Background

Scedosporium species and Lomentospora prolificans (Sc/Lp) are emerging molds that cause invasive disease associated with a high mortality rate. After Aspergillus, these molds are the second filamentous fungi recovered in lung transplant (LT) recipients.

Aims

Our objective was to evaluate the incidence, risk factors and outcome of Sc/Lp infections in LT recipients at a tertiary care hospital with a national reference LT program.

Methods

A nine-year retrospective study was conducted.

Results

During this period, 395 LT were performed. Positive cultures for Sc/Lp were obtained from twenty-one LT recipients. Twelve patients (incidence 3.04%) developed invasive scedosporiosis (IS). In 66.7% of the patients with IS the invasive infection was defined as a breakthrough one. The main sites of infection were lungs and paranasal sinuses. Most of the patients received combination antifungal therapy. The IS crude mortality rate after 30 days was 16.7%, and 33.3% after a year.

Conclusions

Our study highlights improved survival rates associated with combination antifungal therapy in LT recipients and underlines the risk of breakthrough infections in patients with allograft dysfunction on nebulized lipidic amphotericin B prophylaxis. In addition to pretransplant colonization, acute or chronic organ dysfunctions seem to be the main risk factors for IS.

中文翻译：

---

肺移植受者侵袭性角孢子菌病：在三级医院进行的一项为期 9 年的回顾性研究

背景

Scedosporium物种和Lomentospora prolificans ( Sc/Lp ) 是新出现的霉菌，可引起与高死亡率相关的侵袭性疾病。在曲霉菌之后，这些霉菌是在肺移植 (LT) 受者中恢复的第二种丝状真菌。

宗旨

我们的目标是在具有国家参考 LT 计划的三级医疗医院评估LT 受者Sc/Lp感染的发生率、危险因素和结果。

方法

进行了一项为期九年的回顾性研究。

结果

在此期间，进行了 395 次 LT。Sc/Lp阳性培养物来自 21 名 LT 受者。12 名患者（发生率 3.04%）发展为侵袭性角孢子菌病 (IS)。在 66.7% 的 IS 患者中，侵袭性感染被定义为突破性感染。感染的主要部位是肺和鼻窦。大多数患者接受联合抗真菌治疗。30天后IS粗死亡率为16.7%，一年后为33.3%。

结论

我们的研究强调了与 LT 受者联合抗真菌治疗相关的生存率提高，并强调了雾化脂类两性霉素 B 预防治疗同种异体移植物功能障碍患者发生突破性感染的风险。除了移植前定植，急性或慢性器官功能障碍似乎是 IS 的主要危险因素。