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 1, pages 89-99
Published in print January 2005 | ISSN: 1058-4838
Published online January 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/426445
Infections Due to Scedosporium apiospermum and Scedosporium prolificans in Transplant Recipients: Clinical Characteristics and Impact of Antifungal Agent Therapy on Outcome

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Background. Unique characteristics, impact of therapy with antifungal agents, and outcome of infections with Scedosporium species were assessed in transplant recipients.

Methods. The patients comprised a total of 80 transplant recipients with Scedosporium infections, including 13 patients from our institutions (University of Pittsburgh Medical Center [Pittsburgh, PA], University of Maryland [Baltimore], Duke University Medical Center [Durham, NC], Emory University [Atlanta, GA], and Hospital Gregorio Marañón [Madrid, Spain]) and 67 reported in the literature. The transplant recipients were compared with 190 non—transplant recipients with scedosporiosis who were described in the literature.

Results. Overall, 69% of the infections in hematopoietic stem cell transplant (HSCT) recipients and 53% of the infections in organ transplant recipients were disseminated. HSCT recipients, compared with organ transplant recipients, were more likely to have infections caused by Scedosporium prolificans (P = .045), to have an earlier onset of infection (P = .007), to be neutropenic (P < .0001), and to have fungemia (P = .04). Time elapsed from transplantation to Scedosporium infection in transplant recipients has increased in recent years (P = .002). The mortality rate among transplant recipients with scedosporiosis was 58%. In a logistic regression model using amphotericin B as comparison treatment, voriconazole was associated with a trend towards better survival (odds ratio [OR], 10.40; P = .08). Presence of disseminated infection (OR, 0.20; P = .03) predicted lower survival, and receipt of adjunctive surgery as treatment (OR, 5.52; P = .02) independently predicted a better survival in this model.

Conclusions. Scedosporium infections in transplant recipients were associated with a high rate of dissemination and a poor outcome overall. The use of newer triazole agents warrants consideration as a therapeutic modality for these infections.

Journal Article.  7928 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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