Note
Invasive scedosporiosis in lung transplant recipients: A nine-year retrospective study in a tertiary care hospital
Escedosporiasis invasora en receptores de trasplante de pulmón: un estudio retrospectivo de nueve años en un hospital de referencia
Elisa Ibáñez-Martíneza,b,◊, Amparo Soléc,f,◊,
, Antonio Cañada-Martínezd, Carlos F. Muñoz-Núñeze, Amparo Pastorc, Beatriz Montullc, Patricia Falomir-Salcedob,f, Amparo Valentínb,f, José Luis López-Hontangasb,f, Javier Pemánb,f
Corresponding author
a Unidad de Biomarcadores y Medicina de Precisión, Instituto de Investigación Sanitaria La Fe, València, Spain
b Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, València, Spain
c Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic La Fe, València, Spain
d Servicio de Bioestadística y Bioinformática, Instituto de Investigación Sanitaria La Fe, València, Spain
e Servicio de Radiología, Hospital Universitari i Politècnic La Fe, València, Spain
f Grupo de Investigación Infección Grave, Instituto de Investigación Sanitaria La Fe, València, Spain
Read
866
Timeswas read the article
134
Total PDF
732
Total HTML
Share statistics
array:23 [ "pii" => "S1130140621000486" "issn" => "11301406" "doi" => "10.1016/j.riam.2021.06.002" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "613" "copyright" => "Asociación Española de Micología" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Iberoam Micol. 2021;38:184-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1130140621000383" "issn" => "11301406" "doi" => "10.1016/j.riam.2021.05.002" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "611" "copyright" => "Asociación Española de Micología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Iberoam Micol. 2021;38:188-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Note</span>" "titulo" => "Anidulafungin versus fluconazole in the treatment of <span class="elsevierStyleItalic">Candida albicans</span> chorioretinitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "188" "paginaFinal" => "191" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anidulafungina versus fluconazol en el tratamiento de la coriorretinitis por <span class="elsevierStyleItalic">Candida albicans</span>" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2034 "Ancho" => 3167 "Tamanyo" => 370054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Images one year after diagnosis. <span class="elsevierStyleItalic">A – Right eye retinography</span>: residual white focal parafoveal scar (white arrow), complete disappearance of the lesions. <span class="elsevierStyleItalic">B –Enhanced depth imaging optical coherence tomography of the right eye</span>: subfoveal disruption in the external limiting membrane, ellipsoid zone and interdigitation zone with retinal pigment epithelium integrity (red asterisk). <span class="elsevierStyleItalic">C – Left eye retinography</span>: normal. <span class="elsevierStyleItalic">D – Enhanced depth imaging optical coherence tomography of the left eye</span>: normal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Celia Ruiz-Arranz, Eugenio Pérez-Blázquez, Almudena De Pablo-Cabrera, Manuel Ferro-Osuna" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Celia" "apellidos" => "Ruiz-Arranz" ] 1 => array:2 [ "nombre" => "Eugenio" "apellidos" => "Pérez-Blázquez" ] 2 => array:2 [ "nombre" => "Almudena" "apellidos" => "De Pablo-Cabrera" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Ferro-Osuna" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140621000383?idApp=UINPBA00004N" "url" => "/11301406/0000003800000004/v1_202111270552/S1130140621000383/v1_202111270552/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130140621000371" "issn" => "11301406" "doi" => "10.1016/j.riam.2021.04.009" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "610" "copyright" => "Asociación Española de Micología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Iberoam Micol. 2021;38:180-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota</span>" "titulo" => "<span class="elsevierStyleItalic">Cyberlindnera fabianii</span>: primer aislamiento clínico en Chile" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "180" "paginaFinal" => "183" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Cyberlindnera fabianii</span>: first clinical isolate in Chile" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2397 "Ancho" => 3175 "Tamanyo" => 438819 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Árbol filogenético obtenido con el análisis de las secuencias de la región ITS de la cepa ChFC 481 y de especies relacionadas mediante el método de máxima verosimilitud. En los nodos se indican los valores <span class="elsevierStyleItalic">bootstrap</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>70% en base al análisis de 1000 réplicas. En negrita se presenta la cepa de nuestro país.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo Álvarez Duarte, Nicolás Cepeda" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Álvarez Duarte" ] 1 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Cepeda" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140621000371?idApp=UINPBA00004N" "url" => "/11301406/0000003800000004/v1_202111270552/S1130140621000371/v1_202111270552/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Note</span>" "titulo" => "Invasive scedosporiosis in lung transplant recipients: A nine-year retrospective study in a tertiary care hospital" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "184" "paginaFinal" => "187" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisa Ibáñez-Martínez, Amparo Solé, Antonio Cañada-Martínez, Carlos F. Muñoz-Núñez, Amparo Pastor, Beatriz Montull, Patricia Falomir-Salcedo, Amparo Valentín, José Luis López-Hontangas, Javier Pemán" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Elisa" "apellidos" => "Ibáñez-Martínez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] 1 => array:4 [ "nombre" => "Amparo" "apellidos" => "Solé" "email" => array:1 [ 0 => "sole_amp@gva.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Cañada-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Carlos F." "apellidos" => "Muñoz-Núñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "Amparo" "apellidos" => "Pastor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Montull" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Patricia" "apellidos" => "Falomir-Salcedo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 7 => array:3 [ "nombre" => "Amparo" "apellidos" => "Valentín" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 8 => array:3 [ "nombre" => "José Luis" "apellidos" => "López-Hontangas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 9 => array:3 [ "nombre" => "Javier" "apellidos" => "Pemán" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Unidad de Biomarcadores y Medicina de Precisión, Instituto de Investigación Sanitaria La Fe, València, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, València, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic La Fe, València, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Bioestadística y Bioinformática, Instituto de Investigación Sanitaria La Fe, València, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitari i Politècnic La Fe, València, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Grupo de Investigación Infección Grave, Instituto de Investigación Sanitaria La Fe, València, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Escedosporiasis invasora en receptores de trasplante de pulmón: un estudio retrospectivo de nueve años en un hospital de referencia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of invasive infections by <span class="elsevierStyleItalic">Scedosporium apiospermum</span> complex and <span class="elsevierStyleItalic">Lomentospora prolificans</span> (<span class="elsevierStyleItalic">Sc/Lp</span>) in lung transplant recipients (LTR) is increasing.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,11</span></a> In fact, <span class="elsevierStyleItalic">Sc/Lp</span> are the most recovered molds in respiratory samples after <span class="elsevierStyleItalic">Aspergillus</span> in LTR. These fungi are a major concern due to their high intrinsic resistance to antifungal drugs<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,10,13</span></a> and have been considered an absolute contraindication for transplantation in some programs.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16,17</span></a> In addition, therapeutic approach has a wide variability among centers and the evidence used is largely based on case studies which have shown highly inconsistent results.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Our aim was to evaluate the incidence, risk factors and outcome of <span class="elsevierStyleItalic">Sc/Lp</span> infection in LTR patients at La Fe University Hospital (Valencia, Spain), a tertiary care hospital with a national reference lung transplant (LT) program.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Clinical data of LTR from whom <span class="elsevierStyleItalic">Sc/Lp</span> was isolated during 2011–2019, were reviewed. Updated EORTC/MSG consensus definitions and International Society for Heart and Lung Transplantation (ISHLT) criteria were used to classify invasive scedosporiosis (IS) episodes as “proven”, “probable” or “possible”.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7,12</span></a> Colonization was defined as positive respiratory samples in asymptomatic patients with absence of characteristics of endobronchial/lung lesions.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1,9,11</span></a><span class="elsevierStyleItalic">Sc/Lp</span> species were isolated and identified using the standard morphological methodology.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> The antifungal susceptibility testing with a microdilution method (SensititreYeastOne, Thermo-Fisher, Madrid, Spain) was performed only on isolates causing therapeutic failure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thirty-day crude mortality and related mortality rates, as well as one-year evolution rate, were reviewed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the study period, a total of 395 LT were performed in our center. Standard immunotherapy consisted of oral cyclosporine (2.5<span class="elsevierStyleHsp" style=""></span>mg/kg/12<span class="elsevierStyleHsp" style=""></span>h), tacrolimus (0.15<span class="elsevierStyleHsp" style=""></span>mg/kg/12<span class="elsevierStyleHsp" style=""></span>h), intravenous mycophenolate mofetil (1500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h during three weeks, and 1000<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h from then on) and methylprednisolone (0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day and tapering down during 3 months to 10<span class="elsevierStyleHsp" style=""></span>mg/day). Induction immunosuppression is not used in our center and, therefore, it was not used in these patients (i.e. anti-lymphocyte globulin or basiliximab). Acute cellular rejection (ACR) episodes associated with grade A2 or higher clinical symptoms were treated. In order to optimize immunosuppression maintenance, the first-line treatment of ACR consisted of intravenous methylprednisolone 10<span class="elsevierStyleHsp" style=""></span>mg/kg daily for 3 days, followed by prednisone, starting at 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day and decreasing by 5<span class="elsevierStyleHsp" style=""></span>mg every five days until the baseline dose. Antifungal prophylaxis in LTR in our center consists of nebulized lipidic amphotericin B. Antifungal preemptive therapy in LT patients previously colonized with <span class="elsevierStyleItalic">Sc/Lp</span> in our center includes any combination of triazoles (voriconazole or posaconazole) and terbinafine. Isavuconazole had not yet been approved when this study started.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There were twelve invasive infections by <span class="elsevierStyleItalic">Sc/Lp</span> within this population (incidence 3.04%), and all of them underwent bilateral LT, except for patient #6. Among these episodes, seven affected the lungs, three involved skin and soft tissue, and two were disseminated infections. All of them were caused by <span class="elsevierStyleItalic">Scedosporium apiospermum</span> complex, except for two pulmonary infections which were caused by <span class="elsevierStyleItalic">L. prolificans</span>. Clinical features, treatment and outcome are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Pretransplant colonization by <span class="elsevierStyleItalic">Sc/Lp</span> has been related to early infection (first month post-transplantation) with poor outcome, despite antifungal prophylaxis.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8,11</span></a> There were eight patients colonized by <span class="elsevierStyleItalic">Sc/Lp</span> before transplantation, three of them developed IS in the early post-operative period (less than 15 days after surgery), and one of them (#1) died after a thoracic dissemination in the context of increased immunosuppression due to acute rejection. Based on our experience, aggressive pretransplant antifungal prophylaxis with a triazole and intensive preemptive antifungal therapy after surgery are crucial to having a good outcome and should be implemented in pretransplant colonized receptors.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Interestingly, the isolation of <span class="elsevierStyleItalic">Sc/Lp</span> in the respiratory tract of LTR does not necessarily mean invasive disease in the late post-transplant period.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> In our study, 9 LTR in whom <span class="elsevierStyleItalic">S. apiospermum</span> complex (4 patients) or <span class="elsevierStyleItalic">L. prolificans</span> (5 patients) were isolated in respiratory samples (sputum, bronchoaspirate or bronchoalveolar lavage) never developed IS (42.8%). <span class="elsevierStyleItalic">Sc/Lp</span> were found from 3 to 50 months after LT, and only two of these patients received a preemptive antifungal treatment. Thus, microbiological findings should be interpreted always in conjunction with patient risk factors, clinical signs and imaging techniques.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There were eight infections in patients suffering either chronic lung allograft dysfunction (4 patients), or acute rejection (4 patients); interestingly, three out of four late infections (more than six months after LT had passed), occurred during chronic (2/4), or acute rejection episodes (1/4). Intensification of immunosuppression was the main risk factor for the fungal infection, as shown in a previous study.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> Cutaneous infection by <span class="elsevierStyleItalic">Sc/Lp</span> usually occurs by traumatic inoculation or by hematogenous dissemination. In our study, the three cutaneous infections found were caused by <span class="elsevierStyleItalic">S. apiospermum</span> complex more than two months after transplantation. These patients were receiving intensive immunosuppressive therapy due to graft rejection episodes. All of them recovered very slowly despite prolonged antifungal treatment (from six months to years of treatment), possibly because the initial focus could not be controlled or a more extensive surgical debridement could not be performed. In absence of previous trauma, a hematogenous dissemination from an undetected respiratory tract colonization was considered the origin of these three episodes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Breakthrough infections were found in 8 of 12 patients (66.7%), six by <span class="elsevierStyleItalic">S. apiospermum</span> complex and two pulmonary infections by <span class="elsevierStyleItalic">L. prolificans</span>; all but one LTR had received prophylaxis with inhaled amphotericin B lipid complex. This is very similar to what is described in the literature, where 67–100% of IS in LTR are breakthrough infections.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2,15,19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">L. prolificans</span> has been associated with sepsis and positive blood cultures in neutropenic patients, we did not find this species in blood or causing disseminated infection. Therefore, neutropenia appears to have more impact on the incidence and severity of disseminated <span class="elsevierStyleItalic">Sc/Lp</span> infections than solid organ transplant immunosuppression regimens.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Sc/Lp</span> infection was treated in all our patients, except for patients #2 and #6, with combined antifungal therapy, being the most frequent combination liposomal amphotericin B plus a triazole (with or without terbinafine). Furthermore, in patients #1, #3, #4 and #5, aerosolized and/or endobronchial instillation of posaconazole was added to the conventional treatment, as we have reported before.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">One year after the <span class="elsevierStyleItalic">Sc/Lp</span> infection 4 of the 12 patients (33.3%) had died (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In two of these four patients (#1 and #4) the death was related to the fungal infection, both by <span class="elsevierStyleItalic">S. apiospermum</span> complex. Patient #1 died after developing a disseminated infection on the 48th day of the immediate postoperative period in spite of salvage therapy administered with posaconazole local instillations. During the first month post-diagnosis only one patient died (#9), but her dead was not related to IS.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In most studies, the <span class="elsevierStyleItalic">Sc/Lp</span> crude mortality rate reported is very high, ranging 30–70%, even 100% for <span class="elsevierStyleItalic">L. prolificans;</span> mortality is usually associated to dissemination, central nervous system infection, fungemia, and lack of recovery of neutrophils.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,8,10</span></a> To our knowledge, the global mortality observed in our study (33.3%) is one of the lowest ever reported. This low mortality could be explained by the lack of central nervous system infections, the few <span class="elsevierStyleItalic">L. prolificans</span> infections and the use of the combination of triazoles (systemic and local) and lipidic amphotericin B (nebulized or intravenous) in an attempt to reproduce the synergy reported in vitro.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Based on this experience, combination therapy including voriconazole plus lipidic amphotericin B, terbinafine, and local therapy with triazoles should be considered to treat refractory cases of tracheobronquial or lung infections by <span class="elsevierStyleItalic">Sc/Lp</span> species, although this proposal must be confirmed in further studies.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The present study had some limitations. The observational and retrospective design, together with the small sample size, did not allow to identify the risk factors for <span class="elsevierStyleItalic">Sc/Lp</span> infection nor the clinical aspects associated to a favorable outcome. Furthermore, the morphological identification of the species could not be confirmed by molecular techniques since most of the isolates were not stored.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Despite the limitations of the study, our case series is the largest invasive Sc/<span class="elsevierStyleItalic">Lp</span> infection in LTR case series ever published in Europe, and we present the lowest attributable mortality ever reported. This low mortality could be related to the aggressive antifungal therapy used post-lung transplant as preemptive and targeted therapy. The incidence of IS in LTR in our setting is 3.04%, with an increase in the risk of breakthrough infections for patients with allograft dysfunction and prolonged prophylaxis with nebulized lipidic amphotericin B. Finally, based on our experience, we highly recommend the implementation of combined antifungal therapy in IS as well as regular monitorization in <span class="elsevierStyleItalic">Sc/Lp</span> colonized LTR with acute or chronic lung dysfunction.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-23" "fechaAceptado" => "2021-06-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1444831" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Scedosporium apiospermum</span>" 1 => "<span class="elsevierStyleItalic">Lomentospora prolificans</span>" 2 => "Invasive mold infection" 3 => "Scedosporiosis" 4 => "Lomentosporiosis" 5 => "Lung transplant" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1444830" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Scedosporium apiospermum</span>" 1 => "<span class="elsevierStyleItalic">Lomentospora prolificans</span>" 2 => "Infección fúngica invasora" 3 => "Escedosporiasis" 4 => "Lomentosporiasis" 5 => "Trasplante de pulmón" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Scedosporium</span> species and <span class="elsevierStyleItalic">Lomentospora prolificans</span> (<span class="elsevierStyleItalic">Sc/Lp</span>) are emerging molds that cause invasive disease associated with a high mortality rate. After <span class="elsevierStyleItalic">Aspergillus</span>, these molds are the second filamentous fungi recovered in lung transplant (LT) recipients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aims</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Our objective was to evaluate the incidence, risk factors and outcome of <span class="elsevierStyleItalic">Sc/Lp</span> infections in LT recipients at a tertiary care hospital with a national reference LT program.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A nine-year retrospective study was conducted.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">During this period, 395 LT were performed. Positive cultures for <span class="elsevierStyleItalic">Sc/Lp</span> were obtained from twenty-one LT recipients. Twelve patients (incidence 3.04%) developed invasive scedosporiosis (IS). In 66.7% of the patients with IS the invasive infection was defined as a breakthrough one. The main sites of infection were lungs and paranasal sinuses. Most of the patients received combination antifungal therapy. The IS crude mortality rate after 30 days was 16.7%, and 33.3% after a year.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Our study highlights improved survival rates associated with combination antifungal therapy in LT recipients and underlines the risk of breakthrough infections in patients with allograft dysfunction on nebulized lipidic amphotericin B prophylaxis. In addition to pretransplant colonization, acute or chronic organ dysfunctions seem to be the main risk factors for IS.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las especies de <span class="elsevierStyleItalic">Scedosporium</span> y <span class="elsevierStyleItalic">Lomentospora prolificans</span> (<span class="elsevierStyleItalic">Sc/Lp</span>) son mohos emergentes que causan infecciones invasivas con una alta tasa de mortalidad. Después de <span class="elsevierStyleItalic">Aspergillus</span>, estos hongos filamentosos son los más frecuentemente aislados en pacientes receptores de trasplante de pulmón (TP).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo fue evaluar la incidencia, los factores de riesgo y la evolución de la infección por <span class="elsevierStyleItalic">Sc/Lp</span> en receptores de TP en un hospital terciario de referencia nacional para TP.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio retrospectivo de nueve años.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Durante este período se realizaron 395 TP. Veintiún receptores de TP tuvieron cultivos positivos para <span class="elsevierStyleItalic">Sc/Lp</span>, y doce de ellos desarrollaron escedosporiasis invasiva (SI) (incidencia del 3,04%). Se observaron infecciones de brecha en el 66,7% de los pacientes con SI. Los principales focos de infección fueron el pulmón y los senos paranasales. La mayoría de los pacientes recibieron terapia antifúngica combinada. La tasa de mortalidad bruta de la SI a los 30 días fue del 16,7%, ascendiendo al 33,3% al cabo de un año.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio destaca la mejora de la tasa de supervivencia asociada a la terapia antifúngica combinada en TP y subraya el riesgo de infecciones de brecha en pacientes con disfunción de injerto en profilaxis con anfotericina B lipídica nebulizada. La colonización previa al trasplante junto con la disfunción aguda o crónica del injerto parecen ser los principales factores de riesgo de la SI.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Equal first authors.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">LT: lung transplantation; MIC: minimal inhibitory concentration; BI: breakthrough infection; COPD: chronic obstructive pulmonary disease; CF: cystic fibrosis; BRQ: bronchiectasis; M: male; F: female; d: days; m: months; yr: years; CLAD: chronic lung allograft dysfunction; BAL: bronchoalveolar lavage; BAS: bronchoaspirate; AMB: amphotericin B; POS: posaconazole; TER: terbinafine; VOR: voriconazole; MICA: micafungin; CAS: caspofungin; INH: inhaled therapy; IV: intravenous therapy; O: oral therapy; T: topic therapy; NA: not available; IS: invasive scedosporiosis; CMV: cytomegalovirus. → Arrows indicate changes in treatment.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cause of LT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age/sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Species \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time from LT<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Colonization before LT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Organ rejection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sample (<span class="elsevierStyleItalic">n</span>) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MIC (mg/l) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of infection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI/antifungal \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alive at 30 days \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">One-year evolution \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial tissue (1)Bronchial biopsy (1)BAL (3) Pleural liquid (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VOR (IV, INH)TER (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proven disseminated IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/CAS, AMB (INH) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dead <a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">d</span></a>*(48 days) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical wound exudate (2)BAL (5)BAS (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VOR (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disseminated IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (INH) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchial suture (1)BAL (3)BAS (5)Sputum (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (INH)POS (IV/endobronchial/INH)TER (O)Surgical debridement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>80.25NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proven pulmonary<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>tracheobronchitis IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/MICA (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchial biopsy (1)BAL (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (INH, IV)POS (IV, INH, O)TER (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.5NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proven pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (INH) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dead<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL (1)Sputum (1)Bronchial biopsy (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (INH)POS (O, INH)TER (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proven pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (INH), MICA (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">POS (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probable pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (INH) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dead \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BRQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 yr \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CLAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL (2)Sputum (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (INH)POS (IV)TER (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NANANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">L. prolificans</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL (1)Sputum (1)BAS (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (IV)VOR (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probable pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">L. prolificans</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 yr \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CLAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AMB (IV, INH)VOR (O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible pulmonary IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/AMB (INH), POS (IV), CAS (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">f</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dead \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CLAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin biopsy (1)Wound exudate (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→ AMB (IV)VOR (O), TER (O, T)AMB (IV)POS (O)MICA/CAS (IV)Surgical debridement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cutaneous<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>osteomyelitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ChronicitySkin healing >5 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CLAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin biopsy (1)Wound exudate (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VOR (O, IV),TER (O, T), →+ MICA (IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25NANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cutaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Relapse \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. apiospermum</span> complex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wound exudate (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VOR (O, IV)TER (O, T) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cutaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Favorable \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2756279.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Time elapsed from transplantation to IS diagnosis (d: days; m: months; yr: years).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Attributable dead with acute organ rejection, growth of <span class="elsevierStyleItalic">S. apiospermum</span> complex in bronchial biopsy and coinfection with CMV.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Chronic colonization with <span class="elsevierStyleItalic">S. apiospermum</span> complex three years before transplantation, with no isolates ever after.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">One single isolate of <span class="elsevierStyleItalic">L. prolificans</span> two years before transplantation, with no isolates ever after.</p>" ] 4 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "f" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Not attributable dead with intestinal CMV with massive digestive bleeding. Co-infection with <span class="elsevierStyleItalic">Fusarium oxysporum</span>.</p> <p class="elsevierStyleNotepara" id="npar0030"><span class="elsevierStyleSup">b</span> Attributable dead in 48 days.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of lung transplant recipients with scedosporiosis/lomentosporiosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of chronic infection with <span class="elsevierStyleItalic">Aspergillus fumigatus</span> on lung function and hospitalization in patients with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Amin" 1 => "A. Dupuis" 2 => "S.D. Aaron" 3 => "F. Ratjen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-1103" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "171" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19567494" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pseudallescheria boydii</span> (anamorph <span class="elsevierStyleItalic">Scedosporium apiospermum</span>). Infection in solid organ transplant recipients in a tertiary medical center and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Castiglioni" 1 => "D.A. Sutton" 2 => "M.G. Rinaldi" 3 => "J. Fung" 4 => "S. Kusne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005792-200209000-00001" "Revista" => array:5 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2002" "volumen" => "81" "paginaInicial" => "333" "paginaFinal" => "348" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro activities of 35 double combinations of antifungal agents against <span class="elsevierStyleItalic">Scedosporium apiospermum</span> and <span class="elsevierStyleItalic">Scedosporium prolificans</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cuenca-Estrella" 1 => "A. Alastruey-Izquierdo" 2 => "L. Alcazar-Fuoli" 3 => "L. Bernal-Martinez" 4 => "A. Gomez-Lopez" 5 => "M.J. Buitrago" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01160-07" "Revista" => array:5 [ "tituloSerie" => "Antimicrob Agents Chemother [Internet]" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "1136" "paginaFinal" => "1139" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Population-based surveillance for scedosporiosis in Australia: epidemiology, disease manifestations and emergence of <span class="elsevierStyleItalic">Scedosporium aurantiacum</span> infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.H. Heath" 1 => "M.A. Slavin" 2 => "T.C. Sorrell" 3 => "R. Handke" 4 => "A. Harun" 5 => "M. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2009.02802.x" "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol Infect [Internet]" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "689" "paginaFinal" => "693" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atlas of clinical fungi" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. De Hoog" 1 => "J. Guarro" 2 => "J. Gené" 3 => "S. Ahmed" 4 => "A. Al-Hatmi" 5 => "M. Figueras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "3rd e-edition." "fecha" => "2019" "editorial" => "Utrecht/Reus" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections due to <span class="elsevierStyleItalic">Scedosporium apiospermum</span> and <span class="elsevierStyleItalic">Scedosporium prolificans</span> in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Husain" 1 => "P. Muñoz" 2 => "G. Forrest" 3 => "B.D. Alexander" 4 => "J. Somani" 5 => "K. Brennan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/426445" "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis [Internet]" "fecha" => "2005" "volumen" => "40" "paginaInicial" => "89" "paginaFinal" => "99" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Husain" 1 => "A. Sole" 2 => "B.D. Alexander" 3 => "S. Aslam" 4 => "R. Avery" 5 => "C. Benden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2016.01.007" "Revista" => array:5 [ "tituloSerie" => "J Heart Lung Transplant [Internet]" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "261" "paginaFinal" => "282" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, clinical manifestations, and outcomes of <span class="elsevierStyleItalic">Scedosporium</span> infections among solid organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.S. Johnson" 1 => "R.K. Shields" 2 => "C.J. Clancy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tid.12244" "Revista" => array:5 [ "tituloSerie" => "Transpl Infect Dis [Internet]" "fecha" => "2014" "volumen" => "16" "paginaInicial" => "578" "paginaFinal" => "587" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for <span class="elsevierStyleItalic">Aspergillus</span> colonization and allergic bronchopulmonary aspergillosis in children with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Jubin" 1 => "S. Ranque" 2 => "N. Stremler Le Bel" 3 => "J. Sarles" 4 => "J.-C. Dubus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.21240" "Revista" => array:5 [ "tituloSerie" => "Pediatr Pulmonol [Internet]" "fecha" => "2010" "volumen" => "45" "paginaInicial" => "764" "paginaFinal" => "771" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Scedosporium</span> infection in a tertiary care cancer center: a review of 25 cases from 1989–2006" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.A. Lamaris" 1 => "G. Chamilos" 2 => "R.E. Lewis" 3 => "A. Safdar" 4 => "I.I. Raad" 5 => "D.P. Kontoyiannis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/509579" "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis [Internet]" "fecha" => "2006" "volumen" => "43" "paginaInicial" => "1580" "paginaFinal" => "1584" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of invasive respiratory disease caused by emerging non-<span class="elsevierStyleItalic">Aspergillus</span> molds in lung transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Peghin" 1 => "V. Monforte" 2 => "M.T. Martin-Gomez" 3 => "I. Ruiz-Camps" 4 => "C. Berastegui" 5 => "B. Saez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tid.12492" "Revista" => array:6 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "70" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26678668" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Peter Donnelly" 1 => "S.C. Chen" 2 => "C.A. Kauffman" 3 => "W.J. Steinbach" 4 => "J.W. Baddley" 5 => "P.E. Verweij" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciz1008" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2020" "volumen" => "71" "paginaInicial" => "1367" "paginaFinal" => "1376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31802125" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0160" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Scedosporium</span> and <span class="elsevierStyleItalic">Lomentospora</span>: an updated overview of underrated opportunists" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ramirez-Garcia" 1 => "A. Pellon" 2 => "A. Rementeria" 3 => "I. Buldain" 4 => "E. Barreto-Bergter" 5 => "R. Rollin-Pinheiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/mmy/myx113" "Revista" => array:6 [ "tituloSerie" => "Med Mycol" "fecha" => "2018" "volumen" => "56" "numero" => "S1" "paginaInicial" => "S102" "paginaFinal" => "S125" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0165" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perspectives on <span class="elsevierStyleItalic">Scedosporium</span> species and <span class="elsevierStyleItalic">Lomentospora prolificans</span> in lung transplantation: results of an international practice survey from ESCMID fungal infection study group and study group for infections in compromised hosts, and European Confederation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Rammaert" 1 => "M. Puyade" 2 => "O.A. Cornely" 3 => "D. Seidel" 4 => "P. Grossi" 5 => "S. Husain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tid.13141" "Revista" => array:3 [ "tituloSerie" => "Transpl Infect Dis [Internet]" "fecha" => "2019" "volumen" => "21" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0170" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Scedosporium apiospermum</span> (<span class="elsevierStyleItalic">Pseudallescheria boydii</span>) infection in lung transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Sahi" 1 => "R.K. Avery" 2 => "O.A. Minai" 3 => "G. Hall" 4 => "A.C. Mehta" 5 => "P. Raina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2007.01.011" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "350" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17403476" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0175" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective multicenter German study on pulmonary colonization with <span class="elsevierStyleItalic">Scedosporium/Lomentospora</span> species in cystic fibrosis: epidemiology and new association factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Schwarz" 1 => "C. Brandt" 2 => "E. Antweiler" 3 => "A. Krannich" 4 => "D. Staab" 5 => "S. Schmitt-Grohé" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0171485" "Revista" => array:4 [ "tituloSerie" => "PLOS ONE [Internet]" "fecha" => "2017" "volumen" => "12" "paginaInicial" => "e0171485" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0180" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-transplant colonization with non-<span class="elsevierStyleItalic">Aspergillus</span> molds and risk of development of invasive fungal disease in lung transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.P. Silveira" 1 => "E.J. Kwak" 2 => "D.L. Paterson" 3 => "J.M. Pilewski" 4 => "K.R. McCurry" 5 => "S. Husain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2008.05.021" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "850" "paginaFinal" => "855" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18656797" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0185" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Salvage therapy with topical posaconazole in lung transplant recipients with invasive <span class="elsevierStyleItalic">Scedosporium</span> infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Solé" 1 => "A.A. García-Robles" 2 => "C. Jordá" 3 => "E. Cases Viedma" 4 => "N. Mancheño" 5 => "J.L. Poveda-Andrés" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajt.14580" "Revista" => array:5 [ "tituloSerie" => "Am J Transplant" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "504" "paginaFinal" => "509" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0190" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary <span class="elsevierStyleItalic">Scedosporium</span> infection following lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Tamm" 1 => "M. Malouf" 2 => "A. Glanville" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1034/j.1399-3062.2001.30402.x" "Revista" => array:5 [ "tituloSerie" => "Transpl Infect Dis [Internet]" "fecha" => "2001" "volumen" => "3" "paginaInicial" => "189" "paginaFinal" => "194" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003800000004/v1_202111270552/S1130140621000486/v1_202111270552/en/main.assets" "Apartado" => array:4 [ "identificador" => "7995" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Notas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003800000004/v1_202111270552/S1130140621000486/v1_202111270552/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140621000486?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 13 | 3 | 16 |
| 2024 September | 38 | 11 | 49 |
| 2024 August | 39 | 12 | 51 |
| 2024 July | 26 | 3 | 29 |
| 2024 June | 42 | 2 | 44 |
| 2024 May | 42 | 5 | 47 |
| 2024 April | 28 | 2 | 30 |
| 2024 March | 52 | 3 | 55 |
| 2024 February | 40 | 1 | 41 |
| 2024 January | 46 | 3 | 49 |
| 2023 December | 36 | 4 | 40 |
| 2023 November | 43 | 14 | 57 |
| 2023 October | 40 | 7 | 47 |
| 2023 September | 18 | 2 | 20 |
| 2023 August | 17 | 0 | 17 |
| 2023 July | 12 | 1 | 13 |
| 2023 June | 21 | 2 | 23 |
| 2023 May | 30 | 1 | 31 |
| 2023 April | 38 | 4 | 42 |
| 2023 March | 11 | 1 | 12 |
| 2023 February | 16 | 4 | 20 |
| 2023 January | 18 | 10 | 28 |
| 2022 December | 23 | 11 | 34 |
| 2022 November | 21 | 10 | 31 |
| 2022 October | 19 | 10 | 29 |
| 2022 February | 1 | 0 | 1 |
| 2021 December | 1 | 4 | 5 |
| 2021 November | 1 | 0 | 1 |
| 2021 October | 0 | 4 | 4 |
Show all
