Scedosporium apiospermum (Pseudoallescheria boydii) Infection in Lung Transplant Recipients

BACKGROUND: Scedosporium apiospermum, the asexual counterpart of the teleomorph Pseudallescheria boydii, is increasingly recognized as an important opportunistic pathogen in transplant recipients. Infection is associated with a high rate of dissemination and poor outcome overall. METHODS: A retrospective analysis of The Cleveland Clinic lung transplant database identified 5 patients with S. apiospermum isolated from respiratory tract specimens. Demographic data and lung transplant outcomes were obtained by review of medical records. RESULTS: S. apiospermum was isolated from respiratory culture in 5 lung transplant recipients. Disseminated disease developed in 3 patients, whereas 2 appeared only to be colonized. CONCLUSIONS: Our experience and review of the literature highlights the importance of early diagnosis and differentiation from Aspergillus, since Scedosporium is inherently resistant to amphotericin B. Effective therapeutic approaches being explored include combinations of anti-fungals, because even the newer triazoles have a 50% response rate in clinical studies. Surgical débridement and immune recovery are associated with improved prognosis, favoring the use of agents that expedite immune reconstitution in these patients. Close monitoring of clinical improvement and frequent reevaluation of treatment is essential.