Abstract
Species of Scedosporium and Fusarium are considered emerging opportunistic pathogens, causing invasive fungal diseases in humans that are known as scedosporiosis and fusariosis, respectively. These mold infections typically affect patients with immune impairment; however, cases have been reported in otherwise healthy individuals. Clinical manifestations vary considerably, ranging from isolated superficial infection to deep-seated invasive infection—affecting multiple organs—which is often lethal. While there have been a number of advances in the detection of these infections, including the use of polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF MS), diagnosis is often delayed, leading to substantial morbidity and mortality. Although the optimal therapy is controversial, there have also been notable advances in the treatment of these diseases, which often depend on a combination of antifungal therapy, reversal of immunosuppression, and in some cases, surgical resection. In this paper, we review these advances and examine how the management of scedosporiosis and fusariosis may change in the near future.
Highlights
The past few decades have witnessed a remarkable increase in the prevalence and severity of invasive fungal infections (IFI) in children and adults with immune impairment, including patients with hematologic malignancies, stem cell and solid organ transplantations, and primary and acquired immunodeficiencies and preterm neonates [1,2,3]
A fluorescent polymerase chain reaction (PCR) fragment length analysis based on the internally transcribed spacer 2 (ITS2) region is available to distinguish between Aspergillus, Candida, and F. oxysporum, but this method cannot distinguish between the Fusarium spp. that have closely-related internal transcribed spacer (ITS) amplicons [50,51,52]
In a case series of 11 invasive fusariosis from a single center, remarkably high response and survival rates were found when antifungal agents were combined with granulocyte transfusions, which were collected using a specific donor collection protocol
Summary
The past few decades have witnessed a remarkable increase in the prevalence and severity of invasive fungal infections (IFI) in children and adults with immune impairment, including patients with hematologic malignancies, stem cell and solid organ transplantations, and primary and acquired immunodeficiencies and preterm neonates [1,2,3] The majority of these infections are due to Candida spp. and Aspergillus spp., while less common fungal pathogens, such as mucormycetes, Scedosporium spp., and Fusarium spp. are reported with increasing frequency [4,5]. Diagnostic and therapeutic options against IFI have evolved considerably over the past several years, and in this paper, we will review how these advances affect the management of scedosporiosis and fusariosis in children and adults
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