A propos de cinq cas d'infections à Scedosporium apiospermum

We report five cases of infection due to Scedosporium apiospermum and his teleomorph Pseudallescheria boydii (Ascomycete), diagnosed in the University Amiens Hospital. The most important clinical, epidemiological and diagnostic aspects a summurized in the next table. Nb year sex age job clinical statute site mycology (direct culture histology) Ampho B (S or R) TT 1 1992 F 31 secretary sinusitis sinus + S. apiospermum + S surg 2 1993 F 8 schoolgirl cystic fibrosis lung + P. boydii NR R physio 3 1993 M 66 pensioner corticoid cut/scut + S. apiospermum + R keto 4 1994 M 54 farmer corticoid sinus + P. boydii + S surg 5 1994 M 69 pensioner corticoid scut + S. apiospermum NR R surg ampho B: amphotericin B; tt: treatment; histo: histology; S or R: sensitive or resistant; surg: surgery; NR: non realized; physio: physiotherapy, cut/scut: cutaneous/subcutaneous. keto: ketoconazole. Epidemiology. The five cases concern french people living in Picardy (France). All have risk factors: corticotherapy, cystic fibrosis, sinusitis. The average age is 46 years with a sex-ratio 1,5. All the people are living in a rural area and one of them is farmer. The mode of contamination is probably the respiratory tract for the cases 1, 2 and 4. For the third one, the patient reported pricks during a walk in forest. The case 5 occured after forearm surgery. Clinical aspects. The young woman had a past of bacterial sinusal infection with posterior discharge since one year. Unsuccessful treatment With antibiotics and corticoids could explain the development of the fungus. The young girl affected by cystic fibrosis had no modification of the respiratory capacity and we concluded to a simple colonisation of the respiratory tract. For the case 5, the infection by Scedosporium didn't explain the death of the patient three days later. No case led to disseminated infection even for the patients under long-term corticotherapy. Mycology. The teleomorph, P. boydii was observed in only two cases with development of cleistothecia after several weeks of culture at room temperature. In all cases, direct examination showed numerous hyphae excepted the case 4, which showed numerous fungal cells with rare hyphae. Three of the five strains were "in vitro" resistant to amphotericine B and all were sensitive to ketoconazole. Treatment. The treatment were successful in all cases. Conclusion. These five cases of infection due to S. apiospermum are very similar to those described in the literature. Surgery seems to be the best treatment possible. All the strains exhibited low pathogenic power that proves the opportunistic character of this fungus