Multidrug-resistant Trichosporon: an unusual fungal sepsis in preterm neonates

We report a cluster of three extremely-low birth weight (ELBW), preterm neonates who developed late-onset sepsis (LOS) by Trichosporon asahii within a span of 1 week period. Two of these cases had the initial diagnosis of respiratory distress syndrome and the third one was admitted for low birth weight and prematurity. Initial sepsis screen was negative and blood culture was sterile in all. Late-onset sepsis was developed after the first week of life and the presenting features were lethargy, feeding intolerance, bleeding manifestations, positive sepsis screen and severe thrombocytopaenia. The isolates were sensitive to voriconazole but resistant to both amphotericin-B and fluconazole on all occasions. All the infants were treated with liposomal amphotericin-B before the availability of culture reports but the clinical deterioration was rapid and all three neonates succumbed to death before we could procure voriconazole. The source of the outbreak could not be identified from multiple surface cultures from the unit and screening of the health care staffs. We emphasise the need for high index of suspicion for unusual fungal pathogens, resistant to conventional antifungal drugs while treating preterm neonates with LOS.