1887

JMM Case Reports

Volume 2, Issue 3

: a fungal pathogen causing pneumonia in a patient with cystic fibrosis Open Access

Abstract

Introduction:

is a slow-growing pathogenic fungus that can cause pneumonia. Diagnosis of this rare filamentous fungus is challenging. To the best of our knowledge, this is the first case describing an acute pulmonary infection caused by this fungal pathogen in a patient with cystic fibrosis (CF).

Case presentation:

A 35-year-old female with CF, with a 1-month history of irritating cough, increased sputum production and dyspnoea, was admitted to hospital. A chest computed tomography scan revealed new bilateral infiltrations, mediastinal lymphadenopathy and bronchiectasis. and were detected in the bronchoalveolar lavage. The patient's clinical status was not improved by standard antibiotic therapy. Antifungal systemic therapy consisting of systemic caspofungin and oral posaconazole against the highly suspected scedosporiosis was initiated, but the clinical outcome was not significantly improved. Antibodies against the complex were present in the patient's serum. Only after the addition of 50 mg once a day of inhaled liposomal amphotericin B the patient was successfully treated.

Conclusion:

The patient was cured by a combined therapy of two systemic antimycotic drugs and one local antimycotic drug.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Cystic fibrosis , pneumonia and Scedosporium apiospermum
© 2015 The Authors
  • This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).
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2015-06-01
2024-04-23
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References

  1. Aaron S. D., Vandemheen K. L., Freitag A., Pedder L., Cameron W., Lavoie A., Paterson N., Wilcox P., Rabin H. other authors 2012; Treatment of Aspergillus fumigatus in patients with cystic fibrosis: a randomized, placebo-controlled pilot study. PLoS One 7:e36077 [View Article]
     [Google Scholar]
  2. Amin R., Dupuis A., Aaron S. D., Ratjen F. 2010; The effect of chronic infection with Aspergillus fumigatus on lung function and hospitalization in patients with cystic fibrosis. Chest 137:171–176 [View Article]
     [Google Scholar]
  3. Ashbee H. R., Barnes R. A., Johnson E. M., Richardson M. D., Gorton R., Hope W. W. 2014; Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 69:1162–1176 [View Article]
     [Google Scholar]
  4. Bernhardt A., Sedlacek L., Wagner S., Schwarz C., Würstl B., Tintelnot K. 2013; Multilocus sequence typing of Scedosporium apiospermumPseudallescheria boydii isolates from cystic fibrosis patients. J Cyst Fibros 12:592–598 [View Article]
     [Google Scholar]
  5. Bertrand S., Larcher G., Landreau A., Richomme P., Duval O., Bouchara J. P. 2009; Hydroxamate siderophores of Scedosporium apiospermum. Biometals 22:1019–1029 [View Article]
     [Google Scholar]
  6. Brown K., Rosenthal M., Bush A. 1999; Fatal invasive aspergillosis in an adolescent with cystic fibrosis. Pediatr Pulmonol 27:130–133 [View Article]
     [Google Scholar]
  7. Clinical and Laboratory Standards Institute. 2008; Reference method for broth dilution antifungal susceptibility testing of filamentous fungi, approved standard – 2nd ed., M38-A2. Wayne, PA: Clinical and Laboratory Standards Institute.
    [Google Scholar]
  8. Cohen T. S., Prince A. 2012; Cystic fibrosis: a mucosal immunodeficiency syndrome. Nat Med 18:509–519 [View Article]
     [Google Scholar]
  9. Eickmeier O., Rieber N., Eckrich J., Hector A., Graeppler-Mainka U., Hartl D. 2013; Immune response, diagnosis and treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis lung disease. Curr Pharm Des 19:3669–3678 [View Article]
     [Google Scholar]
  10. Garré M., laLabarthe B., Kombila-Favry M., Thomas R., Launois B., Cartier F. 1975; [Pneumocystis carinii pneumonia after kidney transplantation. Early diagnosis by distal bronchial brushing]. Nouv Presse Med 4:393–394 (in French)
    [Google Scholar]
  11. Hartl D., Gaggar A., Bruscia E., Hector A., Marcos V., Jung A., Greene C., McElvaney G., Mall M., Döring G. 2012; Innate immunity in cystic fibrosis lung disease. J Cyst Fibros 11:363–382 [View Article]
     [Google Scholar]
  12. Holle J., Leichsenring M., Meissner P. E. 2014; Nebulized voriconazole in infections with Scedosporium apiospermum – case report and review of the literature. J Cyst Fibros 13:400–402 [View Article]
     [Google Scholar]
  13. Horré R., Marklein G., Siekmeier R., Nidermajer S., Reiffert S. M. 2009; Selective isolation of PseudallescheriaScedosporium species from respiratory tract specimens of cystic fibrosis patients. Respiration 77:320–324 [View Article]
     [Google Scholar]
  14. Knutsen A. P., Hutcheson P. S., Slavin R. G., Kurup V. P. 2004; IgE antibody to Aspergillus fumigatus recombinant allergens in cystic fibrosis patients with allergic bronchopulmonary aspergillosis. Allergy 59:198–203 [View Article]
     [Google Scholar]
  15. Larcher G., Cimon B., Symoens F., Tronchin G., Chabasse D., Bouchara J. P. 1996; A 33 kDa serine proteinase from Scedosporium apiospermum. Biochem J 315:119–126
     [Google Scholar]
  16. Lobo L. J., Noone P. G. 2014; Respiratory infections in patients with cystic fibrosis undergoing lung transplantation. Lancet Respir Med 2:73–82 [View Article]
     [Google Scholar]
  17. Mastella G., Rainisio M., Harms H. K., Hodson M. E., Koch C., Navarro J., Strandvik B., McKenzie S. G.The Investigators of the Epidemiologic Registry of Cystic Fibrosis 2000; Allergic bronchopulmonary aspergillosis in cystic fibrosis. A European epidemiological study. Eur Respir J 16:464–471 [View Article]
     [Google Scholar]
  18. Ostrosky-Zeichner L. 2012; Invasive mycoses: diagnostic challenges. Am J Med 125:S14–S24 [View Article]
     [Google Scholar]
  19. Parize P., Billaud S., Bienvenu A. L., Bourdy S., le Pogam M. A., Reix P., Picot S., Robert R., Lortholary O.other authors 2014a; Impact of Scedosporiumapiospermum complex seroprevalence in patients with cystic fibrosis. J Cyst Fibros 13:667–673 [View Article]
     [Google Scholar]
  20. Parize P., Billaud S., Bienvenu A. L., Bourdy S., le Pogam M. A., Reix P., Picot S., Robert R., Lortholary O.other authors 2014b; Impact of Scedosporiumapiospermum complex seroprevalence in patients with cystic fibrosis. J Cyst Fibros 13:667–673 [View Article]
     [Google Scholar]
  21. Pihet M., Carrere J., Cimon B., Chabasse D., Delhaes L., Symoens F., Bouchara J. P., Pihet M., Carrere J.other authors 2009; Occurrence and relevance of filamentous fungi in respiratory secretions of patients with cystic fibrosis – a review. Med Mycol 47:387–397 [View Article]
     [Google Scholar]
  22. Rainer J., Kaltseis J., de Hoog S. G., Summerbell R. C. 2008; Efficacy of a selective isolation procedure for members of the Pseudallescheria boydii complex. Antonie van Leeuwenhoek 93:315–322 [View Article]
     [Google Scholar]
  23. Sedlacek L., Graf B., Schwarz C., Albert F., Peter S., Würstl B., Wagner S., Klotz M., Becker A.other authors 2015; Prevalence of Scedosporium species and Lomentospora prolificans in patients with cystic fibrosis in a multicenter trial by use of a selective medium. J Cyst Fibros 14:237–241 [View Article]
     [Google Scholar]
  24. Slavin R. G., Hutcheson P. S., Chauhan B., Bellone C. J. 2004; An overview of allergic bronchopulmonary aspergillosis with some new insights. Allergy Asthma Proc 25:395–399
     [Google Scholar]
  25. Slavin M., van Hal S., Sorrell T. C., Lee A., Marriott D. J., Daveson K., Kennedy K., Hajkowicz K., Halliday C.other authors 2015; Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality. Clin MicrobiolInfect [Epub ahead of print]
    [Google Scholar]
  26. Stenbit A. E., Flume P. A. 2011; Pulmonary exacerbations in cystic fibrosis. Curr Opin Pulm Med 17:442–447
     [Google Scholar]
  27. Zouhair R., Rougeron A., Razafimandimby B., Kobi A., Bouchara J. P., Giraud S. 2013; Distribution of the different species of the Pseudallescheriaboydii/Scedosporium apiospermum complex in French patients with cystic fibrosis. Med Mycol 51:603–613 [View Article]
     [Google Scholar]
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Scedosporium apiospermum: a fungal pathogen causing pneumonia in a patient with cystic fibrosis
JMM Case Rep 2, e000061 (2015); https://doi.org/10.1099/jmmcr.0.000061
/content/journal/jmmcr/10.1099/jmmcr.0.000061
/content/journal/jmmcr/10.1099/jmmcr.0.000061
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