JOHNS HOPKINS
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Department of Pathology
600 N. Wolfe Street / Baltimore MD 21287-7093
(410) 955-5077 / FAX (410) 614-8087
Division of Medical Microbiology
THE JOHNS HOPKINS MICROBIOLOGY NEWSLETTER Vol. 25, No. 12
Tuesday, June 20, 2006
A. Provided by Sharon Wallace, Division of Outbreak Investigation, Maryland Department of
Health and Mental Hygiene.
4 outbreaks were reported to DHMH during MMWR Week 23 (June 11-17, 2006):
3 Foodborne Gastroenteritis outbreaks
3 outbreaks of FOODBORNE GASTROENTERITIS associated with Restaurants
(Frederick Co., & Montgomery Co.) and a Private Home (Queen Anne's Co.)
1 Gastroenteritis outbreak
1 outbreak of GASTROENTERITIS associated with a Daycare (Carroll Co.)
B. The Johns Hopkins Hospital, Department of Pathology, Information provided by,
Kathryn Johnson, M.D. Ph. D.
Clinical presentation: The patient was a 62-year-old man with a history
of lung cancer, status post lobectomy as well as relapsed mantle cell lymphoma status post
nonmyeloablative bone marrow transplant and Cytoxan treatment. A few days after his BMT he
began suffering from increasing night time temperatures. He also reported headache, nausea,
vomiting and diarrhea. He did not complain of dyspnea or dysuria. He was admitted to JHH on
06/03/2006 for evaluation of neutropenia fever and diarrhea. Blood cultures were sent. He
continued to deteriorate. Caspofungin and voriconazole were begun after the blood cultures
grew Scedosporium prolificans. In total, he had seven positive blood cultures drawn over five
days and two positive endotracheal cultures collected on the same day. He continued to rapidly
deteriorate with multisystem organ failure and died on 06/07/2006.
Organism,: Scedosporium prolificans (formerly known as Scedosporium inflatum) is a hyaline
mold that typically produces an olive-gray to black, flat, silky colony surface on which water
droplets tend to accumulate. The reverse surface often exhibits dark pigmentation. Microscopic
examination reveals hyaline, septate hyphae with conidiogenic cells which may arise directly
from hyphae or at the tips of the conidiophores, which are unbranched and flask-shaped with
swollen bases and apical annellations. The conidia are brown, ovoid, smooth, thin-walled and
measure 2-5 x 3-13 µm. The tips of the conidiogenic cells develop clumps of conidia. Detached
conidia may also aggregate in clusters.
Clinical significanceError! Bookmark not defined.,Error! Bookmark not defined.,: The epidemiology of
Scedosporium prolificans has changed over the past 15 years. Before 1990, most cases of
Scedosporium were from subcutaneous lesions or
osteomyelitis/septic arthritis following trauma. Since 1990, septic arthritis or osteomyelitis
following trauma to joints is still the most common clinical scenario; however, disseminated
disease has been increasingly reported. These cases are primarily of immunosuppressed patients,
especially those with prolonged neutropenia and post-transplantation therapy. Scedosporium
prolificans is now recognized as the most common cause of disseminated phaeohyphomycosis.
Colonization of the external ear, paranasal sinuses and lung, including "fungus ball" have been
reported, as well as mycotic keratitis. An important aspect of this organism is its frequent
resistance to antifungal therapy.
Treatment: Scedosporium prolificans is resistant to amphotericin B, flucytosine, ketoconazole,
miconazole, fluconazole and itraconazole, voriconazole and caspofungin.
While itraconazole or terbinafine alone are not effective against most Scedosporium prolificans isolates,
synergistic interactions were found in vitro between terbinafine and three azoles (voriconazole,
miconazole, and itraconazole) against five clinical S. prolificans isolates.
Due to its primary multi-resistant nature, treatment of Scedosporium prolificans infections is difficult
and mortality unfortunately remains very high in most of the cases
1
Koneman, EW, et al. Color Atlas and Textbook of Diagnostic Microbiology, 6th edition. 2006
Sutton, DA; Fothergill, AW; and Rinaldi, MG. Guide to Clinically Significant Fungi. 1998.
3
Mycology Online: Scedosporium prolificans, © 2005 The University of Adelaide
Last Modified 11/02/2005 David Ellis, CRICOS Provider Number 00123M.
http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Hyphomycetes_(hyaline)/Scedosporium/prolificans.html
4
Revankar, S. G., J. E. Patterson, D. A. Sutton, R. Pullen, and M. G. Rinaldi. 2002. Disseminated
phaeohyphomycosis: Review of an emerging mycosis. Clin Infect Dis. 34:467-476.
5
Doctorfungus, Scedosporium spp. http://www.doctorfungus.org/thefungi/Scedosporium.htm
6
Meletiadis, J., J. W. Mouton, J. L. Rodriguez-Tudela, J. Meis, and P. E. Verweij. 2000. In vitro interaction of
terbinafine with itraconazole against clinical isolates of Scedosporium prolificans. Antimicrob. Agents Chemother.
44:470-472.
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