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[Trichosporon capitatum septicemia in immunosuppressed patients]
R Herbrecht1, K L Liu, H Koenig
1Service d'Onco-Hématologie, Hôpital de Hautepierre, Strasbourg.
Abstract:
Disseminated Trichosporon capitatum infections are seldom reported. We observed 3 cases in leukemic patients within 4 months. All 3 patients were granulocytopenic. One of them was also treated with cyclosporine and methyl-prednisolone after an allogenic bone marrow transplant. The portal of entry was certainly the digestive tract as Tr. capitatum have been isolated in the stool before the septicemia. All 3 patients were previously treated with an azole antifungal compound. The part of this treatment in the emergence of Tr. capitatum in the digestive tract and in the occurrence of the septicemia must be considered. As Tr. capitatum are usually sensitive to the azole compounds the explanation may be a too low daily dosage for the treatment of severely immunocompromised hosts.
Insights
Disseminated Trichosporon capitatum infections are rare in leukemia patients. Inadequate azole antifungal dosage may contribute to breakthrough infections in immunocompromised individuals.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Disseminated Trichosporon capitatum infections are infrequently reported, posing a diagnostic and therapeutic challenge.
- Leukemic patients, particularly those who are granulocytopenic, are highly susceptible to opportunistic fungal infections.
- The gastrointestinal tract is a potential reservoir for fungal pathogens in immunocompromised hosts.
Observation:
- Three cases of disseminated Trichosporon capitatum infection were observed in leukemic patients within a four-month period.
- All affected patients were granulocytopenic, with one also receiving immunosuppressive therapy post-allogeneic bone marrow transplant.
- Trichosporon capitatum was isolated from stool samples prior to the onset of septicemia, suggesting a gastrointestinal portal of entry.
Findings:
- Previous treatment with azole antifungal agents was noted in all three patients.
- The emergence of Trichosporon capitatum in the digestive tract and subsequent septicemia were potentially linked to prior antifungal therapy.
- Sensitivity of Trichosporon capitatum to azoles suggests that sub-therapeutic dosing might have contributed to treatment failure and infection development.
Implications:
- This case series highlights the importance of considering Trichosporon capitatum in the differential diagnosis of fungal infections in immunocompromised patients.
- Optimal dosing of azole antifungals is crucial for effectively managing and preventing breakthrough fungal infections in severely immunocompromised hosts.
- Further research is warranted to elucidate the role of antifungal resistance and optimal treatment strategies for disseminated Trichosporon capitatum infections.