Pneumonia Caused by Scedosporium in Non-Transplant and Non-Hiv-infected Adults：a Case Series and Review of the Literature

The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its intrinsic resistance to all current antifungal agents, treatment of Scedosporium infections still remains a great challenge. Voriconazole has been recommended to the first-line systemic treatment of Scedosporium infections, but the duration is not well recommended, especially for immunocompetent patients. This case series presented our experience on diagnostic, manifestation, and treatment strategies of Scedosporium pneumonia. The case records of non-Transplanted non-HIV adults with Scedosporium pneumonia hospitalized in our Hospital from January 2020 to February 2022 were retrospectively analyzed, and their case characteristics, antifungal therapy drug selection and treatment course were summarized: All 3 patients had underlying lung disease, 2 female patients had a history of bronchiectasis, and 1 male patient had a history of emphysema. Both female patients had a mixed infection with Scedosporium and nontuberculous mycobacteria. In one female patients, Scedosporium was no longer detected after 2 months of treatment with voriconazole, and the clinical symptoms were improved than before, with no significant change in imaging. In one female patient, although Scedosporium was still isolated from sputum after 12 months with voriconazole treatment, the symptoms were improved than before, and antifungal therapy was discontinued after no significant improvement 1 and a half months after switching to Posaconazole. In one male patient, Scedosporium was no longer detected after 3 months treatment with voriconazole, and the clinical symptoms and imaging were significantly improved. Three patients had voriconazole concentrations between 1.1-2.8 μg/mL during treatment.