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Disseminated Trichosporon asahii infection in a preterm
Alişan Yildiran1, Sükrü Kücüködük, Ahmet Saniç
1Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
Abstract:
Trichosporon asahii (T. asahii) is an uncommon cause of yeast infection in preterms. We present a 27-week gestational age female with clinical evidence of sepsis, such as patchy infiltrations on chest roentgenogram, and yeast growing in urine and blood cultures. Conventional amphotericin B was empirically added in a dose of 0.5 mg/kg, q8h to standard protocol of the neonatal intensive care unit. Dose of the drug was induced to 1 mg/kg because the patient had not improved when the organism was identified as T. asahii on the pretreatment urine and blood cultures. Both cultures were clear on the 10th day of amphotericin B therapy and treatment was ceased on the 21st day. The patient was healthy when discharged. Trichosporon infections in neonates have been almost uniformly fatal. Most strains of T. asahii may be confused with Candida spp. on initial culture examinations. Therefore, delays in appropriate treatment may occur.
Insights
This case study highlights a successful treatment of Trichosporon asahii infection in a preterm infant using amphotericin B. Early identification and dose adjustment of antifungal therapy are crucial for favorable outcomes in neonatal yeast infections.
Area of Science:
- Medical Mycology
- Neonatal Infectious Diseases
Background:
- Trichosporon asahii is an infrequent cause of invasive fungal infections in preterm neonates.
- Neonatal Trichosporon infections carry a high mortality rate and can be misidentified as Candida species, delaying treatment.
Observation:
- A 27-week gestational age preterm infant presented with clinical signs of sepsis, including radiographic infiltrates and positive blood and urine cultures for yeast.
- Empirical treatment with conventional amphotericin B was initiated and subsequently escalated due to lack of clinical improvement.
Findings:
- Identification of the causative agent as Trichosporon asahii prompted an increase in amphotericin B dosage.
- Antifungal therapy led to negative blood and urine cultures by day 10 and successful patient recovery.
Implications:
- This case demonstrates the efficacy of amphotericin B in treating severe Trichosporon asahii infections in neonates.
- Emphasizes the importance of accurate and timely identification of fungal pathogens and appropriate antifungal dosing in critically ill preterm infants.