Disseminated Trichosporon beigelii (cutaneum) Infection in an Artificial Heart Recipient

Abstract

A 44-year-old man with end-stage ischemic cardiomyopathy was supported with an intra-aortic balloon and The Penn State Heart (artificial) prior to orthotopic cardiac transplantation on the 14th hospital day. At the time of transplantation, intraoperative cultures of pericardial and mediastinal fluid showed growth of Trichosporon beigelii (cutaneum). Shortly thereafter the patient developed visceral dissemination of T beigelii with no associated skin lesions. He was treated with amphotericin B and rifampin, but postmortem examination showed persistent, disseminated infection.

A Case of Trichosporon beigelii Endocarditis

“…It is most commonly isolated from the urine of patients with chronic indwelling urinary catheters or other urinary drainage systems [1]. Oligella ureolytica has also been identified as a sporadic coloniser of the respiratory tract in cystic fibrosis patients [3]. Oligella ureolytica has also been identified as a sporadic coloniser of the respiratory tract in cystic fibrosis patients [3].…”

“…Although considered a noninvasive fungus, several fatal cases of Trichosporon infection have been described, mostly in patients with cancer [1] or AIDS [2] or following transplantation [3]. Invasive infection has also been described in patients after cataract extraction [4], intravenous drug abuse [5], and ambulatory peritoneal dialysis [6].…”

First report of chronic meningitis caused byTrichosporon beigelii

“…Most cases occurred in patients suffering from leukaemia and other malignancies, or in artificial heart or prosthetic valve recipients (4,7,8). The fungus is widely distributed in the environment and has been recovered from normal skin and mouth flora.…”

“…Trichosporon beigelii is now recognized as an opportunistic pathogen in immunocompromised patients and in recipients of artificial hearts or prosthetic heart valves (1)(2)(3)(4)(5)(6)(7)(8). Trichosporon beigelii is now recognized as an opportunistic pathogen in immunocompromised patients and in recipients of artificial hearts or prosthetic heart valves (1)(2)(3)(4)(5)(6)(7)(8).…”

“…A high 70 to 80 % mortality has been reported in invasive Trichosporon beigelii infections regardless of treatment(4,7). Meningitis developed despite prophylactic administration of itraconazole.…”