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

Maria Kourti,Emmanuel Roilides

doi:10.3390/pathogens11020242

Maria Kourti, Emmanuel Roilides

Open Access

https://doi.org/10.3390/pathogens11020242

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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.

Highlights

Received: 16 January 2022Trichosporon species are basidiomycetous yeast-like fungi, which are characterized by the formation of arthroconidia that disarticulate from septate hyaline hyphae [1]
Since the vast majority of ITI is due to T. asahii and isolates from invasive deep infections previously reported in the literature as T. beigelii and/or Trichosporon cutaneum would belong to T. asahii, we limited the search to T. asahii
Trichosporonosis is an emerging concern in preterm neonates treated with broadspectrum antimicrobials and indwelling catheters, and in children with hematologic malignant disease receiving prophylaxis or treatment with echinocandins given their lack of efficacy against this yeast

Summary

Introduction

Received: 16 January 2022Trichosporon species are basidiomycetous yeast-like fungi, which are characterized by the formation of arthroconidia that disarticulate from septate hyaline hyphae [1]. Trichosporon is derived from Greek words Tricho (hair) and Sporon (spores). Trichosporon species are found in nature, soil, water, mammals, birds, bats and cattle and colonize the human skin, gastrointestinal tract and mucosal surfaces as part of the human microbiota [2,3]. They are responsible for superficial infections (white piedra), allergic pneumonitis and rarely invasive infection [4,5,6,7,8,9,10]. Invasive Trichosporon infection may involve many organs, while Trichosporon fungemia (TF), including catheter-related fungemia, represents the main type of this opportunistic infection, which accounts for between 58.8 and 74.7%

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