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      A systemic infection involved in lung, brain and spine caused by Scedosporium apiospermum species complex after near-drowning: a case report and literature review

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          Abstract

          Scedosporium apiospermum species complex are widely distributed fungi that can be found in a variety of polluted environments, including soil, sewage, and decaying vegetation. Those opportunistic pathogens with strong potential of invasion commonly affect immunosuppressed populations However, few cases of scedosporiosis are reported in immunocompetent individuals, who might be misdiagnosed, leading to a high mortality rate. Here, we reported an immunocompetent case of systemtic infection involved in lung, brain and spine, caused by S. apiospermum species complex ( S. apiospermum and S. boydii). The patient was an elderly male with persistent fever and systemtic infection after near-drowning. In the two tertiary hospitals he visited, definite diagnosis was extremely difficult. After being admitted to our hospital, he was misdiagnosed as tuberculosis infection, before diagnosis of S. apiospermum species complex infection by the metagenomic next-generation sequencing. His symptoms were alleviated after voriconazole treatment. In the present case, the details associated with its course were reported and published studies on Scedosporium spp. infection were also reviewed, for a better understanding of this disease and reducing the misdiagnosis rate.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12879-023-08279-9.

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          Most cited references37

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          Clinical metagenomics

          Clinical metagenomic next-generation sequencing (mNGS), the comprehensive analysis of microbial and host genetic material (DNA and RNA) in samples from patients, is rapidly moving from research to clinical laboratories. This emerging approach is changing how physicians diagnose and treat infectious disease, with applications spanning a wide range of areas, including antimicrobial resistance, the microbiome, human host gene expression (transcriptomics) and oncology. Here, we focus on the challenges of implementing mNGS in the clinical laboratory and address potential solutions for maximizing its impact on patient care and public health.
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            Infections caused by Scedosporium spp.

            Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.
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              Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology

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                Author and article information

                Contributors
                xiejjgg@hotmail.com
                ted_momo@aliyun.com
                Journal
                BMC Infect Dis
                BMC Infect Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                21 March 2024
                21 March 2024
                2024
                : 24
                : 342
                Affiliations
                [1 ]College of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army General Hospital, ( https://ror.org/05tf9r976) No. 17, Heishanhu Road, Haidian District, Beijing, 100091 China
                [2 ]GRID grid.495325.c, ISNI 0000 0004 0508 5971, China Aerospace Science & Industry Corporation 731 Hospital, ; Beijing, China
                [3 ]The Fifth People’s Hospital of Zunyi City, Zunyi City, Guizhou Province China
                [4 ]GRID grid.508230.c, Vision Medicals for Infection Diseases, ; Guangzhou, Guangdong China
                [5 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Pulmonary and Critical Care Medicine, , Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, ; 1095 Jiefang Ave., Wuhan, Hubei China
                Article
                8279
                10.1186/s12879-023-08279-9
                10956195
                38515075
                c1c2088c-c1c4-4ed3-a2cc-e627627168f4
                © The Author(s) 2024

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 December 2022
                : 25 April 2023
                Categories
                Case Report
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Infectious disease & Microbiology
                scedosporium apiospermum species complex,near-drowning,systemtic infection,metagenomic next-generation sequencing

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