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|Title:||Clinical, pathologic and epidemiologic features of infection with Scedosporium prolificans: four cases and review|
|Citation:||Clinical Microbiology and Infection, 1999; 5(11):672-686|
|Abstract:||Objective: To describe the features of infection with Scedosporium prolificans and to investigate the possibility of a common source of infection. Methods: S.prolificans caused invasive infections in four patients at Liverpool Hospital from 1994 to 1997, prompting a pathologic and epidemiologic investigation. Blood cultures were processed by either the BACTEC NR660 or VITAL systems. MIC testing was performed with Etest strips. Strain differentiation of isolates from three of the patients and two soil samples from the home of one of the patients was performed by allozyme electrophoresis. Results: The four cases represented disseminated infections that arose during prolonged neutropenia, and progressed relentlessly despite treatment, including in one case high-dose liposomal amphotericin B. In two cases, VITAL blood culture bottles contained mycelia of S. prolificans without the reader having signaled. An autopsy was performed in three of the cases. Angio-invasion, tissue necrosis and multiple abscesses were found in each patient. Multiple air samples from the ward were negative for S. prolificans. The organism was grown from two samples of pot plant soil from the home of one patient. Allozyme electrophoresis performed on isolates from three cases and pot plant soil indicated that all strains were unrelated. Furthermore, two patients appeared to harbor at least two different strains of S. prolificans. Conclusions: S. prolificans causes disseminated infection in neutropenic patients. Antifungal treatment, including high-dose liposomal amphotericin B, is ineffective in overcoming these infections. Genetic techniques discriminated all strains and suggested that an outbreak had not occurred. Multiple strains of S. prolificans were isolated from two patients, indicating the possibility of mixed infections occurring.|
|Keywords:||Antifungal agents; disease outbreaks; hyphomycetes; immunocompromised host; leukemia; microbial sensitivity tests; mycologic typing techniques; opportunistic infections; Scedosporium prolificans|
|Appears in Collections:||Dentistry publications|
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