September/October - West Virginia State Medical Association

| Scientific Article
Disseminated infections with
Scedosporium prolificans have been
reported in neutropenic patients
including those with underlying
blood disorders such as acute
leukemia, non-Hodgkin’s lymphoma,
aplastic anemia and multiple
myeloma. 5-7 Less commonly, it may
complicate the post operative course
of solid organ transplant recipients. 8
The most frequent site of entry
of this organism in disseminated
infections appears to be the
respiratory tract, based on the
observation of a high frequency
of pulmonary symptoms and
pulmonary infiltrates. Isolated
cases of entry into the bloodstream
with subsequent dissemination
through a surgical wound, a
Hickman catheter site or an injection
drug site have been reported.
In neutropenic patients,
disseminated infections present
with shock, pneumonia and
respiratory failure, renal failure,
nodular erythematous cutaneous
lesions, visual loss and central
nervous system involvement. 7
S. prolificans is inherently
resistant to many antifungals. 9,10
Echinocandins have been used
for treatment 11 and voriconazole
has been shown to have potent
in vitro activity (MIC 90
= 4mg/
mL). 10 Data on posaconazole
are emerging but breakthrough
infections in immunocompromised
hosts have been reported. 9,12,13 The
role of colony stimulating factors
in the immunocompromised
is theoretically very appealing
but is yet undetermined. 14,15
A review of cases of S. prolificans
infection with cardiac involvement is
presented in Table 1. Amphotericin
alone or in combination with other
antifungals was used in most of these
patients without success; all died. The
patient with pacemaker endocarditis
had underlying hepatitis C and
survived after treatment with
five weeks of oral voriconazole. 16
None of these patients received
echinocandins or posaconazole.
Our patient was immunocompetent,
with no evidence of HIV infection.
He had been involved in an isolated
incident of injection drug use as
part of his suicide attempt. It is
known that propofol may enhance
the growth of Staphylococcus aureus,
Moraxella species, Candida and
other organisms 22 but no data are
available for Scedosporium. The
portal of entry in him was unknown.
Of note, the newer antifungals such
as echinocandins, voriconazole and
posaconazole were not available
at the time of case presentation
and hence sensitivity testing
for the above was not done.
Scedosporium prolificans infection
with cardiac involvement is almost
universally fatal. The inherent
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