Scedosporiosis

(aka Pseudallescheriosis, Maduromycosis of Lung)

Epidemiology

  • High Risk Groups:
    • Immunocompromised Patients:
    • Near Drowning: Scedosporium Boydii is the most common fungal infection associated with near drowning
      • Scedosporium Boydii has been isolated from freshwater lakes, coastal waters, and polluted streams

Etiology

  • Scedosporium Apiospermum
  • Scedosporium Boydii

Physiology

  • Infection with the ubiquitous soil saprophyte Scedosporium Boydii
  • May cause blood vessel invasion with pulmonary infarction (similar to Aspergillus and Mucormycosis)
  • Dissemination to CNS (brain abscess/meningitis/endopthalmitis): may occur early (due to hematogenous spread)

Diagnosis

  • Sputum GS/Cult+Sens: may demonstrate fungal elements on smear
  • FOB
    • BAL: positive culture may represent only colonization
    • TBB: histopathologically identical to Aspergillus (culture is mandatory to differentiate Scedosporium Boydii from Aspergillus)
  • CXR/Chest CT Pattern:
    • Upper Lobe Cavitary Infiltrates: may mimic Chronic Necrotizing Aspergillosis
    • Intracavitary Mycetoma: may mimic Aspergillus Mycetoma
    • Alveolar Infiltrates: may mimic Acute Invasive Aspergillosis

Clinical

Immunocompromised Host

  • Pneumonia (see [[Pneumonia]]): may present as slowly or rapidly progressive infection
  • Disseminated Scedosporiosis
    • Especially to CNS
    • High mortality rate

Following Near Drowning

(symptoms are usually delayed, may occur 1 week-6 months after submersion)

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Treatment

  • Miconazole (not Ampho): may be the treatment of choice
  • Ketoconazole or Itraconazole: efficacy in selected cases
  • Voriconazole: effective
  • Ampho-B: Scedosporium Boydii is often resistant to Ampho

References

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