Abstract
Scedosporium apiospermum is a cosmopolitan mycotic agent with unique characteristics. This is a case of a 65-year-old immunocompetent patient who presented with shortness of breath and fever. Consolidation was observed in both lung fields on chest X-ray. A diagnosis of aspiration pneumonia was made. Extended-spectrum ?-lactamase (ESBL)-producing Klebsiella pneumoniae was identified from his tracheal aspirate and imipenem was administered. Initial blood cultures were negative but after 10 days on imipenem, Candida glabrata was isolated. Amphotericin B was added to the treatment regimen, but after a week on this antifungal, Scedosporium apiospermum was cultured from the blood. The patient succumbed to illness before a change in the antifungal regimen. The case highlights the unwelcome consequence of using a broad spectrum antibiotic and later a broad spectrum antifungal agent. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19154 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.326-328Note: updated with minor changes on 20th June 2014. Last author added.
Highlights
Scedosporium apiospermum is a ubiquitous saprophytic mold readily isolated from numerous environmental sources such as soil, sewage and decaying vegetation[1]
It is almost always resistant to amphotericin B5, and its emergence may even be favoured by the long-term usage of amphotericin B6
The patient was diagnosed with nasopharyngeal carcinoma 20 years ago and has completed radiotherapy treatments. He developed multiple (IX to XII) cranial nerve palsies following the radiotherapy, requiring a tracheostomy for bilateral vocal cord palsy and percutaneous endoscopic gastrostomy (PEG) tube feeding for the loss of gag reflex
Summary
Scedosporium apiospermum (teleomorph: Pseudallescheria boydii) is a ubiquitous saprophytic mold readily isolated from numerous environmental sources such as soil, sewage and decaying vegetation[1]. The mold is a potent agent of severe infections in both immunocompromised and immunocompetent patients[4]. Case report A 65-year-old Chinese gentleman was brought by family members to our medical centre after he developed shortness of breath on the same day. 1. Chuan Hun Ding, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, MALAYSIA.
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