Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature

Danila Seidel; Angela Hassler; Jon Salmanton-García; Philipp Koehler; Sibylle C. Mellinghoff; Fabianne Carlesse; Matthew P. Cheng; Iker Falces-Romero; Raoul Herbrecht; Alfredo Jover Sáenz; Nikolai Klimko; Mihai Mareş; Cornelia Lass-Flörl; Pere Soler-Palacín; Hilmar Wisplinghoff; Oliver A. Cornely; Zoi Pana; Thomas Lehrnbecher

International Journal of Infectious Diseases (Mar 2020)

Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature

Danila Seidel,
Angela Hassler,
Jon Salmanton-García,
Philipp Koehler,
Sibylle C. Mellinghoff,
Fabianne Carlesse,
Matthew P. Cheng,
Iker Falces-Romero,
Raoul Herbrecht,
Alfredo Jover Sáenz,
Nikolai Klimko,
Mihai Mareş,
Cornelia Lass-Flörl,
Pere Soler-Palacín,
Hilmar Wisplinghoff,
Oliver A. Cornely,
Zoi Pana,
Thomas Lehrnbecher

Affiliations

Danila Seidel: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Corresponding author at: University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
Angela Hassler: Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
Jon Salmanton-García: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
Philipp Koehler: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
Sibylle C. Mellinghoff: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
Fabianne Carlesse: Instituto de Oncologia Pediátrica - GRAACC/UNIFESP, São Paulo, SP, Brazil
Matthew P. Cheng: Montreal, McGill University, Department Microbiology and Immunology, Montreal, Canada
Iker Falces-Romero: Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
Raoul Herbrecht: University Hospital of Strasbourg, Hôpital de Hautepierre, Department of Oncology and Hematology, Strasbourg, France
Alfredo Jover Sáenz: Territorial Unit of Nosocomial Infection and antibiotic policy (TUNI). University Hospital Arnau de Vilanova, Lleida, Spain
Nikolai Klimko: North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
Mihai Mareş: Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Romania
Cornelia Lass-Flörl: Medical University of Innsbruck, Institute of Hygiene und Medical Microbiology (HMM), Innsbruck, Austria
Pere Soler-Palacín: Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
Hilmar Wisplinghoff: Wisplinghoff Laboratories, Cologne, Germany; Institute for Virology and Microbiology, University Witten/Herdecke, Witten, Germany; Institute for Medical Microbiology, University of Cologne, Cologne, Germany
Oliver A. Cornely: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
Zoi Pana: Department of Medicine, European University of Cyprus (EUC), Cyprus
Thomas Lehrnbecher: Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany

Journal volume & issue: Vol. 92
pp. 114 – 122

Abstract

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Objectives: Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections. Methods: Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected. Results: Fifty-five children (median age 9 years [IQR: 5–14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment.Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3–28] versus 61 days [IQR: 16–148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35–51.40] and HR 6.12 [95% CI 1.52–24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11–0.99] and HR 0.09 [95% CI 0.02–0.40], respectively). Conclusions: Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome. Keywords: Scedosporium spp., Lomentospora prolificans, Invasive fungal infections, Pediatric patients, Children, Voriconazole, Surgery, FungiScope® registry

Published in International Journal of Infectious Diseases

ISSN: 1201-9712 (Print); 1878-3511 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Infectious and parasitic diseases
Website: http://www.journals.elsevier.com/international-journal-of-infectious-diseases/

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