Trichosporon asahii Infective Endocarditis of Prosthetic Valve: A Case Report and Literature Review

Abstract

Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, cultures of the removed valve demonstrated Trichosporon ashaii as the etiological agent. The patient was treated with amphotericin B at first and subsequently with fluconazole. Given the fragility of the patient and the aggressiveness of the pathogen, life-long prophylactic therapy with fluconazole was prescribed. After 5 years follow-up, no drug-related toxicities were reported and the patient never showed any signs of recurrence. The review of the literature illustrates that Trichosporon spp. endocarditis may present even many years after heart surgery, and it is often associated with massive valve vegetations, severe embolic complications, and unfavorable outcome. Due to the absence of international guidelines, there is no unanimous therapeutic approach, but amphotericin B and azoles are usually prescribed. Additionally, a prompt surgical intervention seems to be of paramount importance. When dealing with a life-threatening disease, such as mycotic endocarditis of prosthetic valves, it is essential to consider and treat even rare etiological agents such as Trichosporon spp.

Hog1-mediated stress tolerance in the pathogenic fungus Trichosporon asahii

“…Amphotericin B and fluconazole are used to treat T. asahii infections 45 , 46 . The hog1 gene-deficient mutants of C. neoformans and C. albicans are sensitive to an antifungal agent the amphotericin B (AMPH-B) 19 , 23 , 38 , 42 .…”

A Repertoire of the Less Common Clinical Yeasts

“…and Aspergillus spp., there might be a propensity to focus solely on their detection, effectively excluding the possibility of other fungal origins [170]. However, this fungal repertoire highlights the cardiac tropism of Trichosporon spp., which may go unnoticed in comparison with much more common species, and must be considered [171]. Trichosporon yeasts are opportunistic agents leading to superficial-to-severe infections in at-risk populations [64].…”

A novel report on the emerging and zoonotic neurotropic fungus Trichosporon japonicum in the brain tissue of the endangered Brazilian guitarfish (Pseudobatos horkelii) off the southeastern coast of Brazil

“…These organisms are widespread worldwide, with a preference for warm and tropical climates and are found in several environmental compartments, such as soil, decomposing wood and in both freshwater and marine environments, as well as in wildlife, such as bats, cattle and fish [ 5 ]. Members belonging to this genus have the potential to induce invasive and life-threatening fungal diseases in immunocompromised individuals [ 6 , 7 ]. They also pose a risk to humans through the consumption of contaminated foodstuffs [ 8 ], including, but not limited, to milk and milk-derived products [ 9 ], honey [ 10 ], truffles [ 11 ] and seafood [ 12 – 17 ], as well as through workers exposed to potentially contaminated animals, such as zookeepers and fishers [ 18 , 19 ].…”