RESUMEN
Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient's condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.
Asunto(s)
Coinfección , Fungemia , Mucormicosis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Tricosporonosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Fungemia/microbiología , Fungemia/tratamiento farmacológico , Resultado Fatal , Coinfección/microbiología , Tricosporonosis/microbiología , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Lactante , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/complicaciones , Antifúngicos/uso terapéutico , BasidiomycotaRESUMEN
La enfermedad fúngica invasora (EFI) es una de las principales causas de morbimortalidad en los pacientes pediátricos inmunocom- prometidos. Los hongos que con mayor frecuencia causan EFI en este grupo de pacientes corresponden a especies de Candida y Aspergillus. Sin embargo, en los últimos años se ha descrito un aumento de patógenos no clásicos, tales como Fusarium, Scedosporium, Mucorales, Cryptococcus, Trichosporon, entre otros. Se presenta un caso de EFI por Trichosporon asahii en un preescolar con una leucemia linfo- blástica aguda en quimioterapia de inducción. Además, se presenta una revisión actualizada de la literatura especializada, con énfasis en la importancia del diagnóstico precoz y el tratamiento antifúngico específico.
Invasive fungal disease (IFD) is one of the leading causes of morbidity and death among immunosuppressed pediatric patients. The fungi that most frequently cause IFD in this group of patients correspond to Candida and Aspergillus species, however, in recent years an increase in non-classical pathogens, such as Fusarium, Scedosporium, Mucorales, Cryptococcus, Trichosporon, among others. A case of invasive fungal disease caused by Trichosporon asahii is presented in a preschool patient with acute lymphoblastic leukemia in induction stage. This review highlights the importance of active search for pathogens in immunosuppressed patients, and proposes a specific treatment.
Asunto(s)
Humanos , Masculino , Preescolar , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Tricosporonosis/complicaciones , Infecciones Fúngicas Invasoras , Trichosporon/aislamiento & purificación , Tricosporonosis/diagnóstico , Tricosporonosis/microbiología , Tricosporonosis/tratamiento farmacológico , Antifúngicos/uso terapéuticoRESUMEN
Trichosporon asteroides is an emerging yeast-like pathogen commonly misidentified by commercial biochemical identification systems. We evaluated the performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of 21 clinical T. asteroides strains using the Bruker Daltonics database (BDAL) and an in-house developed library. Mass spectra were obtained by the FlexControl system v.3.4, and characterizations were performed in the Biotyper BDAL database v.4.1 and the developed in-house library. Species identification for T. asteroides failed as all 21 strains were misidentified as T. japonicum (log-scores 1.89-2.19). Extending the existing database was crucial to achieving 100% correct species-level identification and accurate distinction between species. Our results indicate that the commercial BDAL database has no discriminatory power to distinguish between T. japonicum and T. asteroides. Whereas improvement of the current BDAL database is pending, we strongly advise system users not to exclude the possibility of the failure to report T. asteroides.
Asunto(s)
Técnicas de Tipificación Micológica , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Trichosporon , Tricosporonosis , Humanos , Bases de Datos Factuales , Especificidad de la Especie , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Trichosporon/clasificación , Trichosporon/aislamiento & purificación , Tricosporonosis/diagnóstico , Tricosporonosis/microbiología , Técnicas de Tipificación Micológica/métodosRESUMEN
BACKGROUND: Trichosporon asahii, an emerging fungal pathogen, has been frequently associated with invasive infections in critically ill patients. CASE REPORT: A 74-year-old male patient diagnosed with COVID-19 was admitted to an Intensive Care Unit (ICU). During hospitalization, the patient displayed episodes of bacteremia by Staphylococcus haemolyticus and a possible urinary tract infection by T. asahii. While the bacterial infection was successfully treated using broad-spectrum antibiotics, the fungal infection in the urinary tract was unsuccessfully treated with anidulafungin and persisted until the patient died. CONCLUSIONS: With the evolving COVID-19 pandemic, invasive fungal infections have been increasingly reported, mainly after taking immunosuppressant drugs associated with long-term broad-spectrum antibiotic therapy. Although Candida and Aspergillus are still the most prevalent invasive fungi, T. asahii and other agents have emerged in critically ill patients. Therefore, a proper surveillance and diagnosing any fungal infection are paramount, particularly in COVID-19 immunocompromised populations.
Asunto(s)
COVID-19 , Micosis , Trichosporon , Tricosporonosis , Infecciones Urinarias , Anciano , Antifúngicos/uso terapéutico , Basidiomycota , Enfermedad Crítica , Humanos , Masculino , Micosis/tratamiento farmacológico , Micosis/microbiología , Pandemias , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiologíaRESUMEN
Trichosporon spp. are a constituent of the normal flora of humans that can cause both superficial and invasive infections, mainly in immunocompromised and immunocompetent hosts, respectively. Herein, we a report of Trichosporon asahii causing subcutaneous fungal infection (SFI) in an immunocompetent patient after carpal tunnel surgery. Although susceptible to fluconazole, the treatment of SFI failed even using high doses of this azole. The skin lesion improved following the administration of voriconazole. We conducted a literature minireview searching reports on SFI in immunocompetent patients to check for epidemiological, diagnostic, therapeutic, and outcome characteristics. A total of 32 cases were reported. Despite being uncommon, the clinical suspicion and early diagnosis of SFI in immunocompetent patients undergoing previous surgery are important. Our study indicated that the azoles are the most active antifungal agents against Trichosporon spp., except for fluconazole, and voriconazole can be considered the first therapeutic option.
Asunto(s)
Dermatomicosis , Trichosporon , Tricosporonosis , Antifúngicos/uso terapéutico , Azoles/uso terapéutico , Basidiomycota , Dermatomicosis/tratamiento farmacológico , Fluconazol/uso terapéutico , Humanos , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/microbiología , Voriconazol/uso terapéuticoRESUMEN
Reports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality.
Reports of orthopedic infections caused by Trichosporon species are scarce. We described a case series of orthopedic infections caused by Trichosporon species and reviewed the previous published cases in the literature. We observed a high rate of clinical improvement and a low associated mortality.
Asunto(s)
Trichosporon , Tricosporonosis , Animales , Estudios Retrospectivos , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/veterinaria , Antifúngicos/uso terapéutico , Voriconazol/uso terapéuticoRESUMEN
Trichosporon yeasts are classical agents of superficial mycoses, and they are ranked as the first to second predominant basidiomycetous yeast able to cause invasive infections. The clinical presentation of Trichosporon infections varies with the affected anatomical site, with fungaemia present in the majority of invasive trichosporonosis cases. Only a limited number of antifungal compounds can be used to treat Trichosporon infections. Azoles are the first choice due to their intrinsic resistance to echinocandins. Better laboratory methods and up-to-date databases of commercial platforms are required to improve identification, susceptibility testing and surveillance of this potentially threating infection.
Asunto(s)
Basidiomycota , Trichosporon , Tricosporonosis , Humanos , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Equinocandinas , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/microbiologíaRESUMEN
Trichosporonosis infections have been increasing worldwide. Providing adequate treatment for these infections remains a challenge. This scoping review contains information about potential antifungals to treat this pathology. Using online databases, we found 76 articles published between 2010 and 2020 related to this topic. Classic antifungals, molecules and biomolecules, repositioned drugs and natural products have been tested against species of Trichosporon. Experimental research has lacked depth or was limited to in vitro and in vivo tests, so there are no promising new candidates for the clinical treatment of patients with trichosporonosis. Furthermore, most studies did not present appropriate scientific criteria for drug tests, compromising their quality.
Asunto(s)
Antifúngicos , Tricosporonosis , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Humanos , Trichosporon , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológicoRESUMEN
Abstract Trichosporon asahii is the causal agent of trichosporonosis. Patients with immunosuppression or hematological malignancies are at higher risk of infection. Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers. Internal organ dissemination is lethal. Therapeutic success depends on the underlying disease. Here, the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma, a rare and aggressive haematolymphoid neoplasm. Regretfully, death occurred despite treatment with liposomal amphotericin B and supportive measures, showcasing the fatality of both diseases.
Asunto(s)
Humanos , Trichosporon , Sarcoma Histiocítico/tratamiento farmacológico , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Basidiomycota , Antifúngicos/uso terapéuticoRESUMEN
Trichosporon asahii is the causal agent of trichosporonosis. Patients with immunosuppression or hematological malignancies are at higher risk of infection. Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers. Internal organ dissemination is lethal. Therapeutic success depends on the underlying disease. Here, the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma, a rare and aggressive haematolymphoid neoplasm. Regretfully, death occurred despite treatment with liposomal amphotericin B and supportive measures, showcasing the fatality of both diseases.
Asunto(s)
Sarcoma Histiocítico , Trichosporon , Tricosporonosis , Antifúngicos/uso terapéutico , Basidiomycota , Sarcoma Histiocítico/tratamiento farmacológico , Humanos , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológicoRESUMEN
Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.
Asunto(s)
Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones por VIH/complicaciones , Neutropenia/complicaciones , Tricosporonosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/sangre , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Anfotericina B/administración & dosificación , Antituberculosos/administración & dosificación , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , Quimioterapia Combinada , Femenino , Fluconazol/administración & dosificación , VIH , Infecciones por VIH/diagnóstico , Infecciones por VIH/microbiología , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Neutropenia/diagnóstico , Neutropenia/microbiología , Neutropenia/virología , Trichosporon/aislamiento & purificación , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiologíaAsunto(s)
Profilaxis Antibiótica/métodos , Fungemia/diagnóstico , Leucemia Mieloide Aguda/inmunología , Trichosporon/aislamiento & purificación , Tricosporonosis/diagnóstico , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Resultado Fatal , Femenino , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Fungemia/prevención & control , Humanos , Huésped Inmunocomprometido , Itraconazol/uso terapéutico , Persona de Mediana Edad , Piel/microbiología , Piel/patología , Insuficiencia del Tratamiento , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/microbiología , Tricosporonosis/prevención & controlRESUMEN
BACKGROUND: Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin. CASE PRESENTATION: Here we report the first clinical case of meningoencephalitis due to this species in a female previously healthy patient under corticosteroids and antibiotics therapy for several months. She was submitted to an invasive procedure to remove a left sided acoustic neuroma and further developed a cerebrospinal fistula. After some days of the procedure, she presented a predominantly and intensive occipital holocranial headache, followed by vomiting, hyporexia, weight loss, asthenia, irritability, difficulty to concentrate and rotator vertigo. The patient further developed a cerebrospinal fistula in the occipital region and was submitted to a surgical correction. After several months of clinical interventions, she was diagnosed with CNS Trichosporonosis, after Magnetic Resonance Imaging and positive microbiological cultures obtained within two different occasions (2 weeks apart). Despite the antifungal therapy with Amphotericin B and Voriconazole, the patient did not survive. CONCLUSIONS: Despite CNS Fungal infections are mostly due to Cryptococcus spp., other emergent yeasts, such as T. inkin may be considered as a likely etiological agent. This is the first case report of CNS Trichosporonosis, where species identification was performed with rDNA sequencing.
Asunto(s)
Meningitis Fúngica/tratamiento farmacológico , Trichosporon/efectos de los fármacos , Trichosporon/patogenicidad , Tricosporonosis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Brasil , ADN Ribosómico , Femenino , Humanos , Huésped Inmunocomprometido , Meningitis Fúngica/diagnóstico , Meningitis Fúngica/microbiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis de Secuencia de ADN , Trichosporon/genética , Tricosporonosis/diagnóstico , Voriconazol/uso terapéuticoRESUMEN
We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Trichosporon/genética , Tricosporonosis/diagnóstico , Trichosporon/clasificación , Trichosporon/efectos de los fármacos , Brasil/epidemiología , Pruebas de Sensibilidad Microbiana , Biopelículas/crecimiento & desarrollo , Tricosporonosis/microbiología , Tricosporonosis/epidemiología , Genotipo , América Latina , Antifúngicos/farmacologíaRESUMEN
We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.
Asunto(s)
Trichosporon/genética , Tricosporonosis/diagnóstico , Adolescente , Adulto , Antifúngicos/farmacología , Biopelículas/crecimiento & desarrollo , Brasil/epidemiología , Genotipo , Humanos , América Latina , Masculino , Pruebas de Sensibilidad Microbiana , Trichosporon/clasificación , Trichosporon/efectos de los fármacos , Tricosporonosis/epidemiología , Tricosporonosis/microbiologíaRESUMEN
ABSTRACTEmpirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Antifúngicos/uso terapéutico , Equinocandinas/uso terapéutico , Neutropenia Febril/tratamiento farmacológico , Geotricosis/diagnóstico , Micosis/diagnóstico , Tricosporonosis/diagnóstico , Neutropenia Febril/microbiología , Geotricosis/microbiología , Micosis/microbiología , Enfermedades Raras , Índice de Severidad de la Enfermedad , Tricosporonosis/microbiologíaRESUMEN
Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.
Asunto(s)
Antifúngicos/uso terapéutico , Equinocandinas/uso terapéutico , Neutropenia Febril/tratamiento farmacológico , Geotricosis/diagnóstico , Micosis/diagnóstico , Tricosporonosis/diagnóstico , Adolescente , Caspofungina , Niño , Preescolar , Neutropenia Febril/microbiología , Femenino , Geotricosis/microbiología , Humanos , Lipopéptidos , Masculino , Micosis/microbiología , Enfermedades Raras , Índice de Severidad de la Enfermedad , Tricosporonosis/microbiologíaAsunto(s)
ADN Ribosómico/genética , Piedra/terapia , Piel/microbiología , Trichosporon/patogenicidad , Tricosporonosis/microbiología , Tricosporonosis/terapia , Animales , Humanos , Técnicas de Tipificación Micológica/métodos , Piedra/diagnóstico , Piedra/microbiología , Trichosporon/clasificación , Tricosporonosis/diagnóstico , LevadurasRESUMEN
IMPORTANCE: To our knowledge, these are the first reports of bloodstream infections by Trichosporon inkin in patients with pemphigus. OBSERVATIONS: Trichosporon inkin, a novel organism causing bloodstream infection, was detected in 2 patients with pemphigus. An elderly man with pemphigus foliaceus died despite treatment with liposomal amphotericin B, 3 mg/kg/d, and a young girl with pemphigus vulgaris responded to treatment with voriconazole, 8 mg/kg/d, for 24 days. One of the T inkin isolates had a minimal inhibitory concentration of 2 mg/L against amphotericin B, suggesting resistance to the drug. CONCLUSIONS AND RELEVANCE: Delayed suspicion of invasive infection by T inkin may result in a poor outcome in patients with severe forms of pemphigus. This opportunistic infection is highly refractory to conventional potent antifungal treatment.