Epidemiology, clinical aspects, outcomes and prognostic factors associated with Trichosporon fungaemia: results of an international multicentre study carried out at 23 medical centres

Abstract

Background Trichosporon fungaemia (TF) episodes have increased in recent years and mortality rates remain high despite the advances in the management of sepsis. New concepts about its clinical course, treatment and microbiology need to be investigated for the better management of this infection. Objectives To describe the aetiology, natural history, clinical management and prognostic factors of TF. Methods TF episodes documented between 2005 and 2018 in 23 South American centres were retrospectively investigated by using a standard clinical form. Molecular identification, antifungal susceptibility testing and biofilm production were also performed. Results Eighty-eight TF episodes were studied. Patients had several underlying conditions, including haematological diseases (47.7%), post-operative status (34%), solid organ transplants (n = 7, 7.9%), among others. Seventy-three (82.9%) patients had a central venous catheter (CVC) at TF diagnosis. The 30 day mortality rate was 51.1%. Voriconazole-based therapy was given to 34 patients (38.6%), with a 30 day mortality rate of 38.2%. Multivariate predictors of 30 day mortality were age (OR 1.036), mechanical ventilation (OR 8.25) and persistent neutropenia (OR 9.299). CVC removal was associated with over 75% decreased risk of 30 day mortality (OR 0.241). Microbiological analyses revealed that 77.7% of the strains were identified as Trichosporon asahii, and voriconazole showed the strongest in vitro activity against Trichosporon spp. Most of the strains (63%) were considered medium or high biofilm producers. Conclusions Older age, mechanical ventilation and persistent neutropenia were associated with poor prognosis. CVC may play a role in the pathogenicity of TF and its removal was associated with a better prognosis.

Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders

“…According to our results, targeted monotherapy with VRC was reported in 11 pediatric patients with malignancy or hematologic disorder, resulting in a favorable outcome in 8/11(73%) patients. Combination therapy with AMB and a triazole has not been proven to be superior to VRC alone in vitro and requires more clinical studies to be confirmed [1,62,80]. Our review suggests that azole-including therapy may be superior to echinocandin-or AMB-based therapy in children, as it is in adults.…”

JMM Profile: Trichosporon yeasts: from superficial pathogen to threat for haematological-neutropenic patients

“…Acute hypersensitivity pneumonia episodes include flu-like symptoms which can easily be misdiagnosed due to variable and non-specific clinical presentation, and their potential cause by a wide range of respiratory diseases. Fungaemia is the predominant clinical presentation in invasive trichosporonosis; disseminated infection, endocarditis, peritonitis, central nervous system infections and urinary tract infections are also common findings [1, 3–5].…”

“…There have been a number of reports of cases of hypersensitivity pneumonia from Japan, and it appears likely that environmental factors, antigen exposure and the host's genetic predisposition can trigger this disease. On the other hand, endogenous translocation from the gastrointestinal microbiota and skin colonization followed by colonization (nearby) of, for example, a central venous catheter may play a role in the development of invasive trichosporonosis episodes [1,[3][4][5]31].…”

“…Persistent fever and/or sepsis unresponsive to antibiotics in at-risk populations (mainly haematological malignancies, organ transplantation, long stay in intensive care unit and exposure to antibiotics, invasive medical procedures, and steroids), and ongoing empirical treatment with amphotericin B or echinocandins are the main red flags requiring investigation of putative invasive trichosporonosis. Complications due to cutaneous disseminated skin lesions, pulmonary infiltrate and hepatosplenic abscesses have also been reported in haematology patients affected by invasive trichosporonosis [3, 5].…”

Infección fúngica invasiva por Saprochaete capitata en un niño con aplasia medular

“…talidad y diferentes patrones de resistencia antifúngica según la especie (7) . En Perú son pocos los reportes realizados por infecciones fúngicas invasivas por hongos raros, tanto levaduriformes como filamentosos (8,9) . S. capitata es un hongo raro levaduriforme que no ha sido previamente descrito en el Perú como causa de infección fúngica invasiva en humanos y que ha sido identificado, principalmente, en pacientes inmunocomprometidos, como se describe en el presente caso en un paciente con diagnóstico de aplasia medular y sometido a TPH.…”