Skip to main content
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1995 Dec;33(12):3290–3295. doi: 10.1128/jcm.33.12.3290-3295.1995

Nosocomial outbreak caused by Scedosporium prolificans (inflatum): four fatal cases in leukemic patients.

M Alvarez 1, B Lopez Ponga 1, C Rayon 1, J Garcia Gala 1, M C Roson Porto 1, M Gonzalez 1, J V Martinez-Suarez 1, J L Rodriguez-Tudela 1
PMCID: PMC228690  PMID: 8586719

Abstract

Four cases of fatal disseminated Scedosporium prolificans (inflatum) infection occurring in neutropenic patients are reported. Because of hospital renovation, the patients were cared for in a temporary hematologic facility. S. prolificans (inflatum) was isolated from blood cultures of these four patients, two of whom underwent full necropsy, and revealed abundant vegetative hyphae and ovoid conida with truncate bases in many organs. In vitro susceptibility testing of fungal strains showed all isolates to be resistant to amphotericin B, flucytosine, miconazole, ketoconazole, fluconazole, and itraconazole, with MICs greater than 16 micrograms/ml. The reported infections, two in each of two rooms, occurred over a period of 1 month, with very similar clinical outcomes. Circumstancial evidence suggested a nosocomial outbreak, but the environmental samples collected from the rooms, corridors, and adjacent areas did not yield S. prolificans (inflatum). Nevertheless, circumstantial evidence suggested a nosocomial outbreak of S. prolificans (inflatum) infection.

Full Text

The Full Text of this article is available as a PDF (1.7 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anaissie E. Opportunistic mycoses in the immunocompromised host: experience at a cancer center and review. Clin Infect Dis. 1992 Mar;14 (Suppl 1):S43–S53. doi: 10.1093/clinids/14.supplement_1.s43. [DOI] [PubMed] [Google Scholar]
  2. Espinel-Ingroff A., Kerkering T. M. Spectrophotometric method of inoculum preparation for the in vitro susceptibility testing of filamentous fungi. J Clin Microbiol. 1991 Feb;29(2):393–394. doi: 10.1128/jcm.29.2.393-394.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Farag S. S., Firkin F. C., Andrew J. H., Lee C. S., Ellis D. H. Fatal disseminated Scedosporium inflatum infection in a neutropenic immunocompromised patient. J Infect. 1992 Sep;25(2):201–204. doi: 10.1016/0163-4453(92)94104-6. [DOI] [PubMed] [Google Scholar]
  4. Guarro J., Gaztelurrutia L., Marín J., Bárcena J. Scedosporium inflatum, un nuevo hongo patógeno. A propósito de dos casos con desenlace fatal. Enferm Infecc Microbiol Clin. 1991 Nov;9(9):557–560. [PubMed] [Google Scholar]
  5. Idígoras P., López Lopategui C., García-Arenzana J. M., Díaz de Tuesta J. L., Marín González J. Infección diseminada por Scedosporium inflatum. Enferm Infecc Microbiol Clin. 1993 May;11(5):285–285. [PubMed] [Google Scholar]
  6. Lennon P. A., Cooper C. R., Jr, Salkin I. F., Lee S. B. Ribosomal DNA internal transcribed spacer analysis supports synonomy of Scedosporium inflatum and Lomentospora prolificans. J Clin Microbiol. 1994 Oct;32(10):2413–2416. doi: 10.1128/jcm.32.10.2413-2416.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Lentino J. R., Rosenkranz M. A., Michaels J. A., Kurup V. P., Rose H. D., Rytel M. W. Nosocomial aspergillosis: a retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol. 1982 Sep;116(3):430–437. doi: 10.1093/oxfordjournals.aje.a113427. [DOI] [PubMed] [Google Scholar]
  8. Malekzadeh M., Overturf G. D., Auerbach S. B., Wong L., Hirsch M. Chronic, recurrent osteomyelitis caused by Scedosporium inflatum. Pediatr Infect Dis J. 1990 May;9(5):357–359. doi: 10.1097/00006454-199005000-00010. [DOI] [PubMed] [Google Scholar]
  9. Marin J., Sanz M. A., Sanz G. F., Guarro J., Martínez M. L., Prieto M., Gueho E., Menezo J. L. Disseminated Scedosporium inflatum infection in a patient with acute myeloblastic leukemia. Eur J Clin Microbiol Infect Dis. 1991 Sep;10(9):759–761. doi: 10.1007/BF01972505. [DOI] [PubMed] [Google Scholar]
  10. McWhinney P. H., Kibbler C. C., Hamon M. D., Smith O. P., Gandhi L., Berger L. A., Walesby R. K., Hoffbrand A. V., Prentice H. G. Progress in the diagnosis and management of aspergillosis in bone marrow transplantation: 13 years' experience. Clin Infect Dis. 1993 Sep;17(3):397–404. doi: 10.1093/clinids/17.3.397. [DOI] [PubMed] [Google Scholar]
  11. Nemunaitis J., Meyers J. D., Buckner C. D., Shannon-Dorcy K., Mori M., Shulman H., Bianco J. A., Higano C. S., Groves E., Storb R. Phase I trial of recombinant human macrophage colony-stimulating factor in patients with invasive fungal infections. Blood. 1991 Aug 15;78(4):907–913. [PubMed] [Google Scholar]
  12. Nielsen K., Lang H., Shum A. C., Woodruff K., Cherry J. D. Disseminated Scedosporium prolificans infection in an immunocompromised adolescent. Pediatr Infect Dis J. 1993 Oct;12(10):882–884. doi: 10.1097/00006454-199310000-00018. [DOI] [PubMed] [Google Scholar]
  13. Rodriguez-Tudela J. L., Aviles P. Improved adhesive method for microscopic examination of fungi in culture. J Clin Microbiol. 1991 Nov;29(11):2604–2605. doi: 10.1128/jcm.29.11.2604-2605.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rodriguez-Tudela J. L., Martinez-Suarez J. V. Improved medium for fluconazole susceptibility testing of Candida albicans. Antimicrob Agents Chemother. 1994 Jan;38(1):45–48. doi: 10.1128/aac.38.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Salesa R., Burgos A., Ondiviela R., Richard C., Quindos G., Ponton J. Fatal disseminated infection by Scedosporium inflatum after bone marrow transplantation. Scand J Infect Dis. 1993;25(3):389–393. doi: 10.3109/00365549309008516. [DOI] [PubMed] [Google Scholar]
  16. Salkin I. F., McGinnis M. R., Dykstra M. J., Rinaldi M. G. Scedosporium inflatum, an emerging pathogen. J Clin Microbiol. 1988 Mar;26(3):498–503. doi: 10.1128/jcm.26.3.498-503.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Schmitt H. J., Bernard E. M., Andrade J., Edwards F., Schmitt B., Armstrong D. MIC and fungicidal activity of terbinafine against clinical isolates of Aspergillus spp. Antimicrob Agents Chemother. 1988 May;32(5):780–781. doi: 10.1128/aac.32.5.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sparrow S. A., Hallam L. A., Wild B. E., Baker D. L. Scedosporium inflatum: first case report of disseminated infection and review of the literature. Pediatr Hematol Oncol. 1992 Jul-Sep;9(3):293–295. doi: 10.3109/08880019209016600. [DOI] [PubMed] [Google Scholar]
  19. Summerbell R. C., Krajden S., Kane J. Potted plants in hospitals as reservoirs of pathogenic fungi. Mycopathologia. 1989 Apr;106(1):13–22. doi: 10.1007/BF00436921. [DOI] [PubMed] [Google Scholar]
  20. Tapia M., Richard C., Baro J., Salesa R., Figols J., Zurbano F., Zubizarreta A. Scedosporium inflatum infection in immunocompromised haematological patients. Br J Haematol. 1994 May;87(1):212–214. doi: 10.1111/j.1365-2141.1994.tb04897.x. [DOI] [PubMed] [Google Scholar]
  21. Toy E. C., Rinaldi M. G., Savitch C. B., Leibovitch E. R. Endocarditis and hip arthritis associated with Scedosporium inflatum. South Med J. 1990 Aug;83(8):957–960. doi: 10.1097/00007611-199008000-00025. [DOI] [PubMed] [Google Scholar]
  22. Travis L. B., Roberts G. D., Wilson W. R. Clinical significance of Pseudallescheria boydii: a review of 10 years' experience. Mayo Clin Proc. 1985 Aug;60(8):531–537. doi: 10.1016/s0025-6196(12)60571-0. [DOI] [PubMed] [Google Scholar]
  23. Walsh T. J., Dixon D. M. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol. 1989 Jun;5(2):131–142. doi: 10.1007/BF00156818. [DOI] [PubMed] [Google Scholar]
  24. Wilson C. M., O'Rourke E. J., McGinnis M. R., Salkin I. F. Scedosporium inflatum: clinical spectrum of a newly recognized pathogen. J Infect Dis. 1990 Jan;161(1):102–107. doi: 10.1093/infdis/161.1.102. [DOI] [PubMed] [Google Scholar]
  25. Wood G. M., McCormack J. G., Muir D. B., Ellis D. H., Ridley M. F., Pritchard R., Harrison M. Clinical features of human infection with Scedosporium inflatum. Clin Infect Dis. 1992 May;14(5):1027–1033. doi: 10.1093/clinids/14.5.1027. [DOI] [PubMed] [Google Scholar]
  26. de Hoog G. S., Marvin-Sikkema F. D., Lahpoor G. A., Gottschall J. C., Prins R. A., Guého E. Ecology and physiology of the emerging opportunistic fungi Pseudallescheria boydii and Scedosporium prolificans. Mycoses. 1994 Mar-Apr;37(3-4):71–78. doi: 10.1111/j.1439-0507.1994.tb00780.x. [DOI] [PubMed] [Google Scholar]
  27. del Palacio A., Cuétara M. S., Lumbreras C., González A., Gómez C. Colonización transitoria por Scedosporium prolificans (inflatum) en enferma sometida a trasplante hepático. Enferm Infecc Microbiol Clin. 1994 Dec;12(10):523–524. [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES