Abstract：
Scedosporium/Lomentospora species exist as saprophytic moulds that can potentially lead to serious infections in patients who have experienced near-drowning incidents. Scedosporium species are distributed across different regions of the world while Lomentospora prolificans has quite a restricted geographic distribution. We aimed to systematically review scedosporiosis cases after near-drowning, their clinical manifestations, underlying diseases, treatments, outcomes and its impact through disability-adjusted life years (DALYs). Five available sources were searched from 1 January 2007, to 20 April 2022. Thirty-eight studies, including 41 patients, were evaluated. Mean age was 33.6 ± 18.6 years (range 1-68), and 28 were male (68.3%). Central nervous system (CNS) dissemination predominated (36/41; 87.8%), presenting mainly as multiple brain abscesses (26/41; 63.4%), followed by lung involvement (22/41; 56.4%). Scedosporium apiospermum species complex was the most causative agent (38/41; 92.7%). Overall mortality was 51.2%. Half of the patients (18/37) were cured after receiving proper treatment, and in most cases, voriconazole alone or in combination with surgery or other antifungals caused survival. The mean survival time was 123 ± 27 days. Mean DALYs in 1980-2022 were 46.110 ± 3.318 (39.607-52.612). Time to diagnosis was estimated to be 120 days, and there was no association between time to diagnosis and outcome. Voriconazole is a potentially effective therapy, and combination of surgery and antifungal treatment may lead to more favourable outcome. Advances in early diagnosis and appropriate antifungal therapy may have contributed to reducing its mortality.
摘要：
Scedosporium/Lomentospora物种以腐生霉菌的形式存在，可能导致经历过溺水事件的患者严重感染。Scedosporium物种分布在世界不同地区，而Lomentosporaprolificans的地理分布相当有限。我们的目的是系统地回顾接近溺水后的scedosporiosis病例，他们的临床表现，潜在的疾病，治疗,结果及其通过残疾调整生命年(DALYs)的影响。从2007年1月1日至2022年4月20日搜索了五个可用来源。38项研究,包括41个病人,进行了评估。平均年龄为33.6±18.6岁（范围1-68岁），男性28人(68.3%)。中枢神经系统（CNS）传播占主导地位（36/41;87.8％），主要表现为多发性脑脓肿（26/41；63.4%），其次是肺受累（22/41；56.4%）。尖孢孢子菌是最致病的病原体（38/41；92.7％）。总死亡率为51.2%。一半的患者（18/37）在接受适当治疗后治愈，在大多数情况下,伏立康唑单独或与手术或其他抗真菌药物联合使用导致存活。平均生存时间为123±27天。1980-2022年的平均DALYs为46.110±3.318(39.607-52.612)。确诊时间估计为120天,诊断时间和结局之间没有关联.伏立康唑是一种潜在的有效疗法,手术和抗真菌治疗的组合可能导致更有利的结果。早期诊断和适当抗真菌治疗的进展可能有助于降低其死亡率。
