Would you treat Scedosporium growth in expectorated sputum in a patient with COPD, pulmonary hypertension, and bronchiectasis, who has chronic dyspnea with exertion, thick sputum production, negative bacterial cultures, and no signs of mold infection on a high resolution CT scan, with no other clinical symptoms of infection?

In persons with bronchiectasis, almost anything that grows can be a pathogen, but it is tough to know. If the patient has COPD and no other immunocompromising conditions, I would not expect typical invasive fungal infection findings. Having said that, scedosporium is not the first common pathogen th...

No, I would not. The patient described seems to be colonized with Scedosporium. There is no evidence of invasive disease, so I have no reason to think that antifungal treatment would provide them any benefit.

I would agree with Dr. @Dr. First Last's answer. While most of the time Scedo growth likely represents colonization in patients with bronchiectasis, it can sometimes (rarely?) represent true disease. I would be in favor of treatment if (1) it grows repeatedly (at least 3 times in my opinion), (2) no...