Scedosporium aurantiacum (apiospermum complex)

The donor was a victim of near-drowning and has bilateral lobar consolidation, fever and elevated white blood cell count. Sputum, urine and blood cultures were reported as negative. Three organ recipients (heart, two kidneys) developed fatal scedosporiosis following transplantation of organs from the same deceased nearly-drowned donor; two other recipients (split liver) who received prophylactic voriconazole did not develop any subsequent signs of infection. On post-transplant day 7, the heart transplant recipient presented with high white cell blood count (40,380 cells/mm3), intra-cerebral haemorrhage and seizures. Scedosporium spp. was isolated from blood cultures on day +11. Renal recipient 1 developed altered mental status on post-operative day 23, pulmonary consolidation and pleural effusion, and died on day +36. Renal recipient 2 developed generalised weakness 4 weeks post-transplant, skin abscess in the area overlaying the graft site, and endophthalmitis; the patient died on day 58. Cultures form various sites were positive for Scedosporium spp. The liver recipient received liposomal amphotericin B 1 mg/kg/day between post-transplant day (PT) 1 and 8 as per routine protocol; following diagnosis in the other recipients, oral voriconazole 8 mg/kg/day was given from PT 42 and switched to fluconazole 400mg po qd from PT 80 to PT 220. He was followed until PT 340 without any sign of infection. The second liver recipient (pediatric patient, split liver) received itraconazole prophylaxis for 4 weeks, according to the centre protocol; this was changed to Voriconazole until PT 188 and she was followed to PT 350, without any sign of infection.