Invasive Trichosporon Infection: a Systematic Review on a Re-emerging Fungal Pathogen

Abstract

Objectives: This review aimed to better depict the clinical features and address the issue of therapeutic management of Trichosporon deep-seated infections.Methods: We comprehensively reviewed the cases of invasive Trichosporon infection reported in the literature from 1994 (date of taxonomic modification) to 2015. Data from antifungal susceptibility testing (AST) studies were also analyzed.Results: Two hundred and three cases were retained and split into four groups: homeopathy (n = 79), other immunodeficiency conditions (n = 41), miscellaneous (n = 58) and newborns (n = 25). Trichosporon asahii was the main causative species (46.7%) and may exhibit cross-resistance to different antifungal classes. The unfavorable outcome rate was at 44.3%. By multivariate analysis, breakthrough infection (OR 2.45) was associated with unfavorable outcome, whilst the use of an azole-based therapy improved the prognosis (OR 0.16). Voriconazole-based treatment was associated with favorable outcome in hematological patients (73.6 vs. 41.8%; p = 0.016). Compiled data from AST demonstrated that (i) T. asahii exhibits the highest MICs to amphotericin B and (ii) voriconazole has the best in vitro efficacy against clinical isolates of Trichosporon spp.Conclusions: Trichosporon infection is not only restricted to hematological patients. Analysis of compiled data from AST and clinical outcome support the use of voriconazole as first line therapy.

Evaluating and Improving Vitek MS for Identification of Clinically Relevant Species of Trichosporon and the Closely Related Genera Cutaneotrichosporon and Apiotrichum

“…O pportunistic non-Candida yeasts, including Trichosporon spp., are emerging pathogens of deep-seated infections in the context of immunodepression and/or invasive procedures (1,2). In addition, outbreaks of catheter-related fungemia by these pathogens have been described in neonatal intensive care units (3).…”

“…Among these pathogenic species, T. asahii, T. asteroides, T. faecale, T. inkin, T. coremiiforme, T. dermatis, and T. mycotoxinivorans are the main species associated with deep-seated infections (2,4). Recently, based on multiple-gene sequence analysis, Trichosporon taxonomy has been reassessed, and new genera have been proposed for the monophyletic clades, which include Trichosporon, Cutaneotrichosporon, and Apiotrichum for pathogenic species (5).…”

Comparision of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF MS) with API ID 32C and VITEK 2 for the identification of Trichosporon species

“…Trichosporon asahii Türkiye dâhil birçok ülkede en sık izole edilen Trichosporon türüdür (20)(21)(22)(23) . Bu türün birçok antifungale karşı yüksek MİK değerlerine sahip olması özellikle daha sık izole edildiği immunsupresif ve yenidoğan hasta grubunda sorun oluşturmaktadır (20) .…”

“…Bu türün birçok antifungale karşı yüksek MİK değerlerine sahip olması özellikle daha sık izole edildiği immunsupresif ve yenidoğan hasta grubunda sorun oluşturmaktadır (20) . Ülkemizde yapılan bir çalışmada, bu türün amfoterisin B, flukonazol ve 5-flusitozine düşük duyarlı olduğu ve vorikonazolün en aktif antifungal olduğu belirtilmiştir (23) .…”

Invasive fungal infection caused by Trichosporon mucoides

“…ричиной инфекционных осложнений у пациен-тов с онкогематологическими заболеваниями являются бактерии, устойчивые к антибиотикам: в 10-15% случаев -это грамотрицательные палочки; в 30-40% -грамположительные бактерии, более чем в 50% случаев -грибы [1].…”