Scedosporium and Lomentospora: an updated overview of underrated opportunists Andoni Ramirez-Garcia, Aize Pellon, Aitor Rementeria, Idoia Buldain, Eliana Barreto-Bergter, Rodrigo Rollin-Pinheiro, Jardel Vieira Meirelles, Mariana Ingrid D. S. Xisto, Stephane Ranque, Vladimir Havlicek, et al. To cite this version: Andoni Ramirez-Garcia, Aize Pellon, Aitor Rementeria, Idoia Buldain, Eliana Barreto-Bergter, et al.. Scedosporium and Lomentospora: an updated overview of underrated opportunists. Medical Mycol- ogy, Oxford University Press, 2018, 56 (1), pp.S102-S125. 10.1093/mmy/myx113. hal-01789215 HAL Id: hal-01789215 https://hal.archives-ouvertes.fr/hal-01789215 Submitted on 10 Apr 2019 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Medical Mycology, 2018, 56, S102–S125 doi: 10.1093/mmy/myx113 Review Article Review Article Downloaded from https://academic.oup.com/mmy/article-abstract/56/suppl_1/S102/4925971 by SCDU Mediterranee user on 10 April 2019 Scedosporium and Lomentospora: an updated overview of underrated opportunists Andoni Ramirez-Garcia1,∗, Aize Pellon1, Aitor Rementeria1, Idoia Buldain1, Eliana Barreto-Bergter2, Rodrigo Rollin-Pinheiro2, Jardel Vieira de Meirelles2, Mariana Ingrid D. S. Xisto2, Stephane Ranque3, Vladimir Havlicek4, Patrick Vandeputte5,6, Yohann Le Govic5,6, Jean-Philippe Bouchara5,6, Sandrine Giraud6, Sharon Chen7, Johannes Rainer8, Ana Alastruey-Izquierdo9, Maria Teresa Martin-Gomez10, Leyre M. Lopez-Soria´ 11, Javier Peman12, Carsten Schwarz13, Anne Bernhardt14, Kathrin Tintelnot14, Javier Capilla15, Adela Martin-Vicente15,16, Jose Cano-Lira15, Markus Nagl17, Michaela Lackner17, Laszlo Irinyi18, Wieland Meyer18, Sybren de Hoog19 and Fernando L. Hernando1 1Fungal and Bacterial Biomics Research Group, Department of Immunology, Microbiology and Para- sitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa, Spain, 2Instituto de Microbiologia, UFRJ, Rio de Janeiro, RJ, Brazil, 3Laboratoire de Parasitologie-Mycologie, AP-HM / CHU Timone, Marseille, France, 4Institute of Microbiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic, 5Laboratoire de Parasitologie-Mycologie, CHU, Angers, France, 6Host- Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Angers, France, 7Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, The Univer- sity of Sydney, New South Wales, Australia, 8Institute of Microbiology, Leopold-Franzens University Innsbruck, Austria, 9Mycology Reference Laboratory, National Centre for Microbiology. Instituto de Salud Carlos III. Majadahonda, Madrid, Spain, 10Microbiology Department. Hospital Universitari Vall d’Hebron, Barcelona, Spain, 11Microbiology Department. Hospital Universitario Cruces, Barakaldo, Spain, 12Microbiology Department, Hospital Universitario y Politecnico´ La Fe, Valencia, Spain, 13Cystic Fibrosis Centre Berlin/Charite-Universit´ atsmedizin¨ Berlin, Germany, 14Mycotic and Parasitic Agents and My- cobacteria, Robert Koch Institute, Berlin, Germany, 15Mycology Unit, Medical School and IISPV, Universi- tat Rovira i Virgili, Reus, Spain, 16Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN USA, 17Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria, 18Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School, Sydney Medical School – West- mead Hospital, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead Institute for Medical Research, Sydney, New South Wales, Australia and 19Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands ∗To whom correspondence should be addressed. Dr. Andoni Ramirez-Garcia, Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Leioa 48940, Bizkaia, Spain. Tel: +34-946-015090; Fax: +34-946-013500; E-mail: [email protected] Received 1 June 2017; Revised 17 August 2017; Accepted 10 October 2017; Editorial Decision 8 September 2017 S102 C The Author(s) 2017. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: [email protected] Ramirez-Garcia et al. S103 Abstract Species of Scedosporium and Lomentospora are considered as emerging opportunists, affecting immunosuppressed and otherwise debilitated patients, although classically they are known from causing trauma-associated infections in healthy individuals. Clinical manifestations range from local infection to pulmonary colonization and severe invasive disease, in which mortality rates may be over 80%. These unacceptably high rates are due to the clinical status of patients, diagnostic difficulties, and to intrinsic antifungal re- Downloaded from https://academic.oup.com/mmy/article-abstract/56/suppl_1/S102/4925971 by SCDU Mediterranee user on 10 April 2019 sistance of these fungi. In consequence, several consortia have been founded to increase research efforts on these orphan fungi. The current review presents recent findings and summarizes the most relevant points, including the Scedosporium/Lomentospora taxon- omy, environmental distribution, epidemiology, pathology, virulence factors, immunol- ogy, diagnostic methods, and therapeutic strategies. Key words: fungi, pathogen, emergent, infection. Introduction The high mortality rates of deep and disseminated infec- tions necessitate focusing resources and efforts to cope with Nearly all pathogenic fungi are present in the environ- the challenges posed by Scedosporium and Lomentospora ment adapted to very different habitats where they play species, such as improving diagnostic methods, or designing varying roles in recycling of organic matter. With some of new effective therapies. their causative agents being either opportunistic or primary Therefore, the members of the Scedosporium working pathogens, fungal infections show an increasing incidence group of the International Society for Human and Animal worldwide, affecting millions of individuals, with mortality Mycology (ISHAM), present at their 5th Workshop in Bil- rates that may be higher than 50% in susceptible patient bao in 2016, decided to prepare a detailed review describ- populations.1 ing the taxonomy, environmental distribution, epidemiol- Among pathogenic fungi, Scedosporium species, includ- ogy, pathology, virulence factors, immunology, diagnostic ing Lomentospora prolificans (formerly Scedosporium pro- methods, and available therapeutic strategies. lificans),2 can cause infections in both immunocompetent and immunocompromised hosts, where they can act as pri- mary or opportunistic pathogens.3,4 These species cause a Taxonomy, DNA barcoding, and new species broad range of clinical manifestations, from colonization of The nomenclature of the genus Scedosporium/Pseudalle- the respiratory tract, superficial infections and allergic reac- scheria has undergone numerous changes over the last tions, to severe invasive localized or disseminated mycoses. decade following the introduction of molecular phyloge- Patients at risk are particularly those immunocompromised netics, which led to an increasing resolution at and below 3,5 and with hematological malignancies. Individuals suf- the species level. In addition, the fundamental change in fering from near-drowning events in water polluted with fungal taxonomy allowing only a single name per fun- fungal propagules are also at risk of infections with central gal species, effectively abolishing the dual nomenclature 5 nervous system (CNS) involvement. based on the anamorph/teleomorph concept,13 resulted in Moreover, Scedosporium/Lomentospora are among the the adoption of the name Scedosporium at the expense of most commonly recovered fungi from respiratory se- Pseudallescheria.2 cretions of patients suffering from chronic pulmonary The first comprehensive revision of the genus conducted 6 conditions such as cystic fibrosis (CF). Although they in 2005 by Gilgado et al.14 using four genetic loci (β-tubulin 7,8 are mostly asymptomatic colonizers, this may be (BT2 (= exon 2–4) and TUB (= exon 5–6)), calmodulin the first step toward pathology. L. prolificans typi- and the internal transcribed spacer regions (ITS1/2) of the cally causes disseminated infections in immunocompro- rDNA gene cluster) recognized S. apiospermum (incl. P. mised patients, where it is associated with high mortal- boydii) as a species complex, in addition to S. auranti- 3,8–11 ity. Scedosporium boydii and S. apiospermum are acum and S. minutisporum. Within the S. apiospermum/P. the most frequently isolated species, but in some regions boydii complex, three existing species were recognized: S. aurantiacum is more common. The high degrees of in- P. angusta, P. ellipsoidea, and P. fusoidea.14 A second trinsic antifungal resistance make these infections difficult revision