Rhino-sino-orbital and/or central nervous system infections due to Lomentospora prolificans and Scedosporium spp. in onco-haematology patients
- Author(s)
- Sastre-Escolà, E; Yong, MK; Tio, SY; Douglas, A; Morrissey, CO; Reynolds, G; Chee, L; Bajel, A; Rex, JH; Slavin, M; Neoh, CF;
- Details
- Publication Year 2026-02-28,Volume 64,Issue #3,Page myag016
- Journal Title
- Medical Mycology
- Publication Type
- Research article
- Abstract
- Lomentospora prolificans and Scedosporium spp. are emerging non-Aspergillus moulds causing invasive fungal disease (IFD) in onco-haematology patients. Rhino-sino-orbital and/or central nervous system (CNS) infections are poorly described yet associated with high mortality. We aimed to characterize clinical, microbiological, treatment, and outcome features of rhino-sino-orbital and/or CNS infections due to these moulds in an onco-haematology population. We retrospectively reviewed proven/probable IFD patients with rhino-sino-orbital and/or CNS involvement from 2010 to 2024 caused by L. prolificans and Scedosporium spp. at two Australian tertiary centres in adults with cancer. Eighteen episodes were analysed; 94.5% had haematological malignancy, mainly acute myeloid leukaemia (41.5%), and 53% were haematopoietic stem cell transplant recipients. Lomentospora prolificans predominated (83%) and displayed intrinsic resistance to conventional antifungals. Olorofim showed potent in vitro activity when tested (n = 5, MIC 0.125-0.5 mg/l). Disseminated disease occurred in 78%, mainly affecting lung (79%), CNS (64%), and eye (43%). Initial combination therapy with a voriconazole and terbinafine-including regimen was used in 87.5% and surgery in 50%; olorofim was administered to five patients. Overall mortality was high: 56% at 30-day and 67% at 180-day follow-up, with early death noted if there was CNS involvement (70%). Lower 30-day and 180-day mortality was observed in localized rhino-sino-orbital and Scedosporium spp. infections (0% and 20%, respectively), particularly when surgery and olorofim were used. Our results underline the high mortality from L. prolificans infections in onco-haematology patients with disseminated disease or CNS involvement. Early aggressive surgery and novel antifungals may improve outcomes, but prospective multicentre studies are needed to define optimal treatment strategies.; Lomentospora prolificans and Scedosporium spp. are emerging non-Aspergillus moulds causing invasive fungal disease in onco-haematology patients. Infections at rhino-sino-orbital and/or central nervous system (CNS) sites are poorly described and associated with high mortality. Our objective was to characterize clinical, microbiological, treatment, and outcome features of rhino-sino-orbital and/or CNS infections due to these moulds in the cancer population.; eng
- Publisher
- Oxford University Press
- Keywords
- Humans; *Scedosporium/isolation & purification/drug effects; Male; Female; Middle Aged; Retrospective Studies; Antifungal Agents/therapeutic use/pharmacology; Aged; Adult; *Invasive Fungal Infections/microbiology/drug therapy; *Central Nervous System Fungal Infections/microbiology/drug therapy; *Hematologic Neoplasms/complications; Australia/epidemiology; Young Adult; Aged, 80 and over; Lomentospora prolificans; central nervous system infection; onco-haematology; rhino-sino-orbital infection; scedosporiosis
- Department(s)
- Infectious Diseases; Haematology
- Publisher's Version
- https://doi.org/10.1093/mmy/myag016
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-03-10 04:07:05
Last Modified: 2026-04-07 03:20:36