Infections Due to Pseudallescheria/Scedosporium Species in Patients With Advanced HIV Disease--A Diagnostic and Therapeutic Challenge

Int J Infect Dis. 2011 Jun;15(6):e422-9. doi: 10.1016/j.ijid.2011.03.004. Epub 2011 Apr 20.

Abstract

Objectives: The aim of this study is to highlight the importance of infections caused by members of the genera Pseudallescheria/Scedosporium in HIV-positive patients.

Methods: We describe a case of a fatal scedosporiosis in a treatment-naïve HIV patient and review all previously reported cases of pseudallescheriosis/scedosporiosis from a search of the PubMed and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) databases, applying the terms 'Pseudallescheria', 'Scedosporium', 'Allescheria', 'Monosporium', 'Petriellidium', 'boydii', 'prolificans', 'inflatum', cross-referenced with 'HIV' and 'AIDS'.

Results: Detection of Scedosporium and Pseudallescheria species has been reported in 22 HIV-positive patients. Fourteen isolates belonged to the Pseudallescheria boydii complex and eight to Scedosporium prolificans. Invasive scedosporiosis (IS) was proven in 54.5% of the patients. Among them dissemination was observed in 66.7%. Pseudallescheria/Scedosporium species were mainly isolated from male individuals. Patients with proven IS showed CD4+ cell counts <100/μl and a higher co-infection rate as compared to colonized patients. Patients with central nervous system (CNS) manifestations showed CD4+ cell counts <50/μl. The mortality rate for patients with proven IS was 75% and was 100% for patients with dissemination/CNS manifestations. The fatality rate for patients treated with antifungal drugs plus surgery was lower compared to patients treated with antimycotic agents alone.

Conclusions: IS only occurred in HIV-positive patients with a strongly impaired immune system. The survival rates of patients with advanced HIV disease and invasive scedosporiosis can be improved by rapid diagnosis by biopsy and requires complex therapy with a combination of active antifungal drugs, surgery and supportive immune augmentation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / microbiology
  • Adult
  • Antifungal Agents / therapeutic use*
  • Fatal Outcome
  • Female
  • HIV Infections / complications*
  • Humans
  • Mycetoma / complications
  • Mycetoma / diagnosis*
  • Mycetoma / drug therapy*
  • Mycetoma / microbiology
  • Polymerase Chain Reaction
  • Pseudallescheria / classification*
  • Pseudallescheria / genetics
  • Pseudallescheria / isolation & purification
  • Radiography
  • Scedosporium / classification*
  • Scedosporium / genetics
  • Scedosporium / isolation & purification
  • Toxoplasmosis, Cerebral / complications
  • Toxoplasmosis, Cerebral / diagnostic imaging

Substances

  • Antifungal Agents