Increasing Detection of Scedosporium prolificans in a General Hospital in Spain.



OBJECTIVE: Describe the episodes of Scedosporium prolificans infection detected in our center. RESULTS: From 1988 to 1994 S. prolificans had not been detected in our hospital. From August 1994 to July 1997 103,201 samples were processed in our Blood cultures and Mycology laboratories. Fungi were recovered from 3,727 specimens (2816 Candida spp., 377 Aspergillus spp., 28 Zygomycetes and 4 S. prolificans).In August 1994 the first episode of S. prolificans infection was detected in a 74-year old woman with acute myeloid leukemia. She presented with fungemia, lung infiltrates and skin nodules. Amphotericin B and G-CSF were administered. The evolution was good alongside bone marrow recovery. This case has been published in CID 1996;23:192-3.In April 1996 a 44-year old woman developed bilateral pneumonia, skin nodules and CNS abscesses four months after undergoing a heart transplantation. S. prolificans was recovered form blood cultures and from lower respiratory tract secretions. She died on the sixth day after admission.In June 1996 a 55-year old man with acute lymphoblastic leukemia presented with 4 cm subcutaneous nodules that were excised. S. prolificans was recovered from the biopsy. He received L-AMB with favourable outcome.In July 1997 we detected the first case of S. prolificans LRT colonization in a patient with cystic fibrosis.The four patients had previously received treatment or prophylaxis with itraconazole and one of them with amphotericin B as well. S. prolificans has not been isolated from any enviromental culture despite an intensive search. The patients have not coincided temporarily in the same ward, so the possibility of a related outbreak seems unprobable. The strains have been resistant to all antifungal agents studied.CONCLUSIONS: S. prolificans is an opportunistic filamentous fungus whose incidence as etiologic agent of infections in immunosuppressed patients previously treated with antifungal agents may be increasing.

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38th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 38th