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Case Report
tients are too critical to receive. On the other hand, pul- empirical early use of voriconazole has been proposed in
monary mycosis cannot be excluded if the histopathologi- cases of suspected scedosporiosis after near-drowning or
cal result is negative or if only bacteria is found, it, there- even prophylactically in all near-drowning patients. In re-
fore, has important limits, especially early in the course of cent years, voriconazole in combination with caspofungin
the disease. In the cases presented in this article, patients should be considered as the drug of choice in the manage-
in case 1 and case 2 had a positive culture result of pul- ment of invasive mycosis after near-drowning .[14] A ret-
monary biopsy tissue, which demonstrated infection with rospective study revealed an improved 3-month survival
S apiospermum and Aspergillus Niger. In case 1, early di- rate in patients with IA when treated with a combination
agnosis of scedosporiosis may be difficult because of low therapy of caspofungin and voriconazole as compared to
sensitivity of routine culture methods, as S apiospermum voriconazole only .[15]
was mainly detected in materials where the fungus was
highly concentrated. In our opinion, our early recognition of the disease,
application of broad spectrum antifungal drugs and close
However, some patients who was predisposed to pul- monitoring for side effects has been the most important
monary mycosis may not receive definite diagnosis from contributors to the promising outcomes reached .[16] The
histopathological examination. Therefore, the diagnosis main problem remains attaining an early diagnosis, the
relies on the association of a host factor, clinical course, lack of which prevents effective treatment modalities to
radiological findings and microbiological findings that may manage this life-threatening mycosis successful.
be detected via either direct tests (such as direct culture)
or indirect tests (such as GM or G test) .[12] In these cases References
,the diagnosis was based on the following :(1) Submersion
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[6] Kowacs PA, de Almeida SM, Pinheim RL, et a1, Central
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[7] LI Wen-fang, HE Chao, LIU Xue-feng, WANG Sheng-yun,
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