### Microbiology A fungus, includes *[[Lomentospora]]* *prolificans* and *L*. *infatum*. Was *Scedosporium* aka *[[Pseudallescheria]]*. ### Epidemiologic Risks More common in temperate areas, it has been found in soil, animals and "brackish water and saltwater, sewage, soil, swamps, coastal tidelands, manure of poultry (chicken coop, bird guano) and cattle, and bat feces." [^1] ### Syndromes The occasional [[pneumonia]] and disseminated disease in the immunoincompetent, skin and joint infections (mycetoma) in normal hosts. It can also cause eye infection after penetrating injury. [^2] Infections in near-drowning. ### Treatment Debride as much as is humanly possible. Possibly, maybe, perhaps [[voriconazole]], [[Posaconazole]], and ravuconazole based on *in* *vitro* reports and a smattering of case reports. Perhaps combined with [[Terbinafine]]. [[Voriconazole]] AND [[Terbinafine]] may be best. [^3] Usually resistant to [[Amphotericin B]], [[fluconazole]], intermediate to [[caspofungin]]. In one series, if susceptible, about 60% of patients responded to long-term [[voriconazole]], especially if they were infected with *[[Lomentospora]]* *prolificans*. [^4] ### Curious Cases [Is It Real?](http://www.pusware.com/PW7/IsItReal.html) ### Rationalizations [^1]: Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, Buchanan W, Milanovich J, Sutton DA, Fothergill A, Rinaldi MG, Shea YR, Zaoutis T, Kottilil S, Walsh TJ. Infections caused by Scedosporium spp. Clin Microbiol Rev. 2008 Jan;21(1):157-97. doi: 10.1128/CMR.00039-07. PMID: 18202441; PMCID: PMC2223844. [^2]: Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, Buchanan W, Milanovich J, Sutton DA, Fothergill A, Rinaldi MG, Shea YR, Zaoutis T, Kottilil S, Walsh TJ. Infections caused by Scedosporium spp. Clin Microbiol Rev. 2008 Jan;21(1):157-97. doi: 10.1128/CMR.00039-07. PMID: 18202441; PMCID: PMC2223844. [^3]: Jenks JD, Seidel D, Cornely OA, Chen S, van Hal S, Kauffman C, Miceli MH, Heinemann M, Christner M, Jover Sáenz A, Burchardt A, Kemmerling B, Herbrecht R, Steinmann J, Shoham S, Gräber S, Pagano L, Deeren D, Aslam S, Taplitz R, Revankar SG, Baddley J, Mehta SR, Reed S, Slavin MA, Hoenigl M. [[Voriconazole]] plus [[Terbinafine]] combination antifungal therapy for invasive [[Lomentospora]] prolificans infections: analysis of 41 patients from the FungiScope® registry 2008-2019. Clin Microbiol Infect. 2020 Jun;26(6):784.e1-784.e5. doi: 10.1016/j.cmi.2020.01.012. Epub 2020 Jan 20. PMID: 31972317. [^4]: Troke P, Aguirrebengoa K, Arteaga C, Ellis D, Heath CH, Lutsar I, Rovira M, Nguyen Q, Slavin M, Chen SC; Global Scedosporium Study Group. Treatment of scedosporiosis with [[voriconazole]]: clinical experience with 107 patients. Antimicrob Agents Chemother. 2008 May;52(5):1743-50. doi: 10.1128/AAC.01388-07. Epub 2008 Jan 22. PMID: 18212110; PMCID: PMC2346616.