ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others
A.M. Tortorano
(1)
,
M. Richardson
(2, 3)
,
E. Roilides
(4)
,
A. van Diepeningen
,
M. Caira
(5)
,
P. Munoz
(6)
,
E. Johnson
(7)
,
J. Meletiadis
(8)
,
Z.-D. Pana
(4)
,
M. Lackner
(9)
,
P. Verweij
(10)
,
T. Freiberger
(11)
,
O.A. Cornely
(12)
,
S. Arikan-Akdagli
(13)
,
E. Dannaoui
(14, 15)
,
A.H. Groll
(16)
,
K. Lagrou
(17)
,
A. Chakrabarti
(18)
,
F. Lanternier
(19, 20, 21, 22)
,
L. Pagano
(5)
,
A. Skiada
(8)
,
M. Akova
(13)
,
M.C. Arendrup
(23)
,
T. Boekhout
(24, 25)
,
A. Chowdhary
(26)
,
M. Cuenca-Estrella
(27)
,
J. Guinea
(6)
,
J. Guarro
(28)
,
S. de Hoog
,
W. Hope
(29)
,
S. Kathuria
(26)
,
O. Lortholary
(30, 21, 22)
,
J.F. Meis
(10, 31)
,
A.J. Ullmann
(32)
,
G. Petrikkos
(8)
,
C. Lass-Flörl
(9)
1
UNIMI -
Università degli Studi di Milano = University of Milan
2 University Hospital of South Manchester
3 University of Manchester [Manchester]
4 Aristotle University of Thessaloniki
5 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
6 Hospital General Universitario "Gregorio Marañón" [Madrid]
7 Health Protection Agency
8 NKUA - National and Kapodistrian University of Athens
9 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
10 Radboud University [Nijmegen]
11 MUNI - Masaryk University [Brno]
12 Universität zu Köln = University of Cologne
13 Hacettepe University = Hacettepe Üniversitesi
14 Unité de Parasitologie-Mycologie [CHU HEGP]
15 UPD5 - Université Paris Descartes - Paris 5
16 UKM - University Hospital Münster - Universitaetsklinikum Muenster [Germany]
17 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
18 Post Graduate Institute of Medical Education & Research [Chandigarh, India]
19 Service des Maladies infectieuses et tropicales [CHU Necker]
20 Centre d'infectiologie Necker-Pasteur [CHU Necker]
21 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
22 Mycologie moléculaire
23 Statens Serum Institut [Copenhagen]
24 UMCU - University Medical Center [Utrecht]
25 Second Military Medical University [Shanghai]
26 University of Delhi
27 ISC - Instituto de Salud Carlos III [Madrid]
28 Universitat Rovira i Virgili
29 University of Liverpool
30 Hôpital Necker - Enfants Malades [AP-HP]
31 Canisius-Wilhelmina Hospital [Nijmegen, The Netherlands]
32 JMU - Julius-Maximilians-Universität Würzburg = University of Würzburg
2 University Hospital of South Manchester
3 University of Manchester [Manchester]
4 Aristotle University of Thessaloniki
5 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
6 Hospital General Universitario "Gregorio Marañón" [Madrid]
7 Health Protection Agency
8 NKUA - National and Kapodistrian University of Athens
9 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
10 Radboud University [Nijmegen]
11 MUNI - Masaryk University [Brno]
12 Universität zu Köln = University of Cologne
13 Hacettepe University = Hacettepe Üniversitesi
14 Unité de Parasitologie-Mycologie [CHU HEGP]
15 UPD5 - Université Paris Descartes - Paris 5
16 UKM - University Hospital Münster - Universitaetsklinikum Muenster [Germany]
17 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
18 Post Graduate Institute of Medical Education & Research [Chandigarh, India]
19 Service des Maladies infectieuses et tropicales [CHU Necker]
20 Centre d'infectiologie Necker-Pasteur [CHU Necker]
21 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
22 Mycologie moléculaire
23 Statens Serum Institut [Copenhagen]
24 UMCU - University Medical Center [Utrecht]
25 Second Military Medical University [Shanghai]
26 University of Delhi
27 ISC - Instituto de Salud Carlos III [Madrid]
28 Universitat Rovira i Virgili
29 University of Liverpool
30 Hôpital Necker - Enfants Malades [AP-HP]
31 Canisius-Wilhelmina Hospital [Nijmegen, The Netherlands]
32 JMU - Julius-Maximilians-Universität Würzburg = University of Würzburg
Résumé
Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation.