Lomentospora prolificans

The genus Lomentospora was erected by G. Hennebert and B.G. Desai in 1974 to accommodate a culture obtained from greenhouse soil originating from a forest in Belgium. ==Appearance==

Lomentospora prolificans produces small, delicate annellides with a distinct basal swelling peculiar to this species and absent in the closely related species, Scedosporium apiospermum. Annellides necks become long and distinctly annellated with age. Annellides occur individually or in clusters irregularly along undifferentiated hyphae, frequently exhibiting a pronounced penicillate arrangement in older cultures. Conidia are smooth-walled, light to dark brown, 3–7 x 2–3 μm, accumulating in slime droplets at annelide apices. Colonies of Lomentospora prolificans are grey to brownish, spreading, with scant, cobweb-like aerial mycelium recalling a moth-eaten woolen garment. This species is sensitive to cycloheximide. As this species may be slow to emerge from clinical materials, specimens in which this agent is suspected often require an extended period of culture incubation (e.g., up to 4 weeks). ==Ecology==

Lomentospora prolificans is a soil fungus, and has been found in the soils of ornamental plants and greenhouse plants. Along with other fungi, Lomentospora prolificans has been isolated from soils of Ficus benjamina and Heptapleurum actinophyllum plantings in hospitals, suggesting that these materials have potential to serve as reservoirs of nosocomial fungal pathogens. ==Human disease==

Lomentospora prolificans has been recognized as an agent of opportunistic human disease since the 1990s. This species is primarily associated with subcutaneous lesions arising from injury following traumatic implantation of the agent via contaminated splinters or plant thorns. The majority of Lomentospora prolificans infections in immunologically normal people remain localized, characteristically with bone or joint involvement. Disseminated infections from Lomentospora prolificans are largely limited to people with pre-existing immune impairment. Notably, Lomentospora prolificans exhibits varying tolerance to all currently available antifungal agents. This is particularly true of strains recovered from disseminated infections, and these infections carry a high mortality. Lomentospora prolificans has also been known to cause disseminated disease secondary to myeloblastic leukemia and following lung transplant. In otherwise healthy people, it was recorded as a cause of corneal infection following a lawn trimmer mishap, and bone infection following trauma. ==Drug resistance==

Infections caused by Lomentospora prolificans are recognized to be difficult to treat due to the tendency of this species to exhibit resistance to many commonly used antifungal agents. Successful control of disseminated Lomentospora prolificans infection can be obtained with a combination of voriconazole and terbinafine, but some strains are resistant to this treatment. Drugs that might also be of help are posaconazole, miltefosine and albaconazole. Albaconazole is in phase III clinical trials. ==Notes==