Invasive Infections Due toTrichodermaSpecies: Report of 2 Cases, Findings of In Vitro Susceptibility Testing, and Review of the Literature

Abstract

Trichoderma species are filamentous fungi that were previously considered to be culture contaminants. We report 2 well-documented cases of invasive Trichoderma infections, and we comprehensively review the literature on this topic. Trichoderma species are mainly responsible for continuous ambulatory peritoneal dialysis-associated peritonitis (7 cases) and invasive infections in immunocompromised patients (9 cases) with a hematologic malignancy or solid-organ transplant. Definitive diagnosis is difficult to achieve because of the lack of specific diagnosis tools. Species identification can benefit from a molecular approach. Trichoderma longibrachiatum is the most common species involved in these infections. Regardless of the type of infection, the prognosis was poor, with 8 deaths among 18 cases. This may be partially because of the resistance of these organisms to the majority of available antifungal agents, including amphotericin B. Trichoderma species now should be added to the growing list of emerging filamentous fungal pathogens.

Fatal post-operative Trichoderma longibrachiatum mediastinitis and peritonitis in a paediatric patient with complex congenital cardiac disease on peritoneal dialysis

“…There have been few published case reports of invasive T. longibrachiatum infections (Alanio et al, 2008;Chouaki et al, 2002;De Miguel et al, 2005;Lagrange-Xélot et al, 2008;Munoz et al, 1997). Patients affected by this fungus are typically immunocompromised or on peritoneal dialysis.…”

“…Fungal peritonitis caused by Trichoderma spp. has been increasingly reported in the literature (Eşel et al, 2003;Goldie et al, 1996;Saran et al, 1996) and is associated with a high mortality (Chouaki et al, 2002;De Miguel et al, 2005). Invasive Trichoderma spp.…”

“…Invasive Trichoderma spp. infections have been described in the paediatric population (Alanio et al, 2008;Chouaki et al, 2002;Munoz et al, 1997;Seguin et al, 1995), involving the central nervous system (Seguin et al, 1995), lungs (Alanio et al, 2008;Chouaki et al, 2002) and subcutaneous tissue (Munoz et al, 1997). In one case, the infection mimicked pulmonary aspergillosis, with a chest computed tomography Fig.…”

“…were first described in 1794 as green fungi growing on fallen branches, and commonly found in soil, decaying wood and humid environments. They are usually considered plant saprophytes but are increasingly recognized as a cause of human infections, especially in immunocompromised hosts (Chouaki et al, 2002;De Miguel et al, 2005). We report a case of fatal, disseminated Trichoderma longibrachiatum post-operative infection in a paediatric patient with underlying complex congenital heart disease.…”

The fish egg microbiome : diversity and activity against the oomycete pathogen Saprolegnia

“…Even though Trichoderma species are commonly considered beneficial fungi, some Trichoderma strains, including T. harzianum, Trichoderma koningii, Trichoderma longibrachiatum, Trichoderma pseudokoningii and Trichoderma viride, maybe pathogenic to human (Escudero Gil et al, 1976;Loeppky et al, 1983;Jacobs et al, 1992;Gautheret et al, 1995;Seguin et al, 1995;Tanis et al, 1995;Campos-Herrero et al, 1996;Guiserix et al, 1996;Munoz et al, 1997;Furukawa et al, 1998;Guarro et al, 1999;Richter et al, 1999;Rota et al, 2000;Chouaki et al, 2002;Myoken et al, 2002;De Miguel et al, 2005). Some marine Trichoderma were associated to contaminated mussels and some were even toxic to aquatic animals, such as Artemia larvae (Sallenave-Namont et al, 2000;Marrouchi et al, 2013).…”