Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders

Abstract

(1) Background: Trichosporon species have emerged as important opportunistic fungal pathogens, with Trichosporon asahii being the leading and most frequent cause of invasive disease. (2) Methods: We performed a global review focused on invasive trichosporonosis in neonates and pediatric patients with malignancies or hematologic disorders. We reviewed case reports and case series of trichosporonosis due to T. asahii published since 1994, the year of the revised taxonomic classification. (3) Results: Twenty-four cases of invasive trichosporonosis were identified in neonates with the presence of central venous catheter and use of broad-spectrum antibiotics recognized as the main predisposing factors. Thirty-two cases were identified in children with malignancies or hematologic disorders, predominantly with severe neutropenia. Trichosporon asahii was isolated from blood in 24/32 (75%) pediatric cases. Cutaneous involvement was frequently observed in invasive trichosporonosis. Micafungin was the most commonly used prophylactic agent (9/22; 41%). Ten patients receiving prophylactic echinocandins were identified with breakthrough infections. A favorable outcome was reported in 12/16 (75%) pediatric patients receiving targeted monotherapy with voriconazole or combined with liposomal amphotericin B. Overall mortality in neonates and children with malignancy was 67% and 60%, respectively. (4) Conclusions: Voriconazole is advocated for the treatment of invasive trichosporonosis given the intrinsic resistance to echinocandins and poor susceptibility to polyenes.

Rare Yeasts in Latin America: Uncommon Yet Meaningful

“…Conversely, CVC, leukemia, and cancer were associated with higher rates of Rhodotorula infections, which agrees with the typical risk factors for this genus [5,46]. Mortality associated with invasive infections caused by T. asahii is generally higher than that of Candida infections [117,118]. In Latin America, about 80% of patients affected by T. asahii died.…”

“…Nevertheless, non-blood stream infections (BSI) caused by these pathogens accounted for almost half the cases, including catheter-related infection, urinary tract infection, pneumonia, peritonitis, meningoencephalitis, and endocarditis. As reported in the literature, Trichosporon and Rhodotorula invasive infections, particularly by T. asahii and R. mucilaginosa, are more likely to be fungemia [2,5,11,46,117], while other genera can cause diverse clinical manifestations, such as Geotrichum causing pulmonary infection or Saccharomyces causing oral infection [30,60,119,120].…”

“…The prevalence and outcome of rare yeast infections in Latin America varied as well depending on the risk factors of patients and the etiological agent, even though there are slight differences compared to the global epidemiology of these infections. While hematologic malignancies and neutropenia are considered classical risk factors for invasive Trichosporon infection [2,116,117], in Latin America, surgery and antibiotic use prevail among patients affected by species of this genus. Conversely, CVC, leukemia, and cancer were associated with higher rates of Rhodotorula infections, which agrees with the typical risk factors for this genus [5,46].…”

Rhinocerebral Mucormycosis and Trichosporon asahii Fungemia in a patient with acute lymphoblastic leukemia: A rare co-infection and literature review

“…Trichosporon species have emerged as important opportunistic fungal pathogens, with T. asahii being the leading cause of disseminated infections and result in signi cant morbidity and death among those with a hematologic malignancy. 75% T. asahii was isolated from blood in pediatric cases and invasive T.asahii was frequently observed cutaneous involvement, which is helpful for high index of suspicion, early determine the etiology and initiate appropriate treatment [14]. Clinicians should highly suspicious of trichosporonosis in pediatric patients with a hematologic malignancy who present with persistent fever and neutropenia, especially when echinocandins are given for antifungal prophylaxis [15].…”

Rhinocerebral mucormycosis and Trichosporon asahii fungemia in a pediatric patient with acute lymphoblastic leukemia: a rare coinfection

“…Rhizopus is the most common causative agent of mucormycosis, accounting for approximately 60% of reported cases 2 . Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance 3 . T. asahii is the most common species isolated from invasive trichosporidiosis, and approximately 80% of cases are secondary to fungemia, resulting in a high mortality rate (40-90%) 3 .…”