Fatal pulmonary Scedosporium aurantiacum infection in a patient after near-drowning: A case report

Roya  Ghasemian; Azadeh   Bandegani; Firoozeh  Kermani; Leila Faeli; Behrad  Roohi; Elham  YousefiAbdolmaleki; Mohammad  T. Hedayati; Emmanuel   Roilides; Tahereh   Shokohi

doi:10.18502/cmm.7.4.8410

Roya Ghasemian Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Azadeh Bandegani Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Firoozeh Kermani Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Leila Faeli Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Behrad Roohi Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Elham YousefiAbdolmaleki Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Mohammad T. Hedayati Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Emmanuel Roilides Infectious Diseases Section, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
Tahereh Shokohi Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

DOI: https://doi.org/10.18502/cmm.7.4.8410

Keywords: Antifungal susceptibility test Amphotericin B Invasive pulmonary infection Near-drowning Scedosporium aurantiacum Voriconazole

Abstract

Background and Purpose: Scedosporium spp. is a saprophytic fungus that may cause invasive pulmonary infection due to the aspiration of contaminated water in both immunosuppressed and immunocompetent hosts.

Case report: Herein, we report a fatal case of pulmonary infection caused by Scedosporium species associated with a car crash and near-drowning in a sewage canal.Scedosporium aurantiacum isolated from bronchoalveolar lavage was identified by PCR-sequencing of β-tubulin genes. The minimum inhibitory concentration values for amphotericin B, itraconazole, posaconazole, isavuconazole were >16 µg/ml, and >8 µg/ml for anidulafungin, micafungin, and caspofungin. Voriconazole was found to be the most active agent with a MIC of 1 µg/ml.

Conclusion: This report, as the first case of pulmonary scedosporiosis after near-drowning in Iran, highlights the importance of high suspicion in near-drowning victims, prompt identification of Scedosporium spp., and early initiation of appropriate antifungal therapy.