Li J Y Z, Yong T Y, Grove D I, Coates P T H
Department of Nephrology and Transplantation Services, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Transpl Infect Dis. 2008 Feb;10(1):63-5. doi: 10.1111/j.1399-3062.2007.00240.x. Epub 2007 Apr 11.
Scedosporium species are increasingly isolated from immunocompromised and immunocompetent patients. Scedosporium infections are generally resistant to multiple antifungals, and Scedosporium prolificans is particularly resistant to all single antifungal agents currently in use with in vitro testing. We report here a long-term renal transplant recipient who developed isolated S. prolificans septic monoarthritis and probable osteomyelitis. The infection was successfully treated with a combination of voriconazole and terbinafine in addition to joint washout but did not require radical surgery. This combination has been shown to have synergistic in vitro effect, and anecdotal in vivo success has also been reported recently. We also review the clinical presentation, treatment, and outcome of S. prolificans infection in patients with solid organ transplantation.
多育赛多孢菌越来越多地从免疫功能低下和免疫功能正常的患者中分离出来。赛多孢菌感染通常对多种抗真菌药物耐药，而多育赛多孢菌对目前体外试验中使用的所有单一抗真菌药物尤其耐药。我们在此报告一名长期肾移植受者，其发生了孤立性多育赛多孢菌败血症性单关节炎和可能的骨髓炎。除关节冲洗外，联合伏立康唑和特比萘芬成功治疗了该感染，但无需进行根治性手术。这种联合用药已显示出体外协同作用，最近也有体内成功治疗的个案报道。我们还综述了实体器官移植患者中多育赛多孢菌感染的临床表现、治疗及转归。
