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Trichosporon Fungemia in a Tertiary Pediatric Hospital: A Case Series
Elad Steiner1, Ori Snapiri1, Salvador Fischer2
1Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel.
Background:
Trichosporon asahii is an opportunistic fungal pathogen increasingly recognized in immunocompromised patients, including children. Although rare, T. asahii fungemia carries significant morbidity and mortality, particularly in those with hematologic malignancies or prolonged immunosuppression.
Objectives:
This case series aimed to describe the clinical characteristics, risk factors, microbiological profiles, and treatment outcomes of pediatric patients diagnosed with T. asahii fungemia over a 13-year period at a tertiary care children's hospital.
Methods:
A retrospective review was conducted of all cases of T. asahii fungemia diagnosed between 2010 and 2023 in patients under 18 years of age. Data collected included patient demographics, underlying conditions, immunosuppressive status, presence of central venous catheters (CVCs), neutrophil counts, antifungal susceptibility profiles, treatments administered, and clinical outcomes.
Results:
Most cases occurred in immunocompromised patients, mainly those with neutropenia and a CVC. Half of the patients died. T. asahii isolates were generally susceptible to voriconazole and other azoles but showed partial resistance to amphotericin B. Clinical improvement was mainly associated with early antifungal treatment (particularly voriconazole) and supportive measures, including immunosuppression reduction, neutrophil recovery, and CVC removal.
Conclusions:
Voriconazole appears to be a reasonable empiric treatment option for pediatric T. asahii fungemia, a condition associated with a very poor prognosis. Successful management may also require early recognition of risk factors and interventions aimed at reversing immunosuppression and eliminating potential sources of infection such as CVCs.
Insights
Pediatric Trichosporon asahii fungemia is a serious infection in immunocompromised children, often linked to central venous catheters. Early voriconazole treatment and supportive care improve outcomes but prognosis remains poor.
Area of Science:
- Medical Mycology
- Pediatric Infectious Diseases
- Clinical Microbiology
Background:
- Trichosporon asahii is an opportunistic fungal pathogen causing severe infections in immunocompromised individuals, particularly children.
- Trichosporon asahii fungemia presents a significant risk of morbidity and mortality, especially in pediatric patients with hematologic malignancies or prolonged immunosuppression.
Purpose of the Study:
- To characterize the clinical features, risk factors, microbiological data, and treatment outcomes of pediatric Trichosporon asahii fungemia.
- To analyze a 13-year case series of T. asahii fungemia in a tertiary care children's hospital.
Main Methods:
- Retrospective review of pediatric cases (under 18) diagnosed with T. asahii fungemia from 2010-2023.
- Data collection included demographics, comorbidities, immunosuppression, central venous catheter (CVC) use, neutrophil counts, antifungal susceptibility, treatments, and outcomes.
Main Results:
- Immunocompromised patients, particularly those with neutropenia and CVCs, were most affected, with a 50% mortality rate.
- T. asahii isolates showed susceptibility to voriconazole and azoles, but partial resistance to amphotericin B.
- Clinical improvement correlated with early voriconazole therapy, reduced immunosuppression, neutrophil recovery, and CVC removal.
Conclusions:
- Voriconazole is a potential empiric treatment for pediatric T. asahii fungemia, despite its poor prognosis.
- Early identification of risk factors and prompt interventions, including immunosuppression reversal and CVC removal, are crucial for successful management.
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