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Publications

Journal Article Epublish

PubMed: 42238380 DOI: 10.1093/ofid/ofag123

Endocarditis Due to Scedosporium spp and Lomentospora prolificans: Case Series and Literature Review.

Open Forum Infect Dis 13(6):ofag123

Authors: Carole Vignals, Julien Ternacle, Dea Garcia-Hermoso, Joseph Emmerich, Emilie Catherinot, Laurence Delhaes, Delphine Horeau-Langlard, Jean-Philippe Martellosio, Florent Morio, Olivier Lortholary, Mathilde Puges, Fanny Lanternier, Didier Bronnimann

Affiliations

  • Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Unité Médico-Chirurgicale des valvulopathies, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
  • Centre National de Référence Mycoses Invasives et Antifongiques, Département de Mycologie, Institut Pasteur, Université Paris Cité, Paris, France.
  • Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université Paris Cité, Paris, France.
  • Servicde de Pneumologie, Hôpital Foch, Suresnes, France.
  • Centre National de Référence des Aspergilloses Chroniques, Universitaire de Bordeaux, Bordeaux, France.
  • Service de Parasitologie-Mycologie, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France.
  • Service de Pneumologie, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France.
  • Service de Médecine interne, Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
  • Service de Mycologie Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France.
  • Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France.
  • Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Abstract

BACKGROUND

Scedosporium spp and Lomentospora prolificans are rare fungi involved in mold endocarditis.

METHODS

We reported cases of Scedosporium spp and L prolificans endocarditis from the French Scedosporiosis/Lomentosporiosis Observational Study (S.O.S.) and performed a literature review of previous reported cases in order to describe their predisposing risk factors, clinical presentation, treatment, and outcomes.

RESULTS

We included 30 cases including 4 new cases from the S.O.S. Sixty percent (18/30) of the cases were due to Scedosporium apiospermum complex and 37% (11/30) to L prolificans. Trauma was the main invasive fungal disease host factor (12/30 [40%]), followed by solid organ transplant (10/30 [33%]), short posttransplant delay (median of 45 days), and malignancy (5/30 [17%]). No endocarditis predisposing condition was found in immunocompromised patients (0/16). Eleven cases were healthcare-associated infections (37%). Septic emboli were reported in 93% of the cases (28/30), affecting mainly the central nervous system (CNS) (68%). Pulmonary emboli were present in all right-sided endocarditis (8/8). Blood cultures were negative in 6 cases (27% [6/26]). Surgical valve replacement was performed in 50% of the cases (8/16). Mortality was high whether patients were treated with antifungals only (7/8 [88%]) or with antifungals and surgery (5/7 [71%]). Mortality rose to 100% in the case of CNS emboli.

CONCLUSIONS

Scedosporium spp and L prolificans endocarditis is a life-threatening fungal disease occurring in both immunocompromised and immunocompetent hosts. It should be considered in the presence of fungemia or embolic complications, particularly in the CNS.

MeSH

Endocarditis, Mycoses, Transplants, Scedosporium