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Scedosporium apiospermum and Lomentospora prolificans in lung transplant patients – A single center experience over 24 years
Author(s) -
Vazirani Jaideep,
Westall Glen P.,
Snell Gregory I.,
Morrissey C. Orla
Publication year - 2021
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13546
Subject(s) - scedosporium apiospermum , medicine , lung transplantation , interquartile range , transplantation , cohort , voriconazole , surgery , antifungal , dermatology
Scedosporium apiospermum and Lomentospora prolificans ( Scedosporium/Lomentospora ) species are emerging, multi‐resistant pathogens that cause life‐threatening illnesses among lung transplant (LTx) recipients. The current epidemiology and management in LTx are unknown. Methods We performed a retrospective single center audit of all sputum/bronchoscopy samples for Scedosporium/Lomentospora species in LTx patients over a 24‐year period (1995‐2019). Patients were diagnosed as colonized or with invasive fungal disease. Results From a cohort of 962 LTx recipients, 30 patients (3.1%) cultured Scedosporium/Lomentospora (1.2%, 1.9%, respectively). There were no isolates from 1995 to 2013, with multiple yearly isolates thereafter. Nineteen (63%) cases were classified as IFD, and 11 (37%) as colonization. The median time to first culture from transplantation was 929 days (Interquartile‐range [IQR] 263‐2960). Most patients (63%) had received antifungals prior to the first positive culture of Scedosporium/Lomentospora for other fungal infection. The most common antifungal used for treatment of Scedosporium/Lomentospora was posaconazole ( n = 16; 53%). Median duration of therapy was 364 days (IQR 164‐616). Treatment was associated with improved lung function over 6 months (median FEV1 increased from 1.3L[IQR 0.9‐1.8L] to 1.8L[IQR 1.1‐2.3] P = .05). Six patients cultured Scedosporium/Lomentospora prior to transplantation, and no survival disadvantage was seen as compared to our whole LTx cohort ( P = .8). Conclusion Our single center 24‐year experience suggests that the incidence of Scedosporium/Lomentospora is increasing. Scedosporium/Lomentospora is typically isolated several years after LTx, and requires prolonged anti‐fungal treatment that is usually associated with improved in lung function. Culture of Scedosporium/Lomentospora prior to LTx did not pose a survival disadvantage. Further surveillance is required to fully characterize implications of these organisms for LTx recipients.