Kermani Firoozeh, Yazdani Charati Jamshid, Roohi Behrad, Moslemi Azam, Bandeghani Azadeh, Faeli Leila, Shokohi Tahereh, Roilides Emmanuel
Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Mycoses. 2024 Feb;67(2):e13703. doi: 10.1111/myc.13703.
Scedosporium/Lomentospora species exist as saprophytic moulds that can potentially lead to serious infections in patients who have experienced near-drowning incidents. Scedosporium species are distributed across different regions of the world while Lomentospora prolificans has quite a restricted geographic distribution. We aimed to systematically review scedosporiosis cases after near-drowning, their clinical manifestations, underlying diseases, treatments, outcomes and its impact through disability-adjusted life years (DALYs). Five available sources were searched from 1 January 2007, to 20 April 2022. Thirty-eight studies, including 41 patients, were evaluated. Mean age was 33.6 ± 18.6 years (range 1-68), and 28 were male (68.3%). Central nervous system (CNS) dissemination predominated (36/41; 87.8%), presenting mainly as multiple brain abscesses (26/41; 63.4%), followed by lung involvement (22/41; 56.4%). Scedosporium apiospermum species complex was the most causative agent (38/41; 92.7%). Overall mortality was 51.2%. Half of the patients (18/37) were cured after receiving proper treatment, and in most cases, voriconazole alone or in combination with surgery or other antifungals caused survival. The mean survival time was 123 ± 27 days. Mean DALYs in 1980-2022 were 46.110 ± 3.318 (39.607-52.612). Time to diagnosis was estimated to be 120 days, and there was no association between time to diagnosis and outcome. Voriconazole is a potentially effective therapy, and combination of surgery and antifungal treatment may lead to more favourable outcome. Advances in early diagnosis and appropriate antifungal therapy may have contributed to reducing its mortality.
足分支霉属/多育孢霉属真菌以腐生霉菌的形式存在，可能导致经历过溺水事故的患者发生严重感染。足分支霉属真菌分布于世界各地，而多育孢霉的地理分布则相当有限。我们旨在系统回顾溺水后足分支霉病病例、其临床表现、基础疾病、治疗方法、结局及其通过伤残调整生命年（DALYs）产生的影响。检索了从2007年1月1日至2022年4月20日的五个可用来源。评估了38项研究，包括41例患者。平均年龄为33.6±18.6岁（范围1 - 68岁），男性28例（68.3%）。中枢神经系统（CNS）播散占主导（36/41；87.8%），主要表现为多发性脑脓肿（26/41；63.4%），其次是肺部受累（22/41；56.4%）。伪阿利什霉复合种是最主要的病原体（38/41；92.7%）。总体死亡率为51.2%。一半的患者（18/37）在接受适当治疗后治愈，在大多数情况下，单独使用伏立康唑或与手术或其他抗真菌药物联合使用可使患者存活。平均生存时间为123±27天。1980 - 2022年的平均伤残调整生命年为46.110±3.318（39.607 - 52.612）。估计诊断时间为120天，诊断时间与结局之间无关联。伏立康唑是一种潜在有效的治疗方法，手术与抗真菌治疗联合使用可能会带来更有利的结局。早期诊断和适当抗真菌治疗的进展可能有助于降低其死亡率。
