Successful treatment of aTrichosporon beigelii septicemia in a granulocytopenic patient with amphotericin B and granulocyte colony-stimulating factor

Abstract

Invasive fungal infections have become an increasing problem in severely immunocompromised hosts. We here report a case of septicemia, caused by Trichosporon beigelii, an unusual pathogen of systemic infections. This infection was acquired during a period of severe neutropenia after chemotherapy for relapsed acute myelogenous leukemia following allogeneic bone marrow transplantation. The patient recovered from a life-threatening T. beigelii septicemia due to early intensified treatment with amphotericin B and a rapid neutrophil recovery, enhanced by granulocyte colony-stimulating factor (G-CSF). According to the current literature, amphotericin B is the treatment of choice for systemic T. beigelii infections. In patients with severe granulocytopenia, the rapid recovery of neutrophils remains the most important factor for the outcome of this infection.

GM-CSF-modulated phagocytosis of Trichosporon beigelii by human neutrophils

“…The recovery of neutrophil count appears to be the most important factor influencing the outcome of 7: beigelii infection [20]. The results of the present study suggest that ingestion of Trichosporon can be enhanced by GM-CSF -it is not known whether the fungicidal activity of neutrophils is enhanced by cytokines.…”

Adjuvant therapy with rhGM-CSF for the treatment of Blastoschizomyces capitatus systemic infection in a patient with acute myeloid leukemia

“…Antifungal therapy often fails to induce an improvement in the fungal complication; some authors have suggested that the addition of rhG-CSF or rhGM-CSF, by reducing the neutropenia, favors recovery from infection [3,4].…”

Efficacy of recombinant human granulocyte-colony stimulating factor alone and in combination with antifungal agents against disseminated trichosporonosis in neutropenic mice

“…44 Other antifungal agents, particularly the triazoles, have shown promising activity both in vitro and in vivo against this opportunistic fungal pathogen. 1~ However, the reported clinical experience with triazoles has been limited, 13 and furthermore, since these agents are fungistatic, it has been suggested that trichosporonosis in patients with persistent profound neutropenia may fail to respond to azole alone.…”