Trichosporon Beigelii Infection Research Articles

Unusual complications of bone wax at the skull base.

This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Epidemiology and Outcome of Trichosporon Fungemia: A Review of 185 Reported Cases From 1975 to 2014.

Background. Trichosporon species have emerged as an important non-Candida spp yeast pathogen in immunocompromised patients in recent decades; however, the systemic analysis of Trichosporon epidemiology has seldom been reported. Methods. We reviewed 185 reported cases of Trichosporon fungemia from 1975 to 2014 in the English-language literature, and the epidemiology and prognostic factors of the included cases are described. Results. The number of cases reported has increased with time, especially over the past decade. During the 3 decades from 1975 to 2004, the most commonly used antifungal compounds were amphotericin B/liposomal amphotericin B; however, in recent decades (2005-2014), triazoles (especially voriconazole) have become the most widely used agents, significantly improving outcome in the reported cases. Correlation analysis revealed that negative outcome is associated with several prognostic factors, including a history of antimicrobial use, bacterial bloodstream coinfection, prophylactic/empirical antifungal therapy, Trichosporon beigelii infection, and receiving the antifungal regimen of amphotericin B/liposomal amphotericin B. In addition, a significantly greater proportion of patients with a positive outcome had fungemia without invasive tissue infection and received a voriconazole regimen or an AmB-triazole combined regimen. Significant positive outcome was also associated with patients who had recovered from neutropenia or after central venous catheter removal. Conclusions. Voriconazole can be recommended as a first-line antifungal compound to treat Trichosporon fungemia; the immune status of the host plays a crucial role in the outcome of this infection, and the removal of vascular catheters should be considered if feasible.

Delayed ABLC prophylaxis after allogeneic stem‐cell transplantation

Invasive fungal infections (IFI) are frequent causes of mortality after allogeneic stem-cell transplantation (SCT). A very important risk factor for IFI is the use of steroids. We used a risk-based chemoprevention in an open-labelled pilot study. All patients received oral fluconazole or itraconazole (200-400 mg day(-1)) during their neutropenic episode. Starting on day +30, patients receiving prednisone > or =30 mg day(-1) were switched to twice weekly Amphotericin-B-lipid-complex (ABLC) in a dose of 4 mg kg(-1). Patients receiving lower steroid doses continued on the fluconazole/itraconazole prophylaxis. Between 1999 and 2002, 100 patients were enrolled and followed for IFI for 1 year. Seven patients were started on therapeutic daily ABLC treatment before day +30 because of documented or suspected IFI; four had definite or probable aspergillosis, and two had candidaemia. Thirty patients did not need prophylactic ABLC; only one developed candidaemia. Sixty-three patients received ABLC prophylaxis for a median of 52 days (range: 1-289). Seven of these patients developed IFI; one definite and two probable cases of aspergillosis, one case of probable Trichosporon beigelii infection, and three cases of candidaemia. The twice weekly ABLC was well tolerated. This risk-based chemoprevention appears to be effective and might diminish the role of steroids as risk factor for IFI after allogeneic SCT. The relatively high incidence of early IFI suggests that additional prophylaxis for IFI may be indicated for poor-risk patients prior to day +30.

Fatal, complete splenic infarction and hepatic infection due to disseminated Trichosporon beigelii infection

We report on a 56-year-old woman with acute lymphocytic leukemia who presented with right upper quadrant pain, fever, nausea, and vomiting. Laboratory studies confirmed fungemia with Trichosporum beigelii, and contrast-enhanced computed tomography of the abdomen demonstrated numerous low-attenuation liver lesions and a hypodense spleen with capsular enhancement suggestive of complete splenic infarction. Subsequent splenectomy confirmed that the spleen was completely infarcted and infiltrated with Trichosporum. The patient had a difficult postoperative course and died despite aggressive antifungal therapy.

Efficacy of recombinant human granulocyte-colony stimulating factor alone and in combination with antifungal agents against disseminated trichosporonosis in neutropenic mice

The ability of recombinant human granulocyte colony-stimulating factor (rhG-CSF) to protect and potentiate the activity of antifungal agents against a lethal Trichosporon beigelii infection in myelosuppressed mice was evaluated in this study. Mice were rendered neutropenic by 2 consecutive-day intraperitoneal injections of cyclophosphamide (200mg/kg). Recombinant hG-CSF, given subcutaneously at daily doses of 15, 60, and 120μg/kg for 6 days, shortened the period of neutropenia and increased the number of circulating neutrophils in a dose-dependent manner. When rhG-CSF was administered to neutropenic mice before challenge with T. beigelii (5×106 CFU), it protected against the lethal infection, resulting in improved survival and decreased numbers of fungal cells in the lung, liver, spleen and kidney. However, when the inoculum size increased to 7×106 CFU, a poorer result was obtained using a dose of 60μg/kg of rhG-CSF, suggesting that the activity of rhG-CSF is dependent on the severity of the T. beigelii infection. Combined with fluconazole (10 mg/kg) or amphotericin B (1mg/kg), rhG-CSF improved the median survival time from 16 days with fluconazole (59%) and 12 days with amphotericin B (41%) alone to 20 days (93%) and 16 days (55%) in neutropenic mice treated with rhG-CSF plus fluconazole or amphotericin B, respectively. However, the combination of rhG-CSF and itraconazole did not produce significant improvement in survival or clearance of fungal cells from the organs of neutropenic mice. These findings show that rhG-CSF may be a useful immunomodulator against Trichosporon infections in neutropenic mice and the therapeutic outcome improves when used in combination with fluconazole or amphotericin B.

Disseminated Trichosporon beigelii infection in patients with malignant diseases: immunohistochemical study and review.

Trichosporon beigelii is a causative agent of opportunistic infection and summer-type hypersensitivity pneumonitis in Japan. However, as the diagnosis of Trichosporon beigelii infection is sometimes difficult, the actual incidence of this disease may be underestimated. Of 203 autopsy patients with malignant disease, seven (7.7%) were diagnosed with disseminated Trichosporon beigelii infection by immunohistochemical investigation of formalin-fixed, paraffin-embedded tissue sections. Including these seven, a total of 43 patients with Trichosporon beigelii infection have been reported in Japan. The majority of them had underlying hematologic malignancies, for which they received cytotoxic chemotherapy resulting in neutropenia. This study indicates that the immunohistochemical method, which can be applied to biopsy specimens, is an excellent tool for specific diagnosis of Trichosporon beigelii infection, which is an emerging fatal mycosis in immunocompromised patients with profound neutropenia.

Disseminated Trichosporon beigelii infection: report of nine cases and review

Trichosporon beigelii (formerly called Trichosporon cutaneum) is an emerging pathogen of disseminated trichosporonosis in immunocompromised patients. We conducted postmortem microbiological examinations of lung aspirates and blood in the heart. T. beigelii was isolated from the samples of 7 (2.24%) of 313 patients. Five of 7 patients isolated were diagnosed as having trichosporonosis based on histochemical and clinical findings. The other two were considered as colonization. Immunohistochemical study using Cryptococcus neoformans-absorbed antiserum to T. beigelii was carried out on the sections of autopsied tissues with deep mycoses. The sections from seven patients were positively stained, which were formerly diagnosed as candidiasis and/or aspergillosis. Consequently, 9 patients had disseminated trichosporonosis caused by T. beigelii. In Japan, 43 patients including the present 9, 31 males and 12 females, aged 51 (range, 2-84), were reported in the literature. Thirty-seven (86%) patients had hematologic malignancy, and the majority of them revealed profound neutropenia due to cytotoxic chemotherapy. Thirty-eight (88%) patients died despite the anti-fungal chemotherapy including amphotericin B. New strategies for refractory disseminated trichosporonosis in immunocompromised patients is needed.

Two cases of disseminated trichosporon beigelii infection treated with combination antifungal therapy

Two patients with acute leukemia in whom disseminated Trichosporon beigelii infection developed are reported. The T. beigelii infection developed in the first patient while he was receiving 5-fluorocytosine. He was treated with amphotericin B in addition to 5-fluorocytosine. Despite the continued antifungal therapy, multiple organs were invaded by the organisms at autopsy. The second patient was treated with miconazole and norfloxacin. Although this combination antifungal therapy seemed to be effective, this patient required splenectomy for cure of the infection.

Trichosporon beigelii Infection in an Immunocompromised Host Trichosporon beigelii‐Infektion bei einem abwehrgeschwächten Wirt

A case of Trichosporon beigelii infection in a patient with non-Hodgkins lymphoma that illustrates some of the associated diagnostic and chemotherapeutic problems, is described. Despite prolonged isolation of the yeast from blood cultures, the patient recovered from the infection after treatment with amphotericin B and flucytosine. Presenting features, diagnosis and monitoring of antifungal therapy in renal failure are discussed.

Disseminated Trichosporon beigelii infection in a patient with malignant histiocytosis.

A case of disseminated Trichosporon beigelii infection is reported. Trichosporon inhabits the soil, but may also be present in the human skin and mouth as a normal flora. Occasionally it causes superficial mycotic infection, but it is rarely invasive. A review of literature disclosed 21 reported cases of invasive Trichosporon beigelii infection, to date. Of these, two cases were from Japan. The scarcity of reports on this invasive infection may be due to a lack of awareness of the organism. Histologically, it should be carefully differentiated from Candida.