Personal ViewGlobal guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology
Section snippets
Background
Although invasive aspergillosis and mucormycosis have been the most commonly documented invasive mould infections,1 mycoses caused by rare moulds are increasing.2 These pathogens include dematiaceous moulds that cause phaeohyphomycosis, Fusarium, Lomentospora, Scedosporium, Rasamsonia, Scopulariopsis, Penicillium, Talaromyces species other than T marneffei, Paecilomyces, Purpureocillium and Schizophyllum species, and other basidiomycetes.3, 4, 5, 6 Maximising survival to these infections
Epidemiology of fusariosis
Fusarium spp are the most clinically prevalent rare moulds causing superficial infections, such as keratitis, in immunocompetent hosts, and severe disseminated infections (frequently presenting as fungaemia) in immunocompromised individuals. These fungi are ubiquitous in nature and are found in soil and air.13 Of particular importance are the species complexes Fusarium solani (causing more than 50% of severe cases) and Fusarium oxysporum (causing 20% of severe cases).13, 14 The main routes of
Epidemiology of lomentosporiosis
Lomentospora prolificans (formerly Scedosporium prolificans) is morphologically and clinically distinct from Scedosporium spp, although before phylogenetic profiling both genera were classed together.34 L prolificans is ubiquitously found as a soil saprophyte, predominantly in the arid climates of Australia, southwestern USA, and Spain, which is reflected by the proportionally high number of reported cases in these regions.35, 36, 37 Prevalence and incidence data for lomentosporiosis are
Epidemiology of scedosporiosis
Scedosporium spp are ubiquitous saprophytes mostly found in temperate areas, with regional differences in species distribution.55 In the clinical setting, the most commonly isolated species worldwide are Scedosporium boydii and Scedosporium apiospermum.
Scedosporium spp initiate two distinct diseases: mycetoma and scedosporiosis. In immunocompetent patients, Scedosporium spp are an important cause of eumycotic mycetoma and the most common cause of this infection in the USA.56 Solid organ
Other rare mould infections
This guideline also covers dematiaceous moulds causing phaeohyphomycosis, Rasamsonia spp, Schizophyllum spp and other basidiomycetes, Scopulariopsis, Paecilomyces, Penicillium, Talaromyces, and Purpureocillium spp.6 A summary of antifungal treatment recommendations for these agents is displayed in figure 6.
Details on epidemiology, as well as evidence and recommendations for the diagnosis (including photoplates and pathways) and treatment are outlined in the appendix pp 67–161.
Constraints in optimising management
The identification of rare moulds is complicated by the constant change in the nomenclature, which in turn compromises targeted treatment.65 Advocates for nomenclatural stability of medically important fungi have maintained that new names for fungal species should not be adapted for clinical use until confirmed by independent laboratories.66 Most microbiologists are not familiar with some of the rarest fungal species because they are either rarely encountered or are mistaken for contaminants.
References (75)
- et al.
Rare mould infections caused by Mucorales, Lomentospora prolificans and Fusarium, in San Diego, CA: the role of antifungal combination therapy
Int J Antimicrob Agents
(2018) - et al.
Needles in a haystack: extremely rare invasive fungal infections reported in FungiScope-Global Registry for Emerging Fungal Infections
J Infect
(2020) - et al.
Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium
Lancet Infect Dis
(2019) - et al.
ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp, Scedosporium spp and others
Clin Microbiol Infect
(2014) - et al.
ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi
Clin Microbiol Infect
(2014) - et al.
Improvement in the outcome of invasive fusariosis in the last decade
Clin Microbiol Infect
(2014) New aspects of emerging fungal pathogens. A multifaceted challenge
Clin Lab Med
(1995)- et al.
Successful treatment of Fusarium proliferatum pneumonia with posaconazole in a lung transplant recipient
J Heart Lung Transplant
(2004) - et al.
Population-based surveillance for scedosporiosis in Australia: epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection
Clin Microbiol Infect
(2009) - et al.
Invasive Scedosporium spp and Lomentospora prolificans infections in pediatric patients: analysis of 55 cases from FungiScope and the literature
Int J Infect Dis
(2020)