Lao Chong Kei, Ou Jie-Hao, Fan Yun-Chen, Wu Ting-Shu, Sun Pei-Lun
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan.
Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan.
Mycoses. 2023 Oct;66(10):923-935. doi: 10.1111/myc.13632. Epub 2023 Jul 14.
Scedosporiosis/lomentosporiosis is a globally emerging and crucial fungal infection. However, clinical data on Scedosporium/Lomentospora infections in Taiwan are scarce.
This study aimed to explore the clinical characteristics of Scedosporium/Lomentospora-infected patients and evaluate the susceptibility of these isolates to antifungal agents.
The clinical features of Scedosporium/Lomentospora-infected patients at a tertiary teaching hospital in Northern Taiwan between 2014 and 2021 were retrospectively reviewed; isolates from these patients were identified to species level for antifungal susceptibility testing.
Among 44 patients, 27 (61.4%) had scedosporiosis/lomentosporiosis, whereas 17 (38.6%) were colonised with Scedosporium/Lomentospora species. Scedosporium apiospermum was the main coloniser; scedosporiosis was primarily caused by S. boydii. Trauma history, steroid and immunosuppressant use were the most common risk factors for developing these infections. Among 27 patients with scedosporiosis/lomentosporiosis, one was lost to follow-up and seven (7/26, 26.9%) died. Most patients with S. apiospermum infection have a history of trauma, leading to cutaneous, bone and ocular infections. Pulmonary, sinus and disseminated infections and mortality were frequently reported in patients with S. boydii infection. Voriconazole's minimum inhibitory concentration was low for S. boydii, S. apiospermum and S. aurantiacum. Caspofungin, micafungin and anidulafungin were active against S. boydii and S. apiospermum. A potentially novel Scedosporium species was identified in this study, with distinct clinical manifestations and antifungal susceptibility.
At our centre, S. boydii is the main causative species of scedosporiosis; voriconazole could be the first-line treatment in Taiwan. Our study supports the importance of speciation, rather than only categorising these isolates into S. apiospermum species complex.
波氏假霉样真菌病/洛蒙假霉样真菌病是一种在全球范围内新出现的重要真菌感染。然而，台湾地区关于波氏假霉样真菌/洛蒙假霉样真菌感染的临床数据稀缺。
本研究旨在探讨波氏假霉样真菌/洛蒙假霉样真菌感染患者的临床特征，并评估这些分离株对抗真菌药物的敏感性。
回顾性分析2014年至2021年期间台湾北部一家三级教学医院中波氏假霉样真菌/洛蒙假霉样真菌感染患者的临床特征；对这些患者的分离株进行菌种鉴定以进行抗真菌药敏试验。
44例患者中，27例（61.4%）患有波氏假霉样真菌病/洛蒙假霉样真菌病，而17例（38.6%）为波氏假霉样真菌/洛蒙假霉样真菌定植。多育假霉是主要的定植菌；波氏假霉样真菌病主要由博伊德假霉引起。外伤史、使用类固醇和免疫抑制剂是发生这些感染的最常见危险因素。在27例波氏假霉样真菌病/洛蒙假霉样真菌病患者中，1例失访，7例（7/26，26.9%）死亡。大多数多育假霉感染患者有外伤史，导致皮肤、骨骼和眼部感染。博伊德假霉感染患者经常出现肺部、鼻窦和播散性感染及死亡情况。伏立康唑对博伊德假霉、多育假霉和橙色假霉的最低抑菌浓度较低。卡泊芬净、米卡芬净和阿尼芬净对博伊德假霉和多育假霉有活性。本研究鉴定出一种潜在的新型波氏假霉样真菌菌种，具有独特的临床表现和抗真菌药敏情况。
在我们中心，博伊德假霉是波氏假霉样真菌病的主要致病菌种；伏立康唑可能是台湾地区的一线治疗药物。我们的研究支持菌种鉴定的重要性，而不仅仅是将这些分离株归类为多育假霉菌种复合体。
