Abstract
Invasive trichosporonosis is an extremely rare mycosis, but Trichosporon fungemia (TF) in patients with hematologic malignancies has been increasingly recognized to be a fulminant and highly lethal infection. Although the utility of azole therapy has been demonstrated in several observations, little is known about the efficacy of one of azoles, miconazole (MCZ). To assess its therapeutic role, we retrospectively investigated 6 cases of TF in patients with acute leukemia receiving MCZ containing regimens. Successful outcome was obtained in 4 patients [MCZ + amphotericin B (AmB) in 2, MCZ only and MCZ + fluconazole (FLCZ) + AmB in one each], but not in 2 (MCZ + FLCZ + AmB and MCZ + FLCZ in one each). Although MCZ and AmB exhibited good in vitro activities against isolates from all patients, FLCZ had such finding from only one patient. Considering the reportedly limited utility of AmB, MCZ seemed to play a critical role even in the combination therapies for TF. Despite the release of newer azoles and other classes of antifungals, the use of MCZ remains a potential therapeutic approach for TF in patients with acute leukemia.
Highlights
Trichosporon is a yeast-like fungus usually found in soil and fresh water, and it may colonize the skin, upper respiratory tract, and gastrointestinal tract of humans [1]
Among patients with hematologic malignancies, this type of mycosis has been described to be a life-threatening infection with the mortality rate of approximately 80% [1,3,4,5,6,7]. Those with acute leukemia are by far the most common victims to be affected by Trichosporon fungemia (TF) during the period of neutropenia after chemotherapy [3,6,7]
We retrospectively reviewed 6 consecutive cases (>16 years of age) of TF in patients with acute leukemia at our collaborating 2 hospitals [Mie university hospital (MUH) and Hiroshima Red Cross and AtomicBomb Survivors Hospital] from 1992 to 2012
Summary
Trichosporon is a yeast-like fungus usually found in soil and fresh water, and it may colonize the skin, upper respiratory tract, and gastrointestinal tract of humans [1]. Among patients with hematologic malignancies, this type of mycosis has been described to be a life-threatening infection with the mortality rate of approximately 80% [1,3,4,5,6,7]. Those with acute leukemia are by far the most common victims to be affected by Trichosporon fungemia (TF) during the period of neutropenia after chemotherapy [3,6,7]. The optimal treatment of TF in such patients has not yet been established, several reports describe the usefulness of azole therapy [8,9,10]
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