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Trichosporon species infection in bone marrow transplanted patients
M L Moretti-Branchini1, K Fukushima, A Z Schreiber
1Infectious Diseases Division, Universidade Estadual de Campinas-UNICAMP, São Paulo, Brazil. moretti@hc.unicamp.br
Abstract:
Trichosporon species are emerging as opportunistic agents that cause systemic diseases in immunocompromised patients. Patients undergoing bone marrow transplant are submitted to intense and prolonged periods of neutropenia and consequently to several risk factors to fungal infections as the use of broad spectrum antibiotics and invasive devices. Two cases of fungal infections caused by Trichosporon asahii var. asahii and T. inkin in patients with bone marrow transplant are described T. asahii var. asahii was responsible for fungemia and the identification of this microorganism was later performed. T. inkin caused vascular accesses infection and was recovered from an implanted Hickman-Broviac catheter. Both patients were under oral fluconazole prophylaxis. The patient with systemic infection died despite the therapy with amphotericin B and the patient with catheter-related infection recovered from the fungal infection after catheter removal. Difficulties in the identification of this microorganism lead to delays in treatment and post-mortem diagnosis.
Insights
Two bone marrow transplant patients developed invasive Trichosporon infections despite fluconazole prophylaxis. Early identification and catheter removal were crucial for recovery, highlighting challenges in managing these opportunistic fungal infections.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Opportunistic fungal infections caused by Trichosporon species pose a significant threat to immunocompromised individuals, particularly bone marrow transplant recipients.
- Bone marrow transplant patients are susceptible to fungal infections due to prolonged neutropenia, broad-spectrum antibiotic use, and invasive devices.
Observation:
- Two cases of Trichosporon infections in bone marrow transplant patients are presented: Trichosporon asahii var. asahii causing fungemia and Trichosporon inkin causing vascular access infection.
- Both patients were on oral fluconazole prophylaxis, indicating potential antifungal resistance or breakthrough infections.
- T. asahii fungemia was diagnosed post-mortem, while T. inkin catheter-related infection resolved after catheter removal.
Findings:
- Trichosporon asahii var. asahii caused fatal fungemia despite amphotericin B treatment.
- Trichosporon inkin led to a catheter-related infection that successfully resolved upon removal of the infected Hickman-Broviac catheter.
- Difficulties in rapid and accurate identification of Trichosporon species contributed to treatment delays and impacted patient outcomes.
Implications:
- This study underscores the challenges in diagnosing and treating invasive Trichosporon infections in immunocompromised patients.
- The findings highlight the need for improved diagnostic methods and antifungal stewardship to combat emerging fungal pathogens.
- Vigilance for breakthrough fungal infections and prompt management, including device removal, are critical for improving survival rates in bone marrow transplant recipients.