Trichosporon and Antifungal Resistance: Current Knowledge and Gaps

Trichosporon spp. are ubiquitous environmental and emerging opportunistic fungi that can be part of the normal microbiota of the skin, vagina, and gastrointestinal tract in humans and other animals. In a state of microbiota imbalance, both immunocompromised and non-immunocompromised patients are susceptible to trichosporonosis, which can present as either superficial infections, such as White Piedra, or deep-seated infections, such as fungemia. Due to intrinsic resistance or limited efficacy reported with fluconazole, polyenes, echinocandins, and flucytosine, voriconazole is currently recommended in clinical guidelines. Biofilm formation and the overexpression of efflux pumps may contribute to this limited efficacy, but other resistance mechanisms have also been reported. The high antifungal resistance levels present in this genus highlight the urgent need for new therapeutic approaches and a better understanding of Trichosporon pathogenesis and the molecular mechanisms underlying this resistance. In this review, we discuss antifungal resistance and the mechanisms of this resistance in Trichosporon spp., addressing key points that require further investigation.