<i>Trichosporon asahii</i> fatal infection in a non‐neutropenic patient after orthotopic liver transplantation

Abdala, Edson; Lopes, Roberto Iglesias; Chaves, C.N.; Heins‐Vaccari, Elisabeth Maria; Shikanai-Yasuda, Maria Aparecida

doi:10.1111/j.1399-3062.2005.00104.x

Cited by 25 publications

(28 citation statements)

References 13 publications

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“…However, in two of them, Trichosporon infection appeared in less than a week after liver transplant; one of these patients presented with neutropenia and fulminant hepatic failure [14] and the other required a large blood transfusion and had dialytic renal failure. In our case, as in that described by Abdala et al [15], trichosporonosis occurred many years after transplantation. In this last case, the patient was from Brazil and was not under excessive immunosuppressive therapy.…”

Section: Discussionsupporting

confidence: 71%

Systemic infection caused byTrichosporon asahiiin a patient with liver transplant

et al. 2008

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Section: Discussionsupporting

confidence: 71%

Systemic infection caused byTrichosporon asahiiin a patient with liver transplant

et al. 2008

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“…Trichosporon ovoides, Trichosporon cutaneum, Trichosporon inkin, and Trichosporon asteroides are responsible for superficial skin lesions. Trichosporon asahii and Trichosporon mucoides have been described as agents of invasive diseases in leukemic patients and more recently in liver, kidney, or heart transplant patients (1,3,6,10,14,15,16,20). One case of fungal arteritis with arterial anastomotic dehiscence after kidney transplantation has been reported (5).…”

Section: Case Reportmentioning

confidence: 99%

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

et al. 2012

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Trichosporon mycotoxinivorans is a novel pathogen recently found in cystic fibrosis patients. We report the first case of a disseminated fatal infection with T. mycotoxinivorans associated with invasive Aspergillus fumigatus and Scedosporium apiospermum infection after lung and liver transplantation in a cystic fibrosis patient. CASE REPORTA 35-year-old man with cystic fibrosis (CF) was admitted for rapid respiratory deterioration and high-level oxygen requirements with respiratory acidosis. He was a nonsmoker and was still working actively as a farmer until a few days before his admission. His past medical history included sinonasal polyposis and diabetes mellitus. He was in good general condition despite a severe obstructive pulmonary disease that had been stable over the previous 5 years, with a forced expiratory volume in the first second at 20% of that predicted. He also had a 5-year bronchial colonization with Pseudomonas aeruginosa and Aspergillus fumigatus.Because of respiratory deterioration despite noninvasive ventilation and antibiotics, an extracorporeal membrane oxygenation, inotropic support, and hemodialysis were started and an emergency double lung transplantation (LT) was performed. The immunosuppression included basiliximab and high-dose methylprednisolone for induction, a standard dose of tacrolimus, mycofenolate mofetil, and methylprednisolone for maintenance. Due to immediate postoperative acute liver failure, an emergency liver transplantation was performed on day 2 post-LT. Another dose of basiliximab and high dose of methylprednisolone were given. Antifungal prophylaxis with caspofungin (70 mg) started on the day of LT was discontinued the next day due to liver dysfunction. Amyloidosis AA (deposition of amyloid protein A) was diagnosed on explanted liver. The patient's condition remained stable, although invasive ventilation and hemodialysis were maintained. Routine bronchoalveolar lavage specimens at days 1 and 6 post-LT were positive for P. aeruginosa (treated with ceftazidime, ciprofloxacin, and meropenem) and A. fumigatus. Caspofungin was resumed (50 mg daily) at day 6 post-LT because an Aspergillus galactomannan detection test (Platelia Aspergillus antigen; Bio-Rad) became positive in serum.On day 9 post-LT, nonfebrile sleepiness was noted. Within 4 days, the neurologic condition worsened, with tetraparesis and coma. Cerebral magnetic resonance imaging (MRI) showed multiple foci of cortical, subcortical, and periventricular hyperinten-

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“…Likewise, nonimmunosuppressed patients have suffered from Trichosporon infections associated with ophthalmologic surgery, infections of prosthetic devices, intravenous drug abuse, and peritoneal dialysis (1,17,21).…”

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confidence: 99%

Biofilm Formation by the Emerging Fungal Pathogen Trichosporon asahii : Development, Architecture, and Antifungal Resistance

Bonaventura

Pompilio

Picciani

et al. 2006

Antimicrob Agents Chemother

198

131

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Trichosporon asahii is the most common cause of fatal disseminated trichosporonosis, frequently associated with indwelling medical devices. Despite the use of antifungal drugs to treat trichosporonosis, infection is often persistent and is associated with high mortality. This drove our interest in evaluating the capability of T. asahii to form a biofilm on biomaterial-representative polystyrene surfaces through the development and optimization of a reproducible T. asahii-associated biofilm model. Time course analyses of viable counts and a formazan salt reduction assay, as well as microscopy studies, revealed that biofilm formation by T. asahii occurred in an organized fashion through four distinct developmental phases: initial adherence of yeast cells (0 to 2 h), germination and microcolony formation (2 to 4 h), filamentation (4 to 6 h), and proliferation and maturation (24 to 72 h). Scanning electron microscopy and confocal scanning laser microscopy revealed that mature T. asahii biofilms (72-h) displayed a complex, heterogeneous three-dimensional structure, consisting of a dense network of metabolically active yeast cells and hyphal elements completely embedded within exopolymeric material. Antifungal susceptibility testing demonstrated a remarkable rise in the MICs of sessile T. asahii cells against clinically used amphotericin B, caspofungin, voriconazole, and fluconazole compared to their planktonic counterparts. In particular, T. asahii biofilms were up to 16,000 times more resistant to voriconazole, the most active agent against planktonic cells (MIC, 0.06 g/ml). Our results suggest that the ability of T. asahii to form a biofilm may be a major factor in determining persistence of the infection in spite of in vitro susceptibility of clinical isolates.Candida species are the most common cause of disseminated nosocomial fungal infections (34). Invasive infections by rarer opportunistic fungal pathogens, however, have recently emerged as a significant problem in treatment of immunocompromised patients (8, 34).In particular, disseminated life-threatening Trichosporon infection is becoming increasingly common in patients with underlying hematological malignancies, extensive burns, solid tumors, and AIDS, accounting for approximately 10% of all confirmed cases of disseminated fungal infections (8,12,14,(32)(33)(34). Likewise, nonimmunosuppressed patients have suffered from Trichosporon infections associated with ophthalmologic surgery, infections of prosthetic devices, intravenous drug abuse, and peritoneal dialysis (1, 17, 21).Trichosporon beigelii was formerly considered the causative agent in trichosporonosis, but recent taxonomic findings based on partial sequences of large-subunit rRNA and DNA relatedness (9, 29, 30) revealed that T. beigelii actually consists of six distinct pathogenic Trichosporon species.In particular, Trichosporon asahii is the major cause of disseminated or deep-seated trichosporonosis (12,30). Although most of the reported cases of hematogenous T. asahii infections occurred in patie...

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Trichosporon asahii fatal infection in a non‐neutropenic patient after orthotopic liver transplantation

Cited by 25 publications

References 13 publications

Systemic infection caused byTrichosporon asahiiin a patient with liver transplant

Systemic infection caused byTrichosporon asahiiin a patient with liver transplant

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

Biofilm Formation by the Emerging Fungal Pathogen Trichosporon asahii : Development, Architecture, and Antifungal Resistance

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