Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy Journal Article

  

Authors:	Safdar, A.; Papadopoulos, E. B.; Young, J. W.
Article Title:	Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy
Abstract:	Systemic scedosporiasis due to the anamorph or asexual form Scedosporium apiospermum (Pseudallescheria boydii) has become an important cause of opportunistic mycosis, especially in patients undergoing high-risk hematopoietic stem cell transplantation. We report a case of rapidly progressive cerebellar hyalohyphomycosis due to Scedosporium apiospermum in an allogeneic marrow graft recipient receiving treatment for severe graft-versus-host disease. This fatal breakthrough intracranial abscess, due to amphotericin B-resistant (minimum inhibitory concentration > 16 μg/ml) mold, developed during the course of systemic antifungal therapy given for multicentric pulmonary aspergillosis. Despite treatment with high-dose Abelcet® (10 mg/kg daily), free amphotericin B was not detected in postmortem cerebellar tissue. A broad-spectrum triazole-based agent (voriconazole/UK-109,496-Vfend®), and a novel fungal cell wall inhibitor, an echinocandin/pneumocandin analog (caspofungin/ MK-0991-Cancidas®), which exhibit excellent in vitro activity against most clinical Pseudallescheria boydii-Scedosporium apiospermum isolates, have recently become available in the United States and may provide much needed treatment options for patients at risk.
Keywords:	adult; human tissue; transplantation, homologous; busulfan; prednisone; histopathology; case report; methotrexate; nuclear magnetic resonance imaging; computer assisted tomography; cyclophosphamide; hematopoietic stem cell transplantation; chronic myeloid leukemia; risk; postoperative complication; ciprofloxacin; graft versus host reaction; ketoconazole; immune deficiency; autopsy; immunosuppressive treatment; fluconazole; cyclosporin; voriconazole; antifungal agents; infection risk; lung aspergillosis; thymocyte antibody; itraconazole; flucytosine; amphotericin b lipid complex; ceftazidime; daclizumab; brain abscess; amphotericin b; microbial sensitivity tests; scedosporium; scedosporium apiospermum; pseudallescheria boydii; maduromycosis; humans; human; male; priority journal; article; amphotericin b resistance; breakthrough mycosis; new antifungals; aspergillosis, allergic bronchopulmonary
Journal Title:	Transplant Infectious Disease
Volume:	4
Issue:	4
ISSN:	1398-2273
Publisher:	Wiley Blackwell
Date Published:	2002-12-01
Start Page:	212
End Page:	217
Language:	English
PUBMED:	12535265
PROVIDER:	scopus
DOI:	10.1034/j.1399-3062.2002.02008.x
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-0036966314&partnerID=40&md5=22d6ec1cb1a5aca031443bfaa2588e88
Notes:	Export Date: 14 November 2014 -- Source: Scopus

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