Emerg Infect Dis. 2024 Jun;30(6):1077-1087. doi: 10.3201/eid3006.231409.
Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.
鞘孢菌属和繁茂鞘丝单胞菌是新兴的非曲霉丝状真菌。我们之前进行的鞘菌病/繁茂鞘丝菌病观察性研究报告称,这些真菌常引起血管受累,包括动脉炎和外周动脉炎。在本文中,我们回顾了来自鞘菌病/繁茂鞘丝菌病观察性研究的 7 例鞘孢菌属和繁茂鞘丝单胞菌动脉炎病例,以及来自文献的 13 例病例。70%(14/20)的患者存在潜在免疫抑制,主要是接受实体器官移植的患者(10/14)。50%(10/20)的病例存在骨关节炎定位感染;7/10 的感染与血管感染部位相邻。20 例患者中的 9 例(9/20)在完成非血管性鞘菌病/繁茂鞘丝菌病治疗 ≈3 个月后被诊断为鞘孢菌属/繁茂鞘丝单胞菌感染。11 例主动脉炎中有 8 例(8/11)和 10 例外周动脉炎中有 6 例(6/10)发现动脉瘤。侵袭性真菌病相关死亡率很高(12/18 [67%])。鞘孢菌属和繁茂鞘丝单胞菌的血管趋向性表明需要进行血管成像,如计算机断层血管造影,以管理感染,特别是对于骨关节炎部位。
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