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Mould Identification: A Virtual Self Assessment

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Unknown 3 = Lomentospora prolificans

Case History
A 73 year old man on chemotherapy for AML - Fludarabine, Cytarabine with gCSF. Profound pancytopenia from day 5 post chemotherapy. Developed rigor and fever on day 14 with no foacl symptoms or signs. Empiric antibacterials commenced - cefepime and gentamicin. Ongoing sepsis therefore antibiotics replaced after 4 days with meropenem and teicoplanin. Liposomal Amphotericin added after 7 days. Erythematous rash was also noted at this time and blood cultures grew the fungus below.
Clinical Presentation
One of the erythematous skin papules on the thighs.

In the Australian Scedosporium Study, to date 5 cases of L. prolificans have been reported from blood cultures and have all been associated with a rash - this may be a useful clinical marker.
Culture

Culture of L. prolificans on Sabouraud's dextrose agar are rapid growing, flat, spreading, olive-grey to black and often have an initial yeast like appearance but soon become suede-like to downy with age.
Microscopy

Microscopic morphology of Lomentospora prolificans. Conidia are borne in small groups on distinctive basally swollen, flask-shaped annellides, which occur singly or in clusters along the vegetative hyphae. Conidia are single-celled, hyaline to pale-brown, ovoid to pyriform and have smooth thin walls. Lomentospora prolificans is distinguished from Scedosporium apiospermum, by having basally swollen (inflated), flask-shaped annellides, slower colony development on nutrient agar media, and by not growing on media containing cycloheximide (actidione).
Comment: Lomentospora prolificans appears to occupy a restricted geographic range, with infections occurring mainly in Australia, Spain, and the United States. L. prolificans infections are refractory to antifungal therapy and are associated with high mortality. Major risk factors include malignancy, cystic fibrosis, and solid organ transplantation. The main clinical presentations are disseminated infection and pulmonary mycoses, followed by bone and joint infections.

About Lomentospora Back to Virtual Assessment

What is your identification?

Phialophora verrucosa
Scedosporium apiospermum
Lomentospora prolificans

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Dr David Ellis
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