Successful treatment of a brain abscess due toTrichoderma longibrachiatum after surgical resection

Abstract

A case of brain abscess due to Trichoderma longibrachiatum in a leukemic patient with prolonged neutropenia is reported. Definitive cure was achieved after neurosurgical resection of the abscess and prolonged antifungal therapy. Trichoderma is a filamentous fungus species, which is only exceptionally pathogenic in humans. This genus and particularly the species Trichoderma longibrachiatum should be added to the growing list of fungi causing infection in immunocompromised patients.

Phylogeny of the Clinically Relevant Species of the Emerging Fungus Trichoderma and Their Antifungal Susceptibilities

“…The clinical experience with azolebased therapies also shows variable outcomes; VRC used mostly in combination with CFG has shown some positive results against deep infections by T. longibrachiatum, T. reesei, and T. viride (7,(21)(22)(23)68). ITC has shown success alone and in combination with AMB and surgical resection against T. longibrachiatum (10,11,25), although according to our susceptibility results the apparent effectiveness of ITC might be only anecdotical. Ketoconazole was successful in a peritonitis case attributed to an unidentified Trichoderma species (15), while there are no reports on the use of PSC against Trichoderma infections.…”

“…They cause severe and persistent disseminated infections that usually fail to respond to treatment with amphotericin B (AMB) or voriconazole (VRC) (5)(6)(7)(8)(9). Other diseases attributed to members of this genus are allergic and acute invasive sinusitis (10,11), keratitis (12), otitis externa (13), skin and subcutaneous infections (14), peritonitis (9,(15)(16)(17)(18)(19)(20), deep pulmonary infections (21)(22)(23), endocarditis (24), and brain abscess (25). Most infections are caused by Trichoderma longibrachiatum, which is recognized as the main human pathogen of the genus (4,11,26), but eight other species (i.e., T. atroviride, T. citrinoviride, T. harzianum, T. koningii, T. orientale, T. pseudokoningii, T. reesei, and T. viride) have also been reported occasionally (4,(26)(27)(28).…”

Allergic Fungal Sinusitis Associated with Trichoderma longibrachiatum

“…longibrachiatum is an uncommon cause of invasive, sometimes fatal infection in immunocompromised patients (3,32). Sites involved include brain (7,21,24,29), skin (21), and peritoneum (33). A recent case of otitis externa in an otherwise healthy 12-year-old boy was resolved following treatment with topical nystatin (10).…”

“…In that case, the infection was successfully treated with surgical debridement followed by administration of amphotericin B and oral itraconazole. Previous reports on T. longibrachiatum infections have documented in vitro resistance to various antifungals including itraconazole and amphotericin B (6,21,24,29). The relationship between in vitro MIC for various antifungals and in vivo response has not been established for Trichoderma species.…”

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).…”