Occurrence and Etiology of Fungal Rhino-Sinusitis in a New Delhi Teaching Hospital

Abstract

Invasive trichosporonosis is a rare fungal infection, but this disease has recently increasingly been recognized in patients with hematological disorders. However, little is known about the clinical characteristics of this infectious complication. We evaluated consecutive trichosporon septicemia in 20 patients with hematological disorders at the Mie University Hospital and related hospitals for 5 years between January 2003 and December 2007. All patients were male and age ranged 23-85 years (mean, 60.3). Underlining diseases are acute myelogenous leukemia (AML) in 18, macroglobulinemia in one and aplastic anemia in one. All had a neutrophil count < 500 /l before the diagnosis of septicemia. Seventeen patients developed the sepsis after intensive chemotherapies, one during steroid treatment and two during observation. No patients examined had positive surveillance cultures for trichosporon. Nineteen patients showed breakthrough septicemia during the use of anti-fungal agents such as micafungin (MCFG) in 17, fluconazole (FLCZ) in 5, itraconazole in one and amphotericin-B (AMPH-B) in 3. Only 4 patients, who had an increase of neutrophil > 500 /l, recovered from this infection. Among them, two were treated with AMPH-B, FLCZ and miconazole, one with AMPH-B and FLCZ, and one with voriconazole only. We should pay attention to an occurrence of breakthrough trichosporonemia when we use MCFG as an empirical anti-fungal therapy for male patients with hematological disorders and neutropenia. We need to develop an effective strategy to treat this fungal infection because of rapid onset and high mortality.