Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections.

IF 19 1区 医学 Q1 MICROBIOLOGY Clinical Microbiology Reviews Pub Date : 2024-06-13 Epub Date: 2024-03-29 DOI:10.1128/cmr.00004-23
Chin Fen Neoh, Sharon C-A Chen, Fanny Lanternier, Shio Yen Tio, Catriona L Halliday, Sarah E Kidd, David C M Kong, Wieland Meyer, Martin Hoenigl, Monica A Slavin
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Abstract

SUMMARYAlthough Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.

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Scedosporiosis 和 lomentosporiosis:从现代角度看这些难以治疗的罕见霉菌感染。
摘要虽然头孢菌属(Scedosporium species)和多孔菌属(Lomentospora prolificans)是侵袭性真菌病(IFDs)的不常见病因,但这些感染的死亡率很高,而且用有限的抗真菌药物进行治疗的成本很高。鉴于最近在新型抗真菌药物等方面取得的进展,本综述对这些侵袭性真菌病进行了及时和最新的概述,重点介绍了其分类、临床流行病学、发病机制和宿主免疫反应、疾病表现、诊断、抗真菌药物敏感性和治疗。在过去二十年中,随着免疫调节药物和靶向分子药物的使用增多,接受治疗的人群扩大,以及抗真菌预防措施的广泛采用,面临这些难以治疗的感染风险的宿主也随之增加。临床表现不仅在不同属之间存在差异,而且在不同种的Scedosporium之间也存在差异。多孢子菌(L. prolificans)对大多数现有的抗真菌药物具有内在抗药性,免疫力低下的洛美多孢子菌病患者预后很差。开发和改进诊断方法以早期发现这些罕见的霉菌感染,对于及时进行有针对性的抗真菌治疗和手术(如有必要)至关重要。新的抗真菌药物(如奥洛芬、福斯马诺吉匹克)具有新的作用机制,与现有药物的交叉耐药性较少,可用于口服,药物间相互作用较小,目前已进入后期临床试验阶段,很快就能扩大治疗头孢孢子菌病/洛美多孢子菌病的选择范围。要进一步了解这些感染,尤其是儿科感染,还有很多工作要做。综述中强调了未来研究的知识缺口。
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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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