Grenouillet Frederic, Botterel Françoise, Crouzet Julien, Larosa Fabrice, Hicheri Yosr, Forel Jean-Marie, Helias Philippe, Ranque Stephane, Delhaes Laurence
Mycology-Parasitology Unit, University Hospital J. Minjoz, Besançon, France.
Med Mycol. 2009 Jun;47(4):343-50. doi: 10.1080/13693780802454761. Epub 2008 Dec 12.
For the last ten years, non-Aspergillus mold species have been increasingly involved in human invasive infections, probably as a consequence of more intense immunosuppression and prolonged patient survival, and of selective pressure since antifungal agents are currently used for prophylaxis or therapy. Scedosporium prolificans, one of these emerging fungi, has been isolated in a broad spectrum of clinical presentations in humans, including respiratory-tract colonization, superficial or locally invasive infections, and disseminated infections in immunocompromised patients. Here, we report the recent emergence of invasive infections due to S. prolificans in France, and describe four new cases diagnosed during the last six years. Only one disseminated scedosporiosis has been reported before this in France, in 1994. Three out of our four cases were breakthrough infections in immunocompromised patients receiving posaconazole or voriconazole therapy. The aims of the present review were thus to gain a better understanding of scedosporiosis epidemiology and clinical features, and to review recent advances in multimodal management of these infections, including surgery, recovery and/or enhancement of immunity, and antifungal combinations, especially voriconazole plus terbinafine.
在过去十年中，非曲霉菌属霉菌越来越多地引发人类侵袭性感染，这可能是由于免疫抑制加剧、患者存活时间延长，以及目前将抗真菌药物用于预防或治疗所产生的选择压力所致。多育赛多孢菌就是这些新出现的真菌之一，它已在人类多种临床症状中被分离出来，包括呼吸道定植、浅表或局部侵袭性感染，以及免疫功能低下患者的播散性感染。在此，我们报告法国近期出现的由多育赛多孢菌引起的侵袭性感染情况，并描述过去六年中诊断出的四例新病例。此前在1994年法国仅报告过一例播散性赛多孢菌病。我们这四例病例中有三例是接受泊沙康唑或伏立康唑治疗的免疫功能低下患者出现的突破性感染。因此，本综述的目的是更好地了解赛多孢菌病的流行病学和临床特征，并回顾这些感染多模式管理的最新进展，包括手术、恢复和/或增强免疫力，以及抗真菌联合用药，尤其是伏立康唑加特比萘芬。
