Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature

Danila Seidel; Angela Hassler; Jon Salmanton-García; Philipp Koehler; Sibylle C Mellinghoff; Fabianne Carlesse; Matthew P Cheng; Iker Falces-Romero; Raoul Herbrecht; Alfredo Jover Sáenz; Nikolai Klimko; Mihai Mareş; Cornelia Lass-Flörl; Pere Soler-Palacín; Hilmar Wisplinghoff; Oliver A Cornely; Zoi Pana; Thomas Lehrnbecher

doi:10.1016/j.ijid.2019.12.017

Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature

Int J Infect Dis. 2020 Mar:92:114-122. doi: 10.1016/j.ijid.2019.12.017. Epub 2019 Dec 19.

Authors

Danila Seidel¹, Angela Hassler², Jon Salmanton-García³, Philipp Koehler³, Sibylle C Mellinghoff³, Fabianne Carlesse⁴, Matthew P Cheng⁵, Iker Falces-Romero⁶, Raoul Herbrecht⁷, Alfredo Jover Sáenz⁸, Nikolai Klimko⁹, Mihai Mareş¹⁰, Cornelia Lass-Flörl¹¹, Pere Soler-Palacín¹², Hilmar Wisplinghoff¹³, Oliver A Cornely¹⁴, Zoi Pana¹⁵, Thomas Lehrnbecher²

Affiliations

¹ Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany. Electronic address: Danila.seidel@uk-koeln.de.
² Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany.
³ Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
⁴ Instituto de Oncologia Pediátrica - GRAACC/UNIFESP, São Paulo, SP, Brazil.
⁵ Montreal, McGill University, Department Microbiology and Immunology, Montreal, Canada.
⁶ Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
⁷ University Hospital of Strasbourg, Hôpital de Hautepierre, Department of Oncology and Hematology, Strasbourg, France.
⁸ Territorial Unit of Nosocomial Infection and antibiotic policy (TUNI). University Hospital Arnau de Vilanova, Lleida, Spain.
⁹ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.
¹⁰ Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Romania.
¹¹ Medical University of Innsbruck, Institute of Hygiene und Medical Microbiology (HMM), Innsbruck, Austria.
¹² Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.
¹³ Wisplinghoff Laboratories, Cologne, Germany; Institute for Virology and Microbiology, University Witten/Herdecke, Witten, Germany; Institute for Medical Microbiology, University of Cologne, Cologne, Germany.
¹⁴ Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
¹⁵ Department of Medicine, European University of Cyprus (EUC), Cyprus.

PMID: 31863876
DOI: 10.1016/j.ijid.2019.12.017

Abstract

Objectives: Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections.

Methods: Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected.

Results: Fifty-five children (median age 9 years [IQR: 5-14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment. Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3-28] versus 61 days [IQR: 16-148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35-51.40] and HR 6.12 [95% CI 1.52-24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11-0.99] and HR 0.09 [95% CI 0.02-0.40], respectively).

Conclusions: Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome.

Keywords: Children; FungiScope® registry; Invasive fungal infections; Lomentospora prolificans; Pediatric patients; Scedosporium spp.; Surgery; Voriconazole.

MeSH terms

Adolescent
Amphotericin B / therapeutic use
Antifungal Agents / therapeutic use
Child
Child, Preschool
Female
Humans
Infant
Male
Mycoses / diagnosis*
Mycoses / drug therapy
Mycoses / microbiology
Mycoses / therapy*
Risk Factors
Scedosporium*
Voriconazole / therapeutic use

Substances

Antifungal Agents
Amphotericin B
Voriconazole