Scedosporium and Lomentospora Infections Are Infrequent, Difficult to Diagnose by Histology, and Highly Virulent

Abstract Objective To further characterize the histomorphology and clinicopathologic features of colonization and invasive disease by Scedosporium and Lomentospora. Methods We conducted a 20-year retrospective study. Patients with at least 1 histopathology specimen and concurrent culture were includ...

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Bibliographic Details
Published in:American journal of clinical pathology 2021-12, Vol.156 (6), p.1044-1057
Main Authors: DeSimone, Mia S, Crothers, Jessica W, Solomon, Isaac H, Laga, Alvaro C
Format: Article
Language:English
Subjects:
Antifungal Agents - therapeutic use
Caspofungin
Cell culture
Colonization
Conidia
Diagnosis
Health aspects
Histopathology
Humans
Hyphae
Immunocompromised Host
Medical research
Medicine, Experimental
Methenamine
Mycoses
Opportunist infection
Patients
Posaconazole
Retrospective Studies
Scedosporium
Skin
Skin diseases
Virulence
Virulence (Microbiology)
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Summary:Abstract Objective To further characterize the histomorphology and clinicopathologic features of colonization and invasive disease by Scedosporium and Lomentospora. Methods We conducted a 20-year retrospective study. Patients with at least 1 histopathology specimen and concurrent culture were included. Clinical features, histopathology, microbiology, and outcomes were analyzed. Results Eighteen patients were identified, and all were immunocompromised. Eight patients had colonization, while 10 had invasive disease (pneumonia [n = 3], skin and soft-tissue infections [n = 3], disseminated disease [n = 4]). Scedosporium apiospermum was identified in 15 patients, Lomentospora prolificans in 2 patients, and Scedosporium ellipsoideum in 1 patient. Fungal elements were identified histologically in 11 patients. Granulomatous, suppurative, and necrotizing inflammation with irregular branching hyphae and characteristic microconidia were observed in 9 cases; conidiogenous cells were identified in 4 cases. Seven patients died of invasive disease despite therapy, and 3 recovered after treatment. No deaths were observed in patients with colonization. Conclusions Scedosporium and Lomentospora are rare, virulent opportunistic fungal pathogens. Fungal morphology may overlap with other hyaline molds, but identification of obovoid conidia should allow a diagnosis of non-Aspergillus hyalohyphomycosis and consideration of Scedosporium and Lomentospora. Histopathologic correlation with culture and polymerase chain reaction is critical for diagnosis and treatment.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqab070