Transmission of <i>Trichosporon asahii</i> oesophagitis by a contaminated endoscope

Passo, Carla Lo; Pernice, Ida; Celeste, Anna; Perdichizzi, Giuseppa; Todaro-Luck, Flora

doi:10.1046/j.1439-0507.2001.00614.x

Cited by 44 publications

(20 citation statements)

References 19 publications

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“…The fluconazole MICs for two T. asahii isolates recovered from esophageal biopsy specimens of two patients were found to be relatively high (20 mg/liter), and the isolates were also resistant to nystatin. However, unlike the isolates recovered from the patients in our study, they were susceptible to AMB and flucytosine (MICs, Ͻ1 and Ͻ10 mg/liter, respectively) (25). A T. asahii strain isolated in cultures of blood from a patient who died from invasive trichosporonosis was found to be resistant to AMB in vitro (MIC, 2 mg/liter), but unlike our isolates, it was susceptible to fluconazole and itraconazole (MICs, 1 and 0.25 mg/liter, respectively) (10).…”

Section: Discussioncontrasting

confidence: 63%

Multidrug-Resistant Trichosporon asahii Infection of Nongranulocytopenic Patients in Three Intensive Care Units

et al. 2001

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Trichosporon asahii (Trichosporon beigelii) infections are rare but have been associated with a wide spectrum of clinical manifestations, ranging from superficial involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. We report on the recent recovery of T. asahii isolates with reduced susceptibility in vitro to amphotericin B (AMB), flucytosine, and azoles from six nongranulocytopenic patients who exhibited risk factors and who developed either superficial infections (four individuals) or invasive infections (two individuals) while in intensive care units. The latter two patients responded clinically and microbiologically to AMB treatment. All six isolates were closely related according to random amplified polymorphic DNA studies and showed 71% similarity by amplified fragment length polymorphism analysis, suggesting a common nosocomial origin. We also review the literature pertaining to T. asahii infections and discuss the salient characteristics of this fungus and recent taxonomic proposals for the genus.Trichosporon infections are associated with a wide spectrum of clinical manifestations, ranging from superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients (9, 44). Trichosporon asahii (Trichosporon beigelii) has increasingly been described as an opportunistic pathogen involved in disseminated infections in patients with profound granulocytopenia (9,11,26). Less commonly reported risk factors associated with infections caused by this agent include treatment with immunosuppressive drugs, transplantation, AIDS, extensive burns, and the presence of implanted prosthetic devices (9,11,14,20,24,27,29).Trichosporon species were the most common non-Candida cause of fungemia at a national cancer institute (23). Disseminated Trichosporon infections in immunocompromised patients are frequently fatal, despite therapy with amphotericin B (AMB) (9,44,46). This antifungal agent has been shown to have a limited in vitro effect against Trichosporon species. In contrast, azoles have been demonstrated to have in vitro activity against members of this genus and their use has been associated with favorable responses in animal models (2,3,9,27,31,32,45,46).We report on the recent recovery of T. asahii isolates resistant in vitro to AMB and azoles from six nongranulocytopenic patients who developed either invasive or superficial infections while hospitalized in different intensive care units (ICUs). We describe the demographic and major clinical characteristics of these patients and review the literature pertaining to T. asahii infections. Results from molecular biology-based studies based on random amplified polymorphic DNA (RAPD) and amplified fragment length polymorphism (AFLP) analyses suggest that the isolates recovered from specimens of these six patients were closely related. In addition, we discuss the salient characteristics of this fungus and recent taxonomic proposals for the genus. MATERIALS AND METHODSCase re...

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Section: Discussioncontrasting

confidence: 63%

Multidrug-Resistant Trichosporon asahii Infection of Nongranulocytopenic Patients in Three Intensive Care Units

et al. 2001

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“…Trichosporon asahii is the most common cause of fatal disseminated trichosporonosis (12,30), frequently associated with indwelling medical devices (13,15,18,22,26,28). In spite of antifungal drugs administered, trichosporonosis is often persistent or reestablished soon after treatment (12,34).…”

Section: Discussionmentioning

confidence: 99%

“…Although most of the reported cases of hematogenous T. asahii infections occurred in patients with leukemia during a neutropenic phase, another relevant predisposing factor for infection is represented by the presence of invasive devices, such as intravenous or urinary catheters (13,22,26,28), endoscopic forceps (18), and arteriovenous graft (15). These findings suggest that prosthetic devices could act as substrates for adhesion and, possibly, growth as biofilms, structured microbial communities embedded in an extracellular polymeric substance (EPS).…”

mentioning

confidence: 99%

Biofilm Formation by the Emerging Fungal Pathogen Trichosporon asahii : Development, Architecture, and Antifungal Resistance

Bonaventura

Pompilio

Picciani

et al. 2006

Antimicrob Agents Chemother

205

131

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Trichosporon asahii is the most common cause of fatal disseminated trichosporonosis, frequently associated with indwelling medical devices. Despite the use of antifungal drugs to treat trichosporonosis, infection is often persistent and is associated with high mortality. This drove our interest in evaluating the capability of T. asahii to form a biofilm on biomaterial-representative polystyrene surfaces through the development and optimization of a reproducible T. asahii-associated biofilm model. Time course analyses of viable counts and a formazan salt reduction assay, as well as microscopy studies, revealed that biofilm formation by T. asahii occurred in an organized fashion through four distinct developmental phases: initial adherence of yeast cells (0 to 2 h), germination and microcolony formation (2 to 4 h), filamentation (4 to 6 h), and proliferation and maturation (24 to 72 h). Scanning electron microscopy and confocal scanning laser microscopy revealed that mature T. asahii biofilms (72-h) displayed a complex, heterogeneous three-dimensional structure, consisting of a dense network of metabolically active yeast cells and hyphal elements completely embedded within exopolymeric material. Antifungal susceptibility testing demonstrated a remarkable rise in the MICs of sessile T. asahii cells against clinically used amphotericin B, caspofungin, voriconazole, and fluconazole compared to their planktonic counterparts. In particular, T. asahii biofilms were up to 16,000 times more resistant to voriconazole, the most active agent against planktonic cells (MIC, 0.06 g/ml). Our results suggest that the ability of T. asahii to form a biofilm may be a major factor in determining persistence of the infection in spite of in vitro susceptibility of clinical isolates.Candida species are the most common cause of disseminated nosocomial fungal infections (34). Invasive infections by rarer opportunistic fungal pathogens, however, have recently emerged as a significant problem in treatment of immunocompromised patients (8, 34).In particular, disseminated life-threatening Trichosporon infection is becoming increasingly common in patients with underlying hematological malignancies, extensive burns, solid tumors, and AIDS, accounting for approximately 10% of all confirmed cases of disseminated fungal infections (8,12,14,(32)(33)(34). Likewise, nonimmunosuppressed patients have suffered from Trichosporon infections associated with ophthalmologic surgery, infections of prosthetic devices, intravenous drug abuse, and peritoneal dialysis (1, 17, 21).Trichosporon beigelii was formerly considered the causative agent in trichosporonosis, but recent taxonomic findings based on partial sequences of large-subunit rRNA and DNA relatedness (9, 29, 30) revealed that T. beigelii actually consists of six distinct pathogenic Trichosporon species.In particular, Trichosporon asahii is the major cause of disseminated or deep-seated trichosporonosis (12,30). Although most of the reported cases of hematogenous T. asahii infections occurred in patie...

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“…Health care-associated transmission of Strongyloides stercoralis (150), Trichosporon spp. (151,152), and the yeast Rhodotorula rubra (69,153) have been reported. Crosscontaminations of Blastomyces dermatitidis (154), Legionella pneumophila (155), and Bacillus spp.…”

Section: Bacteriamentioning

confidence: 99%

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

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SUMMARY Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.

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Transmission of Trichosporon asahii oesophagitis by a contaminated endoscope

Cited by 44 publications

References 19 publications

Multidrug-Resistant Trichosporon asahii Infection of Nongranulocytopenic Patients in Three Intensive Care Units

Multidrug-Resistant Trichosporon asahii Infection of Nongranulocytopenic Patients in Three Intensive Care Units

Biofilm Formation by the Emerging Fungal Pathogen Trichosporon asahii : Development, Architecture, and Antifungal Resistance

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

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