PDF(Pubmed)
Abstract：
BACKGROUND: Scedosporium apiospermum (S. apiospermum) belongs to the asexual form of Pseudallescheria boydii and is widely distributed in various environments. S. apiospermum is the most common cause of pulmonary infection; however, invasive diseases are usually limited to patients with immunodeficiency.
METHODS: A 54-year-old Chinese non-smoker female patient with normal lung structure and function was diagnosed with pulmonary S. apiospermum infection by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). The patient was admitted to the hospital after experiencing intermittent right chest pain for 8 months. Chest computed tomography revealed a thick-walled cavity in the upper lobe of the right lung with mild soft tissue enhancement. S. apiospermum was detected by the mNGS of BALF, and DNA sequencing reads were 426. Following treatment with voriconazole (300 mg q12h d1; 200 mg q12h d2-d20), there was no improvement in chest imaging, and a thoracoscopic right upper lobectomy was performed. Postoperative pathological results observed silver staining and PAS-positive oval spores in the alveolar septum, bronchiolar wall, and alveolar cavity, and fungal infection was considered. The patient\'s symptoms improved; the patient continued voriconazole for 2 months after surgery. No signs of radiological progression or recurrence were observed at the 10-month postoperative follow-up.
CONCLUSIONS: This case report indicates that S. apiospermum infection can occur in immunocompetent individuals and that the mNGS of BALF can assist in its diagnosis and treatment. Additionally, the combined therapy of antifungal drugs and surgery exhibits a potent effect on the disease.
METHODS: A 54-year-old Chinese non-smoker female patient with normal lung structure and function was diagnosed with pulmonary S. apiospermum infection by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). The patient was admitted to the hospital after experiencing intermittent right chest pain for 8 months. Chest computed tomography revealed a thick-walled cavity in the upper lobe of the right lung with mild soft tissue enhancement. S. apiospermum was detected by the mNGS of BALF, and DNA sequencing reads were 426. Following treatment with voriconazole (300 mg q12h d1; 200 mg q12h d2-d20), there was no improvement in chest imaging, and a thoracoscopic right upper lobectomy was performed. Postoperative pathological results observed silver staining and PAS-positive oval spores in the alveolar septum, bronchiolar wall, and alveolar cavity, and fungal infection was considered. The patient\'s symptoms improved; the patient continued voriconazole for 2 months after surgery. No signs of radiological progression or recurrence were observed at the 10-month postoperative follow-up.
CONCLUSIONS: This case report indicates that S. apiospermum infection can occur in immunocompetent individuals and that the mNGS of BALF can assist in its diagnosis and treatment. Additionally, the combined therapy of antifungal drugs and surgery exhibits a potent effect on the disease.
摘要：
背景：Scedosporiumapiospermum（S.apiospermum）属于Pseudallescheriaboydii的无性形式，广泛分布在各种环境中。夏草是肺部感染的最常见原因；然而，侵袭性疾病通常仅限于免疫缺陷患者。
方法：一名54岁的中国非吸烟者女性患者，肺结构和功能正常，通过支气管肺泡灌洗液（BALF）的宏基因组下一代测序（mNGS）诊断为肺S.apiospermum感染。患者在经历了8个月的间歇性右胸痛后入院。胸部计算机断层扫描显示右肺上叶有一个厚壁腔，软组织轻度增强。BALF的MNGS检测到了美国的青草，和DNA测序读数为426。伏立康唑治疗后（300mgq12hd1;200mgq12hd2-d20），胸部成像没有改善，并进行了胸腔镜右上叶切除术。术后病理结果观察肺泡隔银染和PAS阳性卵形孢子，细支气管壁，和肺泡腔，考虑真菌感染。患者症状改善；患者术后持续伏立康唑2个月。术后10个月随访时，未观察到放射学进展或复发的迹象。
结论：本病例报告表明，在免疫功能正常的个体中可发生夏培菌感染，BALF的mNGS可以协助其诊断和治疗。此外,抗真菌药物和手术的联合治疗对该疾病具有有效的作用。
方法：一名54岁的中国非吸烟者女性患者，肺结构和功能正常，通过支气管肺泡灌洗液（BALF）的宏基因组下一代测序（mNGS）诊断为肺S.apiospermum感染。患者在经历了8个月的间歇性右胸痛后入院。胸部计算机断层扫描显示右肺上叶有一个厚壁腔，软组织轻度增强。BALF的MNGS检测到了美国的青草，和DNA测序读数为426。伏立康唑治疗后（300mgq12hd1;200mgq12hd2-d20），胸部成像没有改善，并进行了胸腔镜右上叶切除术。术后病理结果观察肺泡隔银染和PAS阳性卵形孢子，细支气管壁，和肺泡腔，考虑真菌感染。患者症状改善；患者术后持续伏立康唑2个月。术后10个月随访时，未观察到放射学进展或复发的迹象。
结论：本病例报告表明，在免疫功能正常的个体中可发生夏培菌感染，BALF的mNGS可以协助其诊断和治疗。此外,抗真菌药物和手术的联合治疗对该疾病具有有效的作用。
