Scedosporium Infection

Scedosporium is a widely distributed mold. It exists as two species: S. apiospermum (asexual anamorph of Pseudallescheria boydii) and S. prolif-icans (S. inflatum). The organism is isolated from soil, potting mix, compost, and animal manure. Infection is by inhalation of spores or by direct inoculation into skin. The range of illness includes colonization, local skin infection, deep infection or disseminated disease. Normal and immunocompromised hosts can be infected. Infections have been reported from the United States, Canada, Germany, France, the Netherlands, and Spain (with a high incidence in northern Spain) (1,15).

The clinical presentation is that of a respiratory infection such as pneumonia that may progress to a fungus ball and allergic bronchopulmonary mycosis with colonization. The skin, bones, joints, and eye can be involved as sites of localized infections. Disseminated disease with sepsis, fungemia, and multiorgan failure can occur. The diagnosis is confirmed by isolation of Scedospermum from tissue, fluids or exudates (1,15).

Treatment for S. apiospermum is with voriconazole or itraconazole used with terbinafine. The organism is variably susceptible to amphotericin B and resistant to fluconazole and flucytosine. The treatment for S. prolificans is problematic because it shows resistance to all agents. Voriconazole is the most active against S. prolificans (12,16).

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