Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-27T02:25:56.298Z Has data issue: false hasContentIssue false
  • English
  • Français

Scedosporium Cerebral Abscesses After Extra-Corporeal Membrane Oxygenation

Published online by Cambridge University Press:  02 December 2014

Hosam Al-Jehani ,
Marie-Christine Guiot ,
Carlos Torres  and
Judith Marcoux
Hosam Al-Jehani
Affiliation:
Department of Neurosurgery, McGill University, Montreal, Quebec
Marie-Christine Guiot
Affiliation:
Department of Pathology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec
Carlos Torres
Affiliation:
Department of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
Judith Marcoux*
Affiliation:
Department of Neurosurgery, McGill University, Montreal, Quebec Department of Neurosurgery, Montreal General Hospital, McGill University, Montreal, Quebec
*
Neurosurgery Department, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room: L7-524, Montreal, Quebec, H3G 1A4, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Scedosporial infections are usually encountered in the immunocompromised patients. However, they are now emerging in the immunocompetent population and have an affinity for the central nervous system. They represent a therapeutic challenge, since they are highly resistant to most antifungal medications.

Methods:

We report the case of an immunocompetent patient with multiple cerebral abscesses secondary to Scedosporium apiospermum following extracorporeal membrane oxygenation (ECMO) and review the literature about this challenging cerebral infection.

Results:

A previously healthy 33-year-old male admitted to the hospital for a community-acquired pneumonia requiring ECMO subsequently developed multiple cerebral abscesses. He was empirically treated with caspofungin, which was changed to voriconazole once surgical aspiration revealed Scedosporium apiospermum. Despite multiple aspirations, decompressive craniectomy to alleviate intracranial pressure, and an appropriate antifungal agent, the patient did not survive this aggressive infection.

Conclusion:

Brain abscesses with Scedosporium apiospermum present a therapeutic challenge. High clinical suspicion leading to early appropriate antifungal therapy and combined surgical interventions might improve the prognosis.

Résumé:

RÉSUMÉ:Contexte:

Les infections à Scédosporium se rencontrent habituellement chez des patients immunocompromis. Cependant, on les rencontre maintenant dans la population immunocompétente et ells ont une affinité pour le système nerveux central. Leur traitement constitue un défi, étant donné qu’elles sont très résistantes à la plupart des medicaments antifongiques.

Méthodes:

Nous décrivons le cas d’un patient immunocompétent qui a présenté de multiples abcès cérébraux dus à Scedosporium apiospermum après assistance respiratoire extracorporelle (AREC) et nous revoyons la littérature sur cette infection cérébrale dont la prise en charge présente un défi.

Résultats:

Un homme de 33 ans sans antécédent pathologique a été hospitalisé pour une pneumonie extrahospitalière qui a nécessité une AREC. Il a par la suite présenté de multiples abcès cérébraux pour lesquels il a été traité de façon empirique par la caspofungine, puis par le voriconazole après que l’aspiration chirurgicale ait révélé la présence de Scédosporium apiospermum. Le patient est décédé malgré de multiples aspirations, une craniectomie décompressive pour diminuer la pression intracrânienne et l’administration d’un antifongique approprié.

Conclusion:

Les abcès cérébraux à Scédosporium apiospermum présentent un défi thérapeutique. Un haut degré de soupçon clinique motivant un traitement précoce par un antifongique approprié, combiné à la chirurgie, pourraient en améliorer le pronostic.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 671 - 676
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Rodriguez-Tudela, JL, Berenguer, J, Guarro, J, et al. Epidemiology and outcome of Scedosporium prolificans infection, a review of 162 cases. Med Mycol. 2008;1:1–12.Google Scholar
2. Baudrillard, JC, Rousseaux, P, Lerais, JM, et al. Fungal mycotic aneurysms and multiple cerebral abscesses caused by Scedosporium apiospermum. A propos of a case with review of the literature. J Radiol. 1985;66(4):321–6.Google ScholarPubMed
3. Buzina, W, Feierl, G, Haas, D, et al. Lethal brain abscess due to the fungus Scedosporium apiospermum (teleomorph Pseudallescheria boydii) after a near-drowning incident: case report and review of the literature. Med Mycol. 2006;44(5):473–7.CrossRefGoogle Scholar
4. Chakraborty, A, Workman, MR, Bullock, PR. Scedosporium apiospermum brain abscess treated with surgery and voriconazole. Case report. J Neurosurg. 2005;103 1 Suppl:83–7.Google ScholarPubMed
5. Dworzack, DL, Clark, RB, Borkowski, WJ Jr, et al. Pseudallescheria boydii brain abscess: association with near-drowning and efficacy of high-dose, prolonged miconazole therapy in patients with multiple abscesses. Medicine (Baltimore). 1989;68(4): 218–24.CrossRefGoogle ScholarPubMed
6. Gari, M, Fruit, J, Rousseaux, P, et al. Scedosporium (Monosporium) apiospermum: multiple brain abscesses. Sabouraudia. 1985;23 (5):371–6.CrossRefGoogle ScholarPubMed
7. Kantarcioglu, AS, Guarro, J, de Hoog, GS. Central nervous system infections by members of the Pseudallescheria boydii species complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome. Mycoses. 2008;51(4):275–90.CrossRefGoogle ScholarPubMed
8. Katragkou, A, Dotis, J, Kotsiou, M, et al. Scedosporium apiospermum infection after near-drowning. Mycoses. 2007;50 (5):412–21.CrossRefGoogle ScholarPubMed
9. Kowacs, PA, Soares Silvado, CE, Monteiro de Almeida, S, et al. Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors. J Clin Pathol. 2004;57(2):205–7.CrossRefGoogle ScholarPubMed
10. Leechawengwongs, M, Milindankura, S, Liengudom, A, et al. Multiple Scedosporium apiospermum brain abscesses after near-drowning successfully treated with surgery and long-term voriconazole: a case report. Mycoses. 2007;50(6):512–6.CrossRefGoogle ScholarPubMed
11. Mursch, K, Trnovec, S, Ratz, H, et al. Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode. Childs Nerv Syst. 2006;22(2):189–92.CrossRefGoogle Scholar
12. Rüchel, R, Wilichowski, E. Cerebral Pseudallescheria mycosis after near-drowning. Mycoses. 1995;38(11-12):473–5.CrossRefGoogle ScholarPubMed
13. Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81–4.CrossRefGoogle ScholarPubMed
14. Cortez, KJ, Roilides, E, Quiroz-Telles, F, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev. 2008 Jan;21(1):157–97.CrossRefGoogle ScholarPubMed
15. Alsip, SG, Cobbs, CG. Pseudallescheria boydii infection of the central nervous system in a cardiac transplant recipient. South Med J. 1986;79(3):383–4.CrossRefGoogle Scholar
16. Castiglioni, B, Sutton, DA, Rinaldi, MG, et al. Pseudallescheria boydii (Anamorph Scedosporium apiospermum). Infection in solid organ transplant recipients in a tertiary medical center and review of the literature. Medicine (Baltimore). 2002;81(5): 333–48.Google ScholarPubMed
17. Luu, KK, Scott, IU, Miller, D, et al. Endogenous Pseudallescheria boydii endophthalmitis in a patient with ring-enhancing brain lesions. Ophthalmic Surg Lasers. 2001;32(4):325–9.CrossRefGoogle Scholar
18. Satirapoj, B, Ruangkanchanasetr, P, Treewatchareekorn, S, et al. Pseudallescheria boydii brain abscess in a renal transplant recipient: first case report in Southeast Asia. Transplant Proc. 2008;40(7):2425–7.CrossRefGoogle Scholar
19. Safdar, A, Papadopoulos, EB, Young, JW. Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy. Transpl Infect Dis. 2002;4(4):212–7.CrossRefGoogle ScholarPubMed
20. Mellinghoff, IK, Winston, DJ, Mukwaya, G, et al. Treatment of Scedosporium apiospermum brain abscesses with posaconazole. Clin Infect Dis. 2002;34(12):1648–50.CrossRefGoogle ScholarPubMed
21. Pagano, L, Caira, M, Falcucci, P, et al. Fungal CNS infections in patients with hematologic malignancy. Expert Rev Anti Infect Ther. 2005;3(5):775–85.CrossRefGoogle ScholarPubMed
22. Yoo, D, Lee, WH, Kwon-Chung, KJ. Brain abscesses due to Pseudallescheria boydii associated with primary non-Hodgkin’s lymphoma of the central nervous system: a case report and literature review. Rev Infect Dis. 1985;7(2):272–7.CrossRefGoogle ScholarPubMed
23. Bhat, SV, Paterson, DL, Rinaldi, MG, et al. Scedosporium prolificans brain abscess in a patient with chronic granulomatous disease: successful combination therapy with voriconazole and terbinafine. Scand J Infect Dis. 2007;39(1):87–90.CrossRefGoogle Scholar
24. Durieu, I, Parent, M, Ajana, F, et al. Monosporium apiospermum meningoencephalitis: a clinico-pathological case. J Neurol Neurosurg Psychiatry. 1991;54(8):731–3.CrossRefGoogle ScholarPubMed
25. Garzoni, C, Emonet, S, Legout, L, et al. Atypical infections in tsunami survivors. Emerg Infect Dis. 2005;11:1591–3.CrossRefGoogle ScholarPubMed
26. Horré, R, Feil, E, Stangel, AP, et al. Scedosporiosis of the brain with fatal outcome after traumatizatio of the foot. Case report. Mycoses. 2000;43 Suppl 2:33–6.Google ScholarPubMed
27. Pennekamp, PH, Diedrich, O, Zhou, H, et al. Foot injury as a rare cause of scendosporiosis with fetal outcome. Unfallchirurg. 2003;106(10):865–8.CrossRefGoogle ScholarPubMed
28. Acharya, A, Ghimire, A, Khanal, B, et al. Brain abscess due to Scedosporium apiospermum in a non immunocompromised child. Indian J Med Microbiol. 2006;24(3):231–2.CrossRefGoogle Scholar
29. Riddell, J 4th, Chenoweth, CE, Kauffman, CA. Disseminated Scedosporium apiospermum infection in a previously healthy woman with HELLP syndrome. Mycoses. 2004;47(9-10):442–6.CrossRefGoogle Scholar
30. Danaher, PJ, Walter, EA. Successful treatment of chronic meningitis caused by Scedosporium apiospermum with oral voriconazole. Mayo Clin Proc. 2004;79(5):707–8.CrossRefGoogle ScholarPubMed
31. Brüggemann, RJ, Antonius, T, Heijst, A, et al. Therapeutic drug monitoring of voriconazole in a child with invasive aspergillosis requiring extracorporeal membrane oxygenation. Ther Drug Monit. 2008;30(6):643–6.CrossRefGoogle Scholar
32. Minette, MS, Ibsen, LM. Survival of candida sepsis in extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2005;6(6): 709–11.CrossRefGoogle ScholarPubMed
33. O’Neill, JM, Schutze, GE, Heulitt, MJ, et al. Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med. 2001;27(8):1247–53.CrossRefGoogle ScholarPubMed
34. Sachweh, JS, Tiete, AR, Fuchs, A, et al. Efficacy of extracorporeal membrane oxygenation in a congenital heart surgery program. Clin Res Cardiol. 2007;96(4):204–10.CrossRefGoogle Scholar
35. Sander, A, Beyer, U, Amberg, R. Systemic Fusarium oxysporum infection in an immunocompetent patient with an adult respiratory distress syndrome (ARDS) and extracorporal membrane oxygenation (ECMO). Mycoses. 1998;41(3-4): 109–11.CrossRefGoogle Scholar
36. Eschertzhuber, S, Velik-Salchner, C, Hoermann, C, et al. Caspofungin-resistant Aspergillus flavus after heart transplantation and mechanical circulatory support: a case report. Transpl Infect Dis. 2008;10(3):190–2.CrossRefGoogle ScholarPubMed
37. Tang, SC, Huang, SJ, Chiu, MJ, et al. Impaired cerebral autoregulation in a case of severe acute encephalitis. J Formos Med Assoc. 2007;106 Suppl 2:S7–12.CrossRefGoogle Scholar
38. Scott, LJ, Simpson, D. Voriconazole: a review of its use in the management of invasive fungal infections. Drugs. 2007;67(2):269–98.CrossRefGoogle ScholarPubMed
39. Troke, P, Aguirrebengoa, K, Arteaga, C, et al. Global Scedosporium Study Group. Treatment of scedosporiosis with voriconazole: clinical experience with 107 patients. Antimicrob Agents Chemother. 2008;52(5):1743–50.CrossRefGoogle Scholar
40. Matsumoto, Y, Oh-I, T, Nagai, A, et al. Case of cutaneous Scedosporium apiospermum infection successfully treated with voriconazole. J Dermatol. 2009;36(2):98–102.CrossRefGoogle ScholarPubMed
41. Stur-Hofmann, K, Stos, S, Saxa-Enenkel, M, et al. Primary cutaneous infection with Scedosporium apiospermum successfully treated with voriconazole. Mycoses. Epub 2009 Nov 18.Google ScholarPubMed
42. Al-Badriyeh, D, Leung, L, Davies, GE, et al. Successful salvage treatment of Scedosporium apiospermum keratitis with topical voriconazole after failure of natamycin. Ann Pharmacother. 2009;43(6):1139–42.CrossRefGoogle ScholarPubMed
43. Bunya, VY, Hammersmith, KM, Rapuano, CJ, et al. Topical and oral voriconazole in the treatment of fungal keratitis. Am J Ophthalmol. 2007;143(1):151–3.CrossRefGoogle ScholarPubMed
44. Jhanji, V, Yohendran, J, Constantinou, M, et al. Scedosporium scleritis or keratitis or both: case series. Eye Contact Lens. 2009; 35(6):312–5.CrossRefGoogle ScholarPubMed
45. Nochez, Y, Arsene, S, Le Guellec, C, et al. Unusual pharmacokinetics of intravitreal and systemic voriconazole in a patient with Scedosporium apiospermum endophthalmitis. J Ocul Pharmacol Ther. 2008;24(1):87–90.CrossRefGoogle Scholar
46. Chen, FK, Chen, SD, Tay-Kearney, ML. Intravitreal voriconazole for the treatment of endogenous endophthalmitis caused by Scedosporium apiospermum. Clin Experiment Ophthalmol. 2007;35(4):382–5.CrossRefGoogle ScholarPubMed
47. Zarkovic, A, Guest, S. Scedosporium apiospermum traumatic endophthalmitis successfully treated with voriconazole. Int Ophthalmol. 2007;27(6):391–4.CrossRefGoogle ScholarPubMed
48. Stripeli, F, Pasparakis, D, Velegraki, A, et al. Scedosporium apiospermum skeletal infection in an immunocompetent child. Med Mycol. 2009;47(4):441–4.CrossRefGoogle Scholar
49. Rogasi, PG, Zanazzi, M, Nocentini, J, et al. Disseminated Scedosporium apiospermum infection in renal transplant recipient: long-term successful treatment with voriconazole: a case report. Transplant Proc. 2007 Jul-Aug;39(6):2033–5.CrossRefGoogle ScholarPubMed
50. Harun, A, Perdomo, H, Gilgado, F, et al. Genotyping of Scedosporium species: a review of molecular approaches. Med Mycol. 2009;47(4):406–14.CrossRefGoogle ScholarPubMed
51. Spiess, B, Seifarth, W, Hummel, M, et al. DNA microarray-based detection and identification of fungal pathogens in clinical samples from neutropenic patients. J Clin Microbiol. 2007;45 (11):3743–53.CrossRefGoogle ScholarPubMed
52. Raparia, K, Powell, SZ, Cernoch, P, et al. Cerebral mycosis: 7-year retrospective series in a tertiary center. Neuropathology. Epub 2009 Oct 21.CrossRefGoogle ScholarPubMed
53. Redmond, A, Dancer, C, Woods, ML. Fungal infections of the central nervous system: a review of fungal pathogens and treatment. Neurol India. 2007;55(3):251–9.Google ScholarPubMed
54. Shamim, MS, Siddiqui, AA, Enam, SA, et al. Craniocerebral aspergillosis in immunocompetent hosts: surgical perspective. Neurol India. 2007;55(3):274–81.Google ScholarPubMed
55. Denning, DW, Stevens, DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2121 published cases [published correction appears in Rev Infect Dis. 1991;13:345]. Rev Infect Dis. 1990;12 :1147–201.CrossRefGoogle Scholar
56. Nadkarni, T, Goel, A. Aspergilloma of the brain: an overview. J Postgrad Med. 2005;51:37–41.Google ScholarPubMed
57. Louati, I, Zaouali, J, Azzouz, O, et al. Cerebral aspergillosis in immunocompetent patients: three case reports. Rev Neurol (Paris). 2009;165(11):957–61.CrossRefGoogle ScholarPubMed
58. Srinivasan, US. Intracranial aspergilloma in immunocompetent patients successfully treated with radical surgical intervention and antifungal therapy: case series. Ann Acad Med Singapore. 2008;37(9):783–7.CrossRefGoogle ScholarPubMed
59. Nesky, MA, McDougal, EC, Peacock, JE. Jr Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis. Clin Infect Dis. 2000;31(3):673–7.CrossRefGoogle ScholarPubMed