First Report of Scedosporium aurantiacum Endocarditis in an Immunocompetent Chinese Male and Literature Review

Chen Liu, Xiaohua Qin, Pei Zhang, Liping Wang, Yunfeng Deng Department of Katharine Hsu International Research Center of Human Infectious Diseases, Public Health Clinical Center Affiliated to Shandong University, Jinan, People’s Republic of ChinaCorrespondence: Liping Wang; Yunfeng Deng, Email [email protected]; [email protected]: Scedosporium aurantiacum is a rare opportunistic pathogen distributed worldwide. S. aurantiacum can cause invasive infections in both immunocompromised and immunocompetent individuals following exposure to contaminated environments. The risk associated with wastewater exposure is an important public health concern. Owing to its multi-drug resistance, the treatment of S. aurantiacum infection is very challenging.Case Presentation: We report a case of a 44-year-old Chinese male with disseminated infection and endocarditis caused by S. aurantiacum after falling into a nearly dry wastewater pool. S. aurantiacum isolated from blood cultures was identified using nanopore sequencing technology of internal transcribed spacer 1 (ITS1) and matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF MS). In vitro antifungal susceptibility testing indicated that voriconazole was the most active agent with a minimum inhibitory concentration (MIC) of 0.5 μg/mL. Despite receiving appropriate antifungal therapy, the patient died 12 days after fungal isolation because of uncontrolled infection and systemic organ failure.Conclusion: This is the first reported clinical case of S. aurantiacum endocarditis in China. This case highlights that even in immunocompetent patients, S. aurantiacum infection should be considered. For clinicians, understanding a detailed history of the contaminated environments that the patient has been exposed to is crucial for early diagnosis. Nanopore sequencing offers a new option for identifying S. aurantiacum. Drug susceptibility testing is essential for determining the most appropriate antimycotic agent.Keywords: Scedosporium aurantiacum, immunocompetent patient, disseminated infection, infective endocarditis, nanopore sequencing technology, multi-drug resistance