Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope® registry

Jeffrey D Jenks; Danila Seidel; Oliver A Cornely; Sharon Chen; Sebastiaan van Hal; Carol Kauffman; Marisa H Miceli; Melina Heinemann; Martin Christner; Alfredo Jover Sáenz; Alexander Burchardt; Björn Kemmerling; Raoul Herbrecht; Joerg Steinmann; Shmuel Shoham; Sandra Gräber; Livio Pagano; Dries Deeren; Monica A Slavin; Martin Hoenigl

doi:10.1111/myc.13067

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry

Mycoses. 2020 May;63(5):437-442. doi: 10.1111/myc.13067. Epub 2020 Apr 15.

Authors

Jeffrey D Jenks^{1

2}, Danila Seidel³, Oliver A Cornely³, Sharon Chen⁴, Sebastiaan van Hal⁵, Carol Kauffman⁶, Marisa H Miceli⁶, Melina Heinemann⁷, Martin Christner⁸, Alfredo Jover Sáenz⁹, Alexander Burchardt¹⁰, Björn Kemmerling¹⁰, Raoul Herbrecht¹¹, Joerg Steinmann^{12

13}, Shmuel Shoham¹⁴, Sandra Gräber¹⁵, Livio Pagano¹⁶, Dries Deeren¹⁷, Monica A Slavin¹⁸, Martin Hoenigl^{1

2

19}

Affiliations

¹ Department of Medicine, University of California San Diego, San Diego, CA, USA.
² Clinical and Translational Fungal Research Group, University of California San Diego, San Diego, CA, USA.
³ Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, CECAD-Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University Hospital Cologne, Cologne, Germany.
⁴ Sydney Medical School, Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Camperdown, New South Wales, Australia.
⁵ Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸ Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁹ Territorial Unit of Nosocomial Infection and antibiotic policy (TUNI), University Hospital Arnau de Vilanova, Lleida, Spain.
¹⁰ Department of Hematology, Hospital of Justus Liebig University, Giessen, Germany.
¹¹ Department of Oncology and Hematology, Strasbourg University Hospital, Strasbourg, France.
¹² Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
¹³ Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹⁴ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig, Leipzig, Germany.
¹⁶ Department of Hematology, Fondazione Policlinico A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁷ Department of Hematology, AZ Delta, Roeselare, Belgium.
¹⁸ Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, Vic., Australia.
¹⁹ Department of Medicine, ECMM Excellence Centre of Medical Mycology, Medical University of Graz, Graz, Austria.

PMID: 32080902
DOI: 10.1111/myc.13067

Abstract

Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections.

Methods: We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope^® registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis.

Results: The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P = .012), with a positive trend observed for treatment regimens that included voriconazole (P = .054).

Conclusions: Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.

Keywords: Lomentospora prolificans; clinical presentation; fungal infections; outcomes; treatment.

MeSH terms

Aged
Antifungal Agents / therapeutic use*
Female
Hematologic Neoplasms / complications
Hematologic Neoplasms / microbiology
Humans
Internationality
Invasive Fungal Infections / drug therapy*
Invasive Fungal Infections / mortality
Male
Middle Aged
Registries
Retrospective Studies
Scedosporium / pathogenicity*
Treatment Outcome

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry

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Abstract

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