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Emerging pan-resistance in Trichosporon species: a case report
Claudy Oliveira dos Santos1, Jan G Zijlstra2, Robert J Porte3
1Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands. c.oliveira.dos.santos@umcg.nl.
Background:
Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.
Case Presentation:
We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.
Conclusion:
This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.
Insights
Pathogenic yeasts like Trichosporon dermatis are developing pan-azole resistance, similar to bacteria. This case highlights a resistant yeast infection unresponsive to standard antifungal treatments, emphasizing prudent antifungal use.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Trichosporon species are common human flora, typically causing superficial infections.
- Emerging opportunistic pathogens, Trichosporon spp. cause invasive infections in immunocompromised individuals.
- While generally azole-sensitive, multi-azole resistant strains are increasingly reported.
Observation:
- A liver re-transplantation patient developed invasive cholangitis caused by Trichosporon dermatis.
- The infection persisted despite fluconazole and amphotericin B prophylaxis.
- Combined liposomal amphotericin B and voriconazole treatment proved ineffective.
Findings:
- This Trichosporon dermatis isolate exhibited high-level pan-azole resistance.
- The yeast demonstrated resistance to multiple azole antifungal agents.
- Treatment failure occurred with standard antifungal therapies.
Implications:
- Pathogenic yeasts, not just bacteria, are evolving pan-resistance.
- Emerging antifungal resistance poses a significant threat in clinical settings.
- Prudent antifungal stewardship is crucial to combat the rise of resistant fungal infections.
