1 INTRODUCTION
The Scedosporium is a group of soil saprophytic moulds, which are
widely distributed in the environment, particularly in soil, sewage and
polluted waters. At least ten distinct Scedosporium species have
been identified in molecular taxonomy. Five of them can cause human
infections, namely S apiospermum, P boydii, Saurantiacum, S dehoogii and S
minutispora 1-3. And their environmental
distribution and epidemiology is different
worldwide4-8. As opportunistic pathogens, infections
caused by Scedosporium genus will happen in not only
immunosuppressed but immunocompetent hosts, but most infections are
associated with compromised immune status9. The
clinical manifestation of infections include respiratory colonization,
cutaneous infections, and severe invasive localized or disseminated
mycosis. There is even a risk of central nervous system infection after
drowning in immunocompetent hosts1, and the mortality
rate of susceptible people exceeds 50%2.
Immunosuppression may increase the prevalence of disseminated infections
caused by Scedosporium , such as in patients with cancer,
hematopoietic stem cells or solid organ transplant recipients, and those
receiving immunosuppressive therapy7. To
immunocompetent populations, Scedosporium infections frequently
caused by trauma, drowning, and aspiration of
conidia1,9, mainly infecting the skin, lungs, soft
tissues, central nervous system, and sinuses, among which pulmonary
infections rank the second10-11, and those with
underlying lung diseases are more susceptible than other healthy
people12. Treatment of Scedosporium infections
still remains a great challenge because of their intrinsic resistance to
all current antifungal agents, easy to relapse, and the mixed infection
with tuberculosis or non-tuberculous mycobacteria or viruses occur
frequently14-16. Voriconazole has been recommended to
the first-line systemic treatment of Scedosporiuminfections13, but the duration of therapy is not well
recommended. Therefore, it is necessary to summarize the clinical cases
and treatment experience of Scedosporium infections, especially
the risk factors, infection routes, therapeutic strategies and duration
of treatment in immunocompetent patients. In this paper, we
retrospectively analyzed 3 cases of non-Transplant, non-HIV adults withScedosporium pneumonia, and present our therapeutic experience
and improved patient outcomes.