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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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Lelièvre B, Briet M, Godon C, Legras P, Riou J, Vandeputte P, Diquet B, Bouchara JP. Impact of Infection Status and Cyclosporine on Voriconazole Pharmacokinetics in an Experimental Model of Cerebral Scedosporiosis. J Pharmacol Exp Ther 2018; 365:408-412. [PMID: 29491040 DOI: 10.1124/jpet.117.245449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/15/2018] [Indexed: 11/22/2022] Open
Abstract
Cerebral Scedosporium infections usually occur in lung transplant recipients as well as in immunocompetent patients in the context of near drowning. Voriconazole is the first-line treatment. The diffusion of voriconazole through the blood-brain barrier in the context of cerebral infection and cyclosporine administration is crucial and remains a matter of debate. To address this issue, the pharmacokinetics of voriconazole was assessed in the plasma, cerebrospinal fluid (CSF), and brain in an experimental model of cerebral scedosporiosis in rats receiving or not receiving cyclosporine. A single dose of voriconazole (30 mg/kg, i.v.) was administered to six groups of rats randomized according to the infection status and the cyclosporine dosing regimen (no cyclosporine, a single dose, or three doses; 15 mg/kg each). Voriconazole concentrations in plasma, CSF, and brain samples were quantified using ultra-performance liquid chromatography-tandem mass spectrometry and high-performance liquid chromatography UV methods and were documented up to 48 hours after administration. Pharmacokinetic parameters were estimated using a noncompartmental approach. Voriconazole pharmacokinetic profiles were similar for plasma, CSF, and brain in all groups studied. The voriconazole Cmax and area under the curve (AUC) (AUC0 ≥ 48 hours) values were significantly higher in plasma than in CSF [CSF/plasma ratio, median (range) = 0.5 (0.39-0.55) for AUC0 ≥ 48 hours and 0.47 (0.35 and 0.75) for Cmax]. Cyclosporine administration was significantly associated with an increase in voriconazole exposure in the plasma, CSF, and brain. In the plasma, but not in the brain, an interaction between the infection and cyclosporine administration reduced the positive impact of cyclosporine on voriconazole exposure. Together, these results emphasize the impact of cyclosporine on brain voriconazole exposure.
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Affiliation(s)
- Bénédicte Lelièvre
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Marie Briet
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Charlotte Godon
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Pierre Legras
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Jérémie Riou
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Patrick Vandeputte
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Bertrand Diquet
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
| | - Jean-Philippe Bouchara
- Service de Pharmacologie-Toxicologie-Centre Régional de Pharmacovigilance, Institut de Biologie en Santé (B.L., M.B., B.D.), MITOVASC, UMR CNRS 6214, Inserm 1083, Université d'Angers (M.B.), Micro- et Nanomédecines Biomimétiques, UMR INSERM 1066-CNRS 6021, Université d'Angers (J.R.), and Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé (J.-P.B.), Centre Hospitalier Universitaire, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène (EA 3142), Université d'Angers, Université de Bretagne Occidentale, Institut de Biologie en Santé, Angers, France (B.L., C.G., P.L., P.V., J.-P.B., B.D.); and Service Commun de l'Animalerie Hospitalo-Universitaire, Université d'Angers, Angers, France (P.L.)
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