Abstract
A man with acute lymphoblastic leukaemia developed disseminated Scedosporium prolificans infection following chemotherapy for disease relapse while on posaconazole prophylaxis. Scedosporium prolificans infection during posaconazole prophylaxis has not been reported previously. This report is timely as the uptake of posaconazole, the broadest spectrum azole clinically available, is likely to grow with recent evidence supporting its role as prophylaxis against invasive fungal infections in high-risk haematology patients.
References
Cornely OA, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348–59. doi:10.1056/NEJMoa061094.
Ullmann AJ, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007;356:335–47. doi:10.1056/NEJMoa061098.
Imhof A, et al. Breakthrough fungal infections in stem cell transplant recipients receiving voriconazole. Clin Infect Dis. 2004;39:743–6. doi:10.1086/423274.
Kantarjian HM, et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000;18:547–61.
Husain S, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis. 2005;40:89–99. doi:10.1086/426445.
Lamaris GA, et al. Scedosporium infection in a tertiary care cancer center: a review of 25 cases from 1989–2006. Clin Infect Dis 2006;43:1580–4. doi:10.1086/509579.
Cooley L, et al. Infection with Scedosporium apiospermum and S. prolificans, Australia. Emerg Infect Dis. 2007;13:1170–7.
Lionakis MS, et al. The significance of blood cultures positive for emerging saprophytic moulds in cancer patients. Clin Microbiol Infect. 2004;10:922–5. doi:10.1111/j.1469–0691.2004.00933.x.
Howden BP, et al. Successful control of disseminated Scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis. 2003;22:111–3.
Li JY, et al. Successful control of Scedosporium prolificans septic arthritis and probable osteomyelitis in a long-term renal transplant recipient. Transpl Infect Dis. 2008;10:63–5.
Steinbach WJ, et al. Scedosporium prolificans osteomyelitis in an immunocompetent child treated with voriconazole and caspofungin, as well as locally applied polyhexamethylene biguanide. J Clin Microbiol. 2003;41:3981–5. doi:10.1128/JCM.41.8.3981-3985.2003.
Singh N, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation. 2006;81:320–6. doi:10.1097/01.tp.0000202421.94822.f7.
Carrillo AJ, et al. In vitro activities of four novel triazoles against Scedosporium spp. Antimicrob Agents Chemother. 2001;45:2151–3. doi:10.1128/AAC.45.7.2151-2153.2001.
Cuenca-Estrella M, et al. Head-to-head comparison of the activities of currently available antifungal agents against 3,378 Spanish clinical isolates of yeasts and filamentous fungi. Antimicrob Agents Chemother. 2006;50:917–21. doi:10.1128/AAC.50.3.917-921.2006.
Siwek GT, et al. Invasive zygomycosis in hematopoietic stem cell transplant recipients receiving voriconazole prophylaxis. Clin Infect Dis. 2004;39:584–7. doi:10.1086/422723.
Kontoyiannis DP, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005;191:1350–60. doi:10.1086/428780.
Maertens J, et al. Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis. Bone Marrow Transplant. 1999;24:307–12. doi:10.1038/sj.bmt.1701885.
Walsh TJ, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis. 2007;44:2–12. doi:10.1086/508774.
Krishna G, Martinho M, Chandrasekar P, Ullmann AJ, Patino H. Pharmacokinetics of oral posaconazole in allogeneic hematopoietic stem cell transplant recipients with graft-versus-host disease. Pharmacotherapy. 2007;27:1627–36. doi:10.1592/phco.27.12.1627.
Ullmann A, et al. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother. 2006;50:658–66. doi:10.1128/AAC.50.2.658-666.2006.
Mullane K, et al. Posaconazole salvage therapy allows successful allogeneic hematopoietic stem cell transplantation in patients with refractory invasive mold infections. Transpl Infect Dis. 2007;9:89–96. doi:10.1111/j.1399-3062.2007.00208.x.
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MAR: No conflicts
AG: Has served on an advisory board for Schering Plough.
MAS: Has served as a consultant for, received grant support and honoraria from and has given lectures for Gilead Sciences, Pfizer, Merck Sharp and Dohme, Bristol-Myers Squibb and Schering Plough.
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Ananda-Rajah, M.R., Grigg, A. & Slavin, M.A. Breakthrough Disseminated Scedosporium prolificans Infection in a Patient with Relapsed Leukaemia on Prolonged Voriconazole Followed by Posaconazole Prophylaxis. Mycopathologia 166, 83–86 (2008). https://doi.org/10.1007/s11046-008-9131-2
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DOI: https://doi.org/10.1007/s11046-008-9131-2