Abstract
BackgroundThe relevance of Trichosporon species for cystic fibrosis (CF) patients has not yet been extensively investigated.MethodsThe clinical course of CF patients with Trichosporon spp. in their respiratory secretions was analysed between 2003 and 2010 in the Munich CF center. All respiratory samples of 360 CF patients (0 – 52.4 years; mean FEV1 2010 81.4% pred) were investigated.ResultsIn 8 patients (2.2%, 3 male, mean age 21.8 years) Trichosporon was detected at least once. One patient carried T. asahii. One patient carried T. mycotoxinivorans and one patient T. inkin as determined by DNA sequencing. As potential risk factors for Trichosporon colonization steroid treatment, allergic bronchopulmonary aspergillosis (ABPA) and CF associated diabetes were identified in 6, 5, and 2 patients respectively. For one patient, the observation period was not long enough to determine the clinical course. One patient had only a single positive specimen and exhibited a stable clinical course determined by change in forced expiratory volume in one second (FEV1), body-mass-index (BMI), C-reactive protein (CRP) and immunoglobulin G (IgG). Of 6 patients with repeatedly positive specimen (mean detection period 4.5 years), 4 patients had a greater decline in FEV1 than expected, 2 of these a decline in BMI and 1 an increase in IgG above the reference range. 2 patients received antimycotic treatment: one patient with a tormenting dry cough subjectively improved under Amphotericin B inhalation; one patient with a severe exacerbation due to T. inkin was treated with i.v. Amphotericin B, oral Voriconazole and Posaconazole which stabilized the clinical condition.ConclusionsThis study demonstrates the potential association of Trichosporon spp. with severe exacerbations in CF patients.
Highlights
The relevance of Trichosporon species for cystic fibrosis (CF) patients has not yet been extensively investigated
Three case reports are available in literature: One 11-year old CF patient suffered from a non-aspergillus allergic bronchopulmonary mycosis due to T. beigelii and recovered within 2 months under intensive steroid and antifungal therapy [11]
One 20-year old, male CF patient died within a few days from admission due to a fulminant pneumonia with T. mycotoxinivorans [12] and one 35year old CF patient died due to a disseminated fatal infection with T. mycotoxinivorans 29 days after lung transplantation [13]
Summary
The relevance of Trichosporon species for cystic fibrosis (CF) patients has not yet been extensively investigated. Trichosporon species (T. spp.) belong to the genus of basidiomycetous yeast and are widely distributed in nature. They are found in soil and water and are known to colonize skin and gastrointestinal tract of humans [1,2]. Numerous Trichosporon spp. have been characterized [3], while only a few cause human neutropenia, malignancies, especially leukemia [7], renal disease, extensive burns and HIV [7,8]. Invasive Trichosporon infections are the second most common yeast fungaemia in humans [4,9], especially in patients with haematological malignancies [10]. Aim of this study was to investigate the detection rate of Trichosporon spp. in a German CF cohort and to describe the clinical course of patients positive for Trichosporon
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