Trichosporon beigelii infection: experience in a regional burn center

Cawley, Michael J.; Braxton, Gayna R.; Haith, Linwood R.; Reilly, Kathleen J.; Guilday, Robert E.; Patton, Mary Lou

doi:10.1016/s0305-4179(99)00181-3

Cited by 47 publications

(20 citation statements)

References 22 publications

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“…41:911, 2003). In addition, a combination of AMB and FCZ was useful in treating systemic infections due to these species (3,8). In this study, 10 strains of T. inkin, including that causing the endocarditis case, were susceptible in vitro to FCZ and ITZ.…”

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confidence: 78%

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Ramos¹,

Cuenca‐Estrella

Gutiérrez³

et al. 2004

J Clin Microbiol

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A fatal case of Trichosporon inkin prosthetic endocarditis is reported. The isolation sites and susceptibility profiles of 10 other isolates are also reviewed. Four strains were recovered from cutaneous or subcutaneous samples, four were recovered from urine, one was recovered from peritoneal liquid, and one was recovered from bone. Voriconazole and amphotericin B had the most potent activities in vitro against the isolates, with MIC geometric means of 0.11 and 0.30 g/ml, respectively. CASE REPORTA 52-year-old male underwent biological valve replacement for an insufficient aortic valve in October 1987. In May 2001, he developed valvular dysfunction with heart failure, and a second aortic valve replacement was performed. Fifteen months later, the patient presented to the Emergency Department with skin lesions on both hands, swelling of the right wrist, and articular pain. Physical examination revealed a temperature of 37.8°C and a leukocyte count of 12.8 ϫ10 6 per liter. Blood culture samples were taken, and the patient was discharged with the diagnosis of cellulitis and placed on amoxicillin-clavulanate therapy. Two days later, he came to the Infectious Diseases outpatient clinic with new skin lesions. An examination showed Osler's nodes in the fingers of both hands and in the feet and splinter hemorrhages on the nail folds. Transthoracic echocardiography showed a huge vegetation along the rim of the prosthetic aortic valve. After two new sets of blood cultures were performed, antibiotic therapy with vancomycin (1 g/12 h), gentamicin (80 mg/8 h), and rifampin (600 mg/day) was instituted. Forty-two hours later, the patient developed left hemiparesis and was transferred to another hospital for cardiovascular surgery. Unfortunately, after another 30 hours, he suffered a cardiopulmonary arrest and died before the surgery could be performed. An autopsy was not done.No growth was detected in the broth blood cultures after 7 days of incubation, but subcultures on Sabouraud glucose agar with gentamicin and chloramphenicol yielded colonies of a cream-colored organism after 48 h of incubation. Microscopic examination revealed budding cells and arthroconidia. Urease activity was positive. The API ID32C clinical yeast identification system (Biomerieux SA, Marcy-L'Etoile, France) was used to identify the isolate. With this commercial kit, we obtained the code 525764371, which is listed in the API ID32C database as a very good identification of Trichosporon inkin. However, the strain did not show growth on N-acetylglucosamine (the carbon source), a test by which the majority of T. inkin strains included in the API database are positive. Therefore, the isolate was sent to the Mycology Laboratory of the National Center for Microbiology of Spain for definitive identification and susceptibility testing.Identification of the isolate. At the National Center for Microbiology, the strain was labeled as CNM-CL-4811 (Spanish Centro Nacional de Microbiología yeast culture collection). The isolate was identified by routine physiological ...

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confidence: 78%

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Ramos¹,

Cuenca‐Estrella

Gutiérrez³

et al. 2004

J Clin Microbiol

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“…Crude mortality rates were 30% for children and 87.5% for adult patients (P ϭ 0.025) (24,25). Finally, small series of cases of invasive trichosporonosis have also been described for burn victims, patients with secondary hemochromathosis, and Job's syndrome (23,26,73,162).…”

Section: Deep-seated Infectionsmentioning

confidence: 99%

“…However, despite being less frequent, there are increasing reports of episodes of organ-specific infections and patients with disseminated trichosporonosis presenting with pneumonia, soft tissue lesions and eventually endophthalmitis, endocarditis, brain abscess, meningitis, arthritis, esophagitis, lymphadenopathy, liver, splenic abscess, and uterine infections (23,24,26,27,74,98,110,117,154,178).…”

Section: Deep-seated Infectionsmentioning

confidence: 99%

Current Knowledge of Trichosporon spp. and Trichosporonosis

2011

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SUMMARY Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive trichosporonosis. Disseminated trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.

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“…In general the most common treatment for yeast infections is based on the use of amphotericin B (AMB) and fluconazole (FLC). However, against infections caused by the five above-mentioned species, these drugs have repeatedly failed (3,5,7,12,13,21). Such a limitation, associated with AMB toxicity, determines the interest in evaluating the potential antifungal role of the new azoles and echinocandins.…”

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confidence: 99%

In Vitro Antifungal Susceptibilities of Uncommon Basidiomycetous Yeasts

Serena

Pastor

Ortoneda

et al. 2004

Antimicrob Agents Chemother

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The in vitro activities of eight antifungal drugs against 50 isolates of basidiomycetous yeasts were determined by a microdilution method. In general fluconazole and micafungin were inactive. Terbinafine was active only against Sporobolomyces salmonicolor. The activities of the other antifungals were variable and depended on the species tested. The new triazoles showed the lowest MICs, but amphotericin B and itraconazole were the only drugs active against Cryptococcus albidus.Basidiomycetous yeasts are anamorphs (asexual states) of members of jelly fungi (Tremellales) or smuts (Ustilaginales). Some of these yeasts, such as Cryptococcus neoformans and Malassezia spp., are well-known human pathogens. However, many other species are also able to cause human infections, mainly in immunosuppressed patients. Among these, Cryptococcus albidus, Cryptococcus laurentii, Sporobolomyces salmonicolor, Rhodotorula glutinis, and, more commonly, Trichosporon asahii have been reported to cause severe infections (1,4,10,12,19,23). In general the most common treatment for yeast infections is based on the use of amphotericin B (AMB) and fluconazole (FLC). However, against infections caused by the five above-mentioned species, these drugs have repeatedly failed (3,5,7,12,13,21). Such a limitation, associated with AMB toxicity, determines the interest in evaluating the potential antifungal role of the new azoles and echinocandins. Although some of these species have been tested in vitro, only the responses of a reduced number of isolates are known (6,24). Trichosporon has received the most attention (2, 3, 21-23), but in most studies the strains tested were identified as Trichosporon beigelii, which is a not valid name, and so it is not known which current species were actually tested.In this study we have evaluated the in vitro activity of eight antifungal drugs against the five opportunistic species mentioned above. Although a reference method for testing these species does not exist, we have used M27-A2 (17), which has been shown to be very useful for testing the more-common yeasts.A total of 50 isolates were tested (10 species each of C. albidus, C. laurentii, R. glutinis, S. salmonicolor, and T. asahii). Most of them are clinical isolates provided by the BCCM/ IHEM Biomedical Fungi/Yeast collection or Centraalbureau voor Schimmelcultures. The isolates were stored lyophilized and were subcultured on Sabouraud dextrose agar for the study. T. asahii, S. salmonicolor, and R. glutinis were incubated at 35°C for 24 to 72 h, and C. albidus and C. laurentii were incubated at 30°C for 48 to 72 h. Candida krusei ATCC 6258 and Candida parapsilosis ATCC 22019 were included in each batch of tests as a quality control.Antifungal agents were obtained as pure powders. AMB (USP, Rockville, Md.), albaconazole (ABC; J. Uriach & Cía, Barcelona, Spain), voriconazole (VRC; Pfizer Inc., Madrid, Spain), itraconazole (ITC; Janssen Pharmaceutica, Beerse, Belgium), ravuconazole (RVC; Bristol-Myers Squibb Company, New Brunswick, N.J.), and terbinafine (TBF...

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Trichosporon beigelii infection: experience in a regional burn center

Cited by 47 publications

References 22 publications

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Current Knowledge of Trichosporon spp. and Trichosporonosis

In Vitro Antifungal Susceptibilities of Uncommon Basidiomycetous Yeasts

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