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Abstract zur Publikation: Infections due to Pseudallescheria/Scedosporium species in patients with advanced HIV disease - a diagnostic and therapeutic challenge

Tammer I, Tintelnot K et al. (2011): Infections due to Pseudallescheria/Scedosporium species in patients with advanced HIV disease - a diagnostic and therapeutic challenge.
Int. J. Infect. Dis. 15 (6): e422-e429. Epub Apr 19.

Objectives

The aim of this study is to highlight the importance of infections caused by members of the genera Pseudallescheria/Scedosporium in HIV-positive patients.

Methods

We describe a case of a fatal scedosporiosis in a treatment-naïve HIV patient and review all previously reported cases of pseudallescheriosis/scedosporiosis from a search of the PubMed and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) databases, applying the terms ‘Pseudallescheria’, ‘Scedosporium’, ‘Allescheria’, ‘Monosporium’, ‘Petriellidium’, ‘boydii’, ‘prolificans’, ‘inflatum’, cross-referenced with ‘HIV’ and ‘AIDS’.

Results

Detection of Scedosporium and Pseudallescheria species has been reported in 22 HIV-positive patients. Fourteen isolates belonged to the Pseudallescheria boydii complex and eight to Scedosporium prolificans. Invasive scedosporiosis (IS) was proven in 54.5% of the patients. Among them dissemination was observed in 66.7%. Pseudallescheria/Scedosporium species were mainly isolated from male individuals. Patients with proven IS showed CD4+ cell counts <100/μl and a higher co-infection rate as compared to colonized patients. Patients with central nervous system (CNS) manifestations showed CD4+ cell counts <50/μl. The mortality rate for patients with proven IS was 75% and was 100% for patients with dissemination/CNS manifestations. The fatality rate for patients treated with antifungal drugs plus surgery was lower compared to patients treated with antimycotic agents alone.

Conclusions

IS only occurred in HIV-positive patients with a strongly impaired immune system. The survival rates of patients with advanced HIV disease and invasive scedosporiosis can be improved by rapid diagnosis by biopsy and requires complex therapy with a combination of active antifungal drugs, surgery and supportive immune augmentation.

Zusatzinformationen

Gesundheitsmonitoring

In­fek­ti­ons­schutz

Forschung

Kom­mis­sio­nen

Ser­vice

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