Clinical spectrum, clinical associations, and treatment outcomes of scedosporiosis in South India: A retrospective cohort study

Abstract

Scedosporium is an emerging opportunistic filamentous fungus widely distributed in soil and stagnant water. Mortality remains substantial and management is often challenging due to intrinsic antifungal resistance and delays in diagnosis. In this retrospective cohort study, we describe the clinical spectrum, microbiological characteristics, and outcomes of microbiologically culture-confirmed scedosporiosis at a tertiary care centre in South India between May 2016 and August 2024. A total of 18 patients were included, with a median age of 54 years and a predominance of male patients. Contrary to the patterns described in many Western and transplant-focused cohorts, the majority of infections in our series involved osteomyelitis and paranasal sinus disease. Disseminated infection was rare but was associated with poor outcomes. Voriconazole-based therapy was the most commonly used antifungal regimen, and surgical intervention was required in six cases. Our findings highlight a distinct clinical pattern of scedosporiosis in our setting, with osteomyelitis and sinusitis emerging as predominant presentations. These observations emphasize the importance of maintaining a high index of suspicion for Scedosporium infection in chronic bone and sinus disease, particularly when patients fail to respond to conventional antibacterial therapy.