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Neoh CF, Chen SCA, Lanternier F, Tio SY, Halliday CL, Kidd SE, Kong DCM, Meyer W, Hoenigl M, Slavin MA. Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections. Clin Microbiol Rev 2024; 37:e0000423. [PMID: 38551323 PMCID: PMC11237582 DOI: 10.1128/cmr.00004-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYAlthough Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- The University of Sydney, Sydney, Australia
- Department of Infectious Diseases, Westmead Hospital, Sydney, Australia
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
- School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - David C M Kong
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
| | - Wieland Meyer
- The University of Sydney, Sydney, Australia
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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2
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Han J, Liang L, Li Q, Deng R, Liu C, Wu X, Zhang Y, Zhang R, Dai H. Diagnosis of pulmonary Scedosporium apiospermum infection from bronchoalveolar lavage fluid by metagenomic next-generation sequencing in an immunocompetent female patient with normal lung structure: a case report and literature review. BMC Infect Dis 2024; 24:308. [PMID: 38481149 PMCID: PMC10935950 DOI: 10.1186/s12879-024-09140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Scedosporium apiospermum (S. apiospermum) belongs to the asexual form of Pseudallescheria boydii and is widely distributed in various environments. S. apiospermum is the most common cause of pulmonary infection; however, invasive diseases are usually limited to patients with immunodeficiency. CASE PRESENTATION A 54-year-old Chinese non-smoker female patient with normal lung structure and function was diagnosed with pulmonary S. apiospermum infection by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). The patient was admitted to the hospital after experiencing intermittent right chest pain for 8 months. Chest computed tomography revealed a thick-walled cavity in the upper lobe of the right lung with mild soft tissue enhancement. S. apiospermum was detected by the mNGS of BALF, and DNA sequencing reads were 426. Following treatment with voriconazole (300 mg q12h d1; 200 mg q12h d2-d20), there was no improvement in chest imaging, and a thoracoscopic right upper lobectomy was performed. Postoperative pathological results observed silver staining and PAS-positive oval spores in the alveolar septum, bronchiolar wall, and alveolar cavity, and fungal infection was considered. The patient's symptoms improved; the patient continued voriconazole for 2 months after surgery. No signs of radiological progression or recurrence were observed at the 10-month postoperative follow-up. CONCLUSION This case report indicates that S. apiospermum infection can occur in immunocompetent individuals and that the mNGS of BALF can assist in its diagnosis and treatment. Additionally, the combined therapy of antifungal drugs and surgery exhibits a potent effect on the disease.
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Affiliation(s)
- Jingru Han
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400010, China
| | - Lifang Liang
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Qingshu Li
- Department of Pathology, School of Basic Medicine, Chongqing Medical University, No.1 Medical College Road, Yuzhong District, Chongqing, 400016, China
| | - Ruihang Deng
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Chenyang Liu
- The Second College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Xuekai Wu
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Yuxin Zhang
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Ruowen Zhang
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Haiyun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuan Jiagang, Yuzhong District, Chongqing, 400010, China.
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3
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Tosco A, Poli P, Casale A, De Gregorio F, Sepe A, Buonpensiero P, Di Pasqua A, Castaldo A, Cimbalo C, Buzzetti R, Raia V, Berlucchi M, Timpano S, Badolato R, Padoan R, Orlando C. The Role of Bronchoscopy in the Management of Children With Cystic Fibrosis. J Bronchology Interv Pulmonol 2023; 30:258-267. [PMID: 35698279 DOI: 10.1097/lbr.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Currently, no consensus guidelines recommend routine bronchoscopy procedure in cystic fibrosis (CF), as no evidence is available concerning its use as either a diagnostic or therapeutic tool. Its efficacy is controversial, and no randomized controlled prospective trials are available to check its effectiveness. The aims of the present study were to evaluate the effectiveness of bronchoscopy as a diagnostic/therapeutic tool in CF children and adolescents; and to verify the effect of serial bronchoscopy on lung disease progression in subjects with CF not responding to a single procedure. METHODS Data of patients who received bronchoscopy at 2 Italian CF centers were collected. Bronchoalveolar lavage was performed during the procedure including airway clearance with mucolytics, inhaled antibiotics, and/or surfactant instillation. RESULTS A total of 16 patients in center 1 and 17 in center 2 underwent, respectively, 28 and 23 bronchoscopic procedure in the study period. Five patients in each center underwent >1 procedure. All procedures were generally well tolerated. No patient required admission to the pediatric intensive therapy unit. In 19.6% of bronchoalveolar lavages, growth of Aspergillus fumigatus was evident, although not detected by sputum analyses. After the procedure, an increase in mean percent predicted forced expiratory volume in the 1 second >10% was observed, and a significant decrease in pulmonary exacerbations yearly was evident. CONCLUSION Based on the results, we suggest bronchoscopy is not to be considered an obsolete tool, and it remains useful in CF management, although in selected cases. We encourage to support longitudinal observational studies to standardize the procedure, focusing on the choice of drugs to be instilled, modalities and timing of serial bronchoscopy and subsequent follow-up in selected severe clinical conditions.
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Affiliation(s)
- Antonella Tosco
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Piercarlo Poli
- Paediatric Department, Cystic Fibrosis Support Centre, University of Brescia, ASST Spedali Civili Brescia
| | - Alida Casale
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Fabiola De Gregorio
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Angela Sepe
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Paolo Buonpensiero
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Antonio Di Pasqua
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Alice Castaldo
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Chiara Cimbalo
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Roberto Buzzetti
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
- Freelance Epidemiologist, Bergamo, Italy
| | - Valeria Raia
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, Federico II University
| | - Marco Berlucchi
- Unit of Pediatric Otorhinolaryngology, ASST Spedali Civili Brescia
| | - Silviana Timpano
- Paediatric Department, Cystic Fibrosis Support Centre, University of Brescia, ASST Spedali Civili Brescia
| | - Raffaele Badolato
- Paediatric Department, Cystic Fibrosis Support Centre, University of Brescia, ASST Spedali Civili Brescia
- Department of Molecular and Translational Medicine, Angelo Nocivelli Institute for Molecular Medicine, University of Brescia, Brescia
| | - Rita Padoan
- Paediatric Department, Cystic Fibrosis Support Centre, University of Brescia, ASST Spedali Civili Brescia
- Department of Molecular and Translational Medicine, Angelo Nocivelli Institute for Molecular Medicine, University of Brescia, Brescia
| | - Claudio Orlando
- Department of Pediatric Respiratory Endoscopy and Difficult Airways Management, Naples
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4
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Thornton CR. Detection of the 'Big Five' mold killers of humans: Aspergillus, Fusarium, Lomentospora, Scedosporium and Mucormycetes. ADVANCES IN APPLIED MICROBIOLOGY 2019; 110:1-61. [PMID: 32386603 DOI: 10.1016/bs.aambs.2019.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fungi are an important but frequently overlooked cause of morbidity and mortality in humans. Life-threatening fungal infections mainly occur in immunocompromised patients, and are typically caused by environmental opportunists that take advantage of a weakened immune system. The filamentous fungus Aspergillus fumigatus is the most important and well-documented mold pathogen of humans, causing a number of complex respiratory diseases, including invasive pulmonary aspergillosis, an often fatal disease in patients with acute leukemia or in immunosuppressed bone marrow or solid organ transplant recipients. However, non-Aspergillus molds are increasingly reported as agents of disseminated diseases, with Fusarium, Scedosporium, Lomentospora and mucormycete species now firmly established as pathogens of immunosuppressed and immunocompetent individuals. Despite well-documented risk factors for invasive fungal diseases, and increased awareness of the risk factors for life-threatening infections, the number of deaths attributable to molds is likely to be severely underestimated driven, to a large extent, by the lack of readily accessible, cheap, and accurate tests that allow detection and differentiation of infecting species. Early diagnosis is critical to patient survival but, unlike Aspergillus diseases, where a number of CE-marked or FDA-approved biomarker tests are now available for clinical diagnosis, similar tests for fusariosis, scedosporiosis and mucormycosis remain experimental, with detection reliant on insensitive and slow culture of pathogens from invasive bronchoalveolar lavage fluid, tissue biopsy, or from blood. This review examines the ecology, epidemiology, and contemporary methods of detection of these mold pathogens, and the obstacles to diagnostic test development and translation of novel biomarkers to the clinical setting.
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5
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Boyle M, Moore JE, Whitehouse JL, Bilton D, Downey DG. The diagnosis and management of respiratory tract fungal infection in cystic fibrosis: A UK survey of current practice. Med Mycol 2019; 57:155-160. [PMID: 29554296 DOI: 10.1093/mmy/myy014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/19/2018] [Indexed: 12/30/2022] Open
Abstract
Aspergillus fumigatus is commonly found in the airways of patients with cystic fibrosis (CF), and allergic bronchopulmonary aspergillosis (ABPA) is the most recognized associated clinical condition. However, accurate diagnosis remains challenging, and there is a paucity of clinical trials to guide clinical management of fungal disease. The aim of this survey was to assess the variability in current practice across the UK in diagnosis and management of fungal lung disease in CF patients. A 21 question anonymous online survey was sent to 94 paediatric and adult CF consultants in the UK. The response rate was 60.6% (32 adult physicians, 25 pediatricians) with 55 full and 2 partially completed surveys. For a first diagnosis of ABPA 20 (35.1%) treat with prednisolone alone, 38 (66.7%) use prednisolone with itraconazole and 2 (3.5%) choose voriconazole. Only 5 (8.8%) treat with prednisolone alone for a 1st relapse, 33 (58%) used prednisolone with itraconazole. To reduce treatment, 21 (36.8%) decrease steroids to zero over time and maintain azole therapy, 18 (31.6%) stop the azole and steroid after a fixed time, and 5 (8.8%) stop the azole after a fixed time and maintain a small steroid dose. Thirty-eight (66.7%) respondents believe Aspergillus colonization of the airway can cause clinical deterioration, and 37 (66.1%) would treat this. Scedosporium apiospermum infection has been diagnosed and treated by 35 (61.4%) of respondents. Results of this survey highlight the variance in clinical practice and the limited evidence available to guide management of fungal infection in CF.
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Affiliation(s)
- M Boyle
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - J E Moore
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | | | - D Bilton
- Royal Brompton Hospital, London, UK
| | - D G Downey
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK.,Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK
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6
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Shields BE, Rosenbach M, Brown-Joel Z, Berger AP, Ford BA, Wanat KA. Angioinvasive fungal infections impacting the skin. J Am Acad Dermatol 2019; 80:869-880.e5. [DOI: 10.1016/j.jaad.2018.04.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/19/2023]
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7
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Schwarz C, Brandt C, Melichar V, Runge C, Heuer E, Sahly H, Schebek M, Köster H, Bouchara JP, Biedermann T, Meißner P, Große-Onnebrink J, Skopnik H, Hartl D, Sedlacek L, Tintelnot K. Combined antifungal therapy is superior to monotherapy in pulmonary scedosporiosis in cystic fibrosis. J Cyst Fibros 2019; 18:227-232. [DOI: 10.1016/j.jcf.2018.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/06/2018] [Accepted: 08/31/2018] [Indexed: 12/13/2022]
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8
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Schwarz C, Vandeputte P, Rougeron A, Giraud S, Dugé de Bernonville T, Duvaux L, Gastebois A, Alastruey-Izquierdo A, Martín-Gomez MT, Mazuelos EM, Sole A, Cano J, Pemán J, Quindos G, Botterel F, Bougnoux ME, Chen S, Delhaès L, Favennec L, Ranque S, Sedlacek L, Steinmann J, Vazquez J, Williams C, Meyer W, Le Gal S, Nevez G, Fleury M, Papon N, Symoens F, Bouchara JP. Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis. Med Mycol 2018. [PMID: 29538733 DOI: 10.1093/mmy/myx106] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.
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Affiliation(s)
- Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Vandeputte
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
| | - Amandine Rougeron
- Université de Bordeaux, Microbiologie Fondamentale et Pathogénicité UMR 5234, Bordeaux, France; CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France; Laboratoire de Parasitologie-Mycologie, CHU, Bordeaux, France
| | - Sandrine Giraud
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Thomas Dugé de Bernonville
- Biomolécules et Biotechnologies Végétales (EA 2106), Département de Biologie et Physiologie Végétales, UFR Sciences et Techniques, Université François Rabelais, Tours
| | - Ludovic Duvaux
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Institut de Recherche en Horticulture et Semences (IRHS), UMR INRA 1345, Beaucouzé, France
| | - Amandine Gastebois
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Teresa Martín-Gomez
- Respiratory Bacteriology Unit & Clinical Mycology Unit, Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amparo Sole
- Unidad de Trasplante Pulmonar y Fibrosis Quística, Hospital Universitari la Fe, Valencia, Spain
| | - Josep Cano
- Mycology Unit, Medical School/Oenology School, Universitat Rovira i Virgili, Reus, Spain
| | - Javier Pemán
- Unidad de Micología, Servicio de Microbiología, Universitari la Fe, Valencia, Spain
| | - Guillermo Quindos
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco, Bilbao, Spain
| | - Françoise Botterel
- Laboratoire de Parasitologie-Mycologie, CHU Henri Mondor, Créteil, France
| | | | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Laurence Delhaès
- Center for Cardiothoracic Research of Bordeaux, Inserm U1045, Bordeaux, France
| | - Loïc Favennec
- Laboratoire de Parasitologie-Mycologie, EA 3800, CHU Charles Nicolle and Université de Rouen, Rouen, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, AP-HM Timone, Marseille, France
| | - Ludwig Sedlacek
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jose Vazquez
- Division of Infectious Diseases, Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Craig Williams
- University of the West of Scotland, Institute of Healthcare Associated Infection, University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School, Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Solène Le Gal
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Gilles Nevez
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Maxime Fleury
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Nicolas Papon
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Françoise Symoens
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Jean-Philippe Bouchara
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
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9
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Ramirez-Garcia A, Pellon A, Rementeria A, Buldain I, Barreto-Bergter E, Rollin-Pinheiro R, de Meirelles JV, Xisto MIDS, Ranque S, Havlicek V, Vandeputte P, Govic YL, Bouchara JP, Giraud S, Chen S, Rainer J, Alastruey-Izquierdo A, Martin-Gomez MT, López-Soria LM, Peman J, Schwarz C, Bernhardt A, Tintelnot K, Capilla J, Martin-Vicente A, Cano-Lira J, Nagl M, Lackner M, Irinyi L, Meyer W, de Hoog S, Hernando FL. Scedosporium and Lomentospora: an updated overview of underrated opportunists. Med Mycol 2018. [PMID: 29538735 DOI: 10.1093/mmy/myx113] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Species of Scedosporium and Lomentospora are considered as emerging opportunists, affecting immunosuppressed and otherwise debilitated patients, although classically they are known from causing trauma-associated infections in healthy individuals. Clinical manifestations range from local infection to pulmonary colonization and severe invasive disease, in which mortality rates may be over 80%. These unacceptably high rates are due to the clinical status of patients, diagnostic difficulties, and to intrinsic antifungal resistance of these fungi. In consequence, several consortia have been founded to increase research efforts on these orphan fungi. The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxonomy, environmental distribution, epidemiology, pathology, virulence factors, immunology, diagnostic methods, and therapeutic strategies.
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Affiliation(s)
- Andoni Ramirez-Garcia
- Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Aize Pellon
- Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Aitor Rementeria
- Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Idoia Buldain
- Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | | | | | | | | | - Stephane Ranque
- Laboratoire de Parasitologie-Mycologie, AP-HM / CHU Timone, Marseille, France
| | - Vladimir Havlicek
- Institute of Microbiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Patrick Vandeputte
- Laboratoire de Parasitologie-Mycologie, CHU, Angers, France.,Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Angers, France
| | - Yohann Le Govic
- Laboratoire de Parasitologie-Mycologie, CHU, Angers, France.,Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Angers, France
| | - Jean-Philippe Bouchara
- Laboratoire de Parasitologie-Mycologie, CHU, Angers, France.,Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Angers, France
| | - Sandrine Giraud
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Angers, France
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, The University of Sydney, New South Wales, Australia
| | - Johannes Rainer
- Institute of Microbiology, Leopold-Franzens University Innsbruck, Austria
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology. Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | | | | | - Javier Peman
- Microbiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carsten Schwarz
- Cystic Fibrosis Centre Berlin/Charité-Universitätsmedizin Berlin, Germany
| | - Anne Bernhardt
- Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Kathrin Tintelnot
- Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Javier Capilla
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Adela Martin-Vicente
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Reus, Spain.,Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN USA
| | - Jose Cano-Lira
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Markus Nagl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laszlo Irinyi
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School, Sydney Medical School - Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School, Sydney Medical School - Westmead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Fernando L Hernando
- Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain
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10
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Luplertlop N. Pseudallescheria/Scedosporium complex species: From saprobic to pathogenic fungus. J Mycol Med 2018; 28:249-256. [PMID: 29567285 DOI: 10.1016/j.mycmed.2018.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 12/16/2022]
Abstract
Scedosporiosis is an emerging fungal infection caused by Pseudallescheria/Scedosporium complex species (PSC). This pathogen has been drawn significant interest in recent years due to its worldwide prevalence, the seriousness of its infection, associated with high mortality in both immunocompromised and immunocompetent hosts and its cryptic ecology, distribution and epidemiology across the globe. These species complexes can be found in environments impacted by human. The purpose of this review is to describe the characteristics, mode of transmission, ecology, prevalence, global epidemiology of this fungal group in order to increase the awareness of among clinicians and microbiologists, especially in regions with high endemic, as well as to promote further research on all of its aspects.
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Affiliation(s)
- N Luplertlop
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand.
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11
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Scheffold A, Schwarz C, Bacher P. Fungus-Specific CD4 T Cells as Specific Sensors for Identification of Pulmonary Fungal Infections. Mycopathologia 2017; 183:213-226. [PMID: 29168073 DOI: 10.1007/s11046-017-0229-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022]
Abstract
Patients with cystic fibrosis (CF) suffer from chronic lung infections, caused by bacterial, viral or fungal pathogens, which determine morbidity and mortality. The contribution of individual pathogens to chronic disease and acute lung exacerbations is often difficult to determine due to the complex composition of the lung microbiome in CF. In particular, the relevance of fungal pathogens in CF airways remains poorly understood due to limitations of current diagnostics to identify the presence of fungal pathogens and to resolve the individual host-pathogen interaction status. T-lymphocytes play an essential role in host defense against pathogens, but also in inappropriate immune reactions such as allergies. They have the capacity to specifically recognize and discriminate the different pathogens and orchestrate a diverse array of effector functions. Thus, the analysis of the fungus-specific T cell status of an individual can in principle provide detailed information about the identity of the fungal pathogen(s) encountered and the actual fungus-host interaction status. This may allow to classify patients, according to appropriate (protective) or inappropriate (pathology-associated) immune reactions against individual fungal pathogens. However, T cell-based diagnostics are currently not part of the clinical routine. The identification and characterization of fungus-specific T cells in health and disease for diagnostic purposes are associated with significant challenges. Recent technological developments in the field of fungus-specific T helper cell detection provide new insights in the host T cell-fungus interaction. In this review, we will discuss basic principles and the potential of T cell-based diagnostics, as well as the perspectives and further needs for use of T cells for improved clinical diagnostics of fungal diseases.
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Affiliation(s)
- Alexander Scheffold
- Department of Cellular Immunology, Clinic for Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- German Rheumatism Research Centre (DRFZ) Berlin, Leibniz Association, Berlin, Germany.
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Centre Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Bacher
- Department of Cellular Immunology, Clinic for Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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12
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Fungal Pathogens in CF Airways: Leave or Treat? Mycopathologia 2017; 183:119-137. [PMID: 28770417 DOI: 10.1007/s11046-017-0184-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/22/2017] [Indexed: 02/07/2023]
Abstract
Chronic airway infection plays an essential role in the progress of cystic fibrosis (CF) lung disease. In the past decades, mainly bacterial pathogens, such as Pseudomonas aeruginosa, have been the focus of researchers and clinicians. However, fungi are frequently detected in CF airways and there is an increasing body of evidence that fungal pathogens might play a role in CF lung disease. Several studies have shown an association of fungi, particularly Aspergillus fumigatus and Candida albicans, with the course of lung disease in CF patients. Mechanistically, in vitro and in vivo studies suggest that an impaired immune response to fungal pathogens in CF airways renders them more susceptible to fungi. However, it remains elusive whether fungi are actively involved in CF lung disease pathologies or whether they rather reflect a dysregulated airway colonization and act as microbial bystanders. A key issue for dissecting the role of fungi in CF lung disease is the distinction of dynamic fungal-host interaction entities, namely colonization, sensitization or infection. This review summarizes key findings on pathophysiological mechanisms and the clinical impact of fungi in CF lung disease.
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13
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Progress in Definition, Prevention and Treatment of Fungal Infections in Cystic Fibrosis. Mycopathologia 2017; 183:21-32. [DOI: 10.1007/s11046-017-0182-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
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14
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Noni M, Katelari A, Kapi A, Stathi A, Dimopoulos G, Doudounakis SE. Scedosporium apiospermum complex in cystic fibrosis; should we treat? Mycoses 2017; 60:594-599. [PMID: 28504471 DOI: 10.1111/myc.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/07/2017] [Accepted: 04/16/2017] [Indexed: 11/29/2022]
Abstract
Species of the Scedosporium apiospermum complex are the second most frequent filamentous fungi after Aspergillus fumigatus that can be found in cystic fibrosis (CF). Mixed colonisation by S. apiospermum complex and A. fumigatus is also quite common. In this study we summarise all CF patients who were colonised by S. apiospermum complex during their childhood and we present two CF patients who were treated as fungal bronchitis due to S. apiospermum complex. The medical records of 400 CF patients were reviewed in order to identify those with positive respiratory cultures for S. apiospermum complex. Scedosporium apiospermum complex was isolated in 10 CF patients and six of them had more than two positive sputum cultures during the study period. By the time of first isolation, the median age was 14.5 years, the median BMI was 19.41 kg/m2 , the median predicted FEV1 % was 78.65% and six patients had a history of A. fumigatus isolation. Two patients presented symptoms of infection while they were colonised by S. apiospermum complex. A rapid remission of their symptoms was observed only when antifungal therapy was administered. Antifungal treatment should be considered in CF patients who present symptoms of infection not responding to antibacterial therapy and S. apiospermum complex is persistently growing in sputum cultures.
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Affiliation(s)
- Maria Noni
- Medical School, Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Katelari
- Medical School, Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kapi
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Angeliki Stathi
- Laboratory of Microbiology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George Dimopoulos
- Faculty of Medicine, Department of Critical Care, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
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15
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Abstract
For a long time, the microbiology of cystic fibrosis has been focussed on Pseudomonas aeruginosa and associated Gram-negative pathogens. An increasing body of evidence has been compiled demonstrating an important role for moulds and yeasts within this complex patient group. Whether or not fungi are active participants, spectators or transient passersby remain to be elucidated. However, functionally, they do appear to play a contributory role in pathogenesis, albeit we do not know if this is a direct or indirect effect. The following review examines some of the key evidence for the role of fungi in CF pathogenesis.
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