O337 Abstract (oral session) Exserohilum infections: review of 49 cases before the US outbreak A. Katragkou*, Z.D. Pana, T.J. Walsh, E. Roilides (Thessaloniki, GR; New York, US)

Objective: Exserohilum species are soil-borne fungi that were heretofore uncommon causes of human disease. The ongoing tragic outbreak in the United States of more than 500 cases of Exserohilum rostratum meningitis that arose from injection of contaminated methylprednisolone solution warrants improved understanding of this pathogen. To our knowledge, there is no current report of pre-outbreak Exserohilum infections by which to provide a mycological and historical context for the outbreak. Thus, our objective was to systematically review all cases of Exserohilum spp. infections published before the outbreak in order to provide a better understanding of the organism and its wider spectrum of human disease. Methods: Cases of Exserohilum infections were retrieved by searching PUBMED using terms “Exserohilum”, “Drechslera halodes”, “Drechslera longirostrata”, “Drechslera rostrata”, “ halodes”, “Bipolaris rostrata”, “Helminthosporium halodes”, “Helminthosporium rostrata”, “Luttrellia rostrata” and “ rostrata”. Demographic data, underlying conditions, microbiology, clinical manifestations, therapy and outcome were recorded and analyzed. Results: We studied 49 evaluable pre-outbreak cases, 41% of which were reported from 2002 to 2012. The majority were reported from southern USA (55%) or India and Israel (26%). Median age was 25 (IQR, 11 to 44) years with a 1.7:1 M:F ratio. Most infections (59%) were due to Exserohilum rostratum followed by Exserohilum longirostratum (8%), Exserohilum mcginnissi (1%) while 15% unidentified species. The most frequent predisposing factors were immunosuppression (49%), trauma (12%) and atopy (12%). Exserohilum disease manifested as sinusitis in 43%, skin infections 35%, invasive infections (in lungs, brain or bones) 25% and keratitis in 14%. In 20% of cases, concomitant multifocal lesions were reported. Antifungal therapy consisted mainly of amphotericin B (40%), alone or combined with a triazole. Surgery was used in 49% of cases and in 33% with antifungal therapy. Outcome was unfavorable in 8 (16%) cases while, notably, all of those who died except one had an underlying hematological malignancy. Conclusions: Exserohilum spp. infections are reported with increasing frequency. Sinusitis is the predominant manifestation. It affects young immunosuppressed and immunocompetent individuals. Antifungal therapy and surgical intervention, when indicated, may improve outcome.