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First report of chronic meningitis caused by Trichosporon beigelii
I Surmont1, B Vergauwen, L Marcelis
1Department of Microbiology, St. Rafael University Hospital, Leuven, Belgium.
Abstract:
Trichosporon beigelii (Trichosporon cutaneum) was identified as the causative agent of chronic meningitis in a 15-year-old boy with acute lymphocytic leukaemia. After a neutropenic episode following cytostatic treatment and itraconazole therapy as prophylaxis, cerebrospinal fluid (CSF) samples yielded growth of Trichosporon beigelii. Treatment with amphotericin B, flucytosine and high doses of fluconazole was followed by clinical improvement, although CSF pleocytosis remained. The cross-reactivity between Cryptococcus neoformans and Trichosporon beigelii in a cryptococcal antigen latex test was used as a means of diagnosis in CSF and serum samples.
Insights
A rare case of chronic meningitis caused by Trichosporon beigelii in a leukemia patient is detailed. Diagnosis was aided by cross-reactivity in a cryptococcal antigen test, highlighting challenges in fungal meningitis identification.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Fungal meningitis is a serious complication, particularly in immunocompromised individuals.
- Trichosporon beigelii is an opportunistic pathogen that can cause invasive infections.
- Acute lymphocytic leukemia (ALL) patients undergoing chemotherapy are at high risk for opportunistic infections due to neutropenia.
Observation:
- A 15-year-old boy with ALL developed chronic meningitis after cytostatic treatment and itraconazole prophylaxis.
- Cerebrospinal fluid (CSF) cultures confirmed Trichosporon beigelii as the causative agent during a neutropenic episode.
- Clinical improvement was observed with a combination antifungal therapy, but CSF pleocytosis persisted.
Findings:
- The study identified Trichosporon beigelii as the cause of chronic meningitis in an immunocompromised pediatric patient.
- A cryptococcal antigen latex test showed cross-reactivity with Trichosporon beigelii, aiding in diagnosis of CSF and serum samples.
- Combination therapy including amphotericin B, flucytosine, and high-dose fluconazole was initiated for treatment.
Implications:
- This case highlights the importance of considering rare fungal pathogens like Trichosporon beigelii in immunocompromised patients with meningitis.
- The diagnostic utility of cryptococcal antigen latex test cross-reactivity in identifying Trichosporon infections is demonstrated.
- Effective management of Trichosporon meningitis requires a multi-faceted approach involving prompt diagnosis and aggressive antifungal therapy.