EXPERIENCE WITH INFECTION BY SCEDOSPORIUM PROLIFICANS INCLUDING APPARENT CURE WITH FLUCONAZOLE THERAPY

Five cases of human infection with Scedosporium prolificans are descri bed. There were two groups of patients. In group one, two were immunoc ompetent males with localized bone and joint infections, a man with po st-traumatic septic arthritis, responded to surgical treatment alone a nd a boy with post-traumatic septic arthritis, appeared to respond to treatment with oral fluconazole, without surgery. The second group con sisted of three immunocompromised patients. S. prolificans was isolate d at autopsy from the hings of one patient with acute leukaemia, and f rom the lungs, liver, and kidneys of another. Nosocomial S. prolifican s infection of a synthetic vascular graft occurred in the third patien t with end-stage renal failure on corticosteroid therapy for idiopathi c hypereosinophilia. His infection faied to respond to combinations of surgery, fluconazole and itraconazole. All isolates of S. prolificans were resistant in vitro to antifungal drugs, including the first case , which responded clinically to fluconazole.