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Francisco EC, Desnos-Ollivier M, Dieleman C, Boekhout T, Santos DWDCL, Medina-Pestana JO, Colombo AL, Hagen F. Unveiling Trichosporon austroamericanum sp. nov.: A Novel Emerging Opportunistic Basidiomycetous Yeast Species. Mycopathologia 2024; 189:43. [PMID: 38709328 DOI: 10.1007/s11046-024-00851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/27/2024] [Indexed: 05/07/2024]
Abstract
During an epidemiological survey, a potential novel species within the basidiomycetous yeast genus Trichosporon was observed. The clinical strain was obtained from a urine sample taken from a Brazilian kidney transplant recipient. The strain was molecularly identified using the intergenic spacer (IGS1) ribosomal DNA locus and a subsequent phylogenetic analysis showed that multiple strains that were previously reported by other studies shared an identical IGS1-genotype most closely related to that of Trichosporon inkin. However, none of these studies provided an in-depth characterization of the involved strains to describe it as a new taxon. Here, we present the novel clinically relevant yeast for which we propose the name Trichosporon austroamericanum sp. nov. (holotype CBS H-24937). T. austroamericanum can be distinguished from other siblings in the genus Trichosporon using morphological, physiological, and phylogenetic characters.
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Affiliation(s)
- Elaine C Francisco
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute (WI-KNAW), Uppsalalaan 8, 3584CT, Utrecht, The Netherlands
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marie Desnos-Ollivier
- Département de Mycologie, Centre National de Référence des Mycoses invasives et Antifongiques, Institut Pasteur, Université de Paris Cité, Paris, France
| | - Chendo Dieleman
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute (WI-KNAW), Uppsalalaan 8, 3584CT, Utrecht, The Netherlands
| | - Teun Boekhout
- College of Science, King Saud University, 11451, Riyadh, Saudi Arabia
| | | | - José O Medina-Pestana
- Serviço de Nefrologia, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo L Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), São Paulo, Brazil
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute (WI-KNAW), Uppsalalaan 8, 3584CT, Utrecht, The Netherlands.
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands.
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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2
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Yang T, Fu Y. Trichosporon asahii co-infection with Pneumocystis jiroveci in a renal transplant patient. IDCases 2024; 36:e01951. [PMID: 38707649 PMCID: PMC11066508 DOI: 10.1016/j.idcr.2024.e01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024] Open
Abstract
Trichosporon asahii is considered an opportunistic pathogen, capable of causing superficial infections in humans and invasive deep-seated infections in immunocompromised hosts. Pneumocystis jirovecii can cause life-threatening pneumonia in immunosuppressed patients. Both Trichosporon and Pneumocystis jirovecii are highly lethal in immunocompromised individuals. Here we present a case of invasive Trichosporon asahii co-infection with Pneumocystis jiroveci in a renal transplant patient.
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Affiliation(s)
- Tingting Yang
- Department of Laboratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yajie Fu
- Department of Laboratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310006, China
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3
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Lee EH, Choi MH, Lee KH, Song YG, Han SH. Differences of clinical characteristics and outcome in proven invasive Trichosporon infections caused by asahii and non-asahii species. Mycoses 2023; 66:992-1002. [PMID: 37515448 DOI: 10.1111/myc.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Trichosporon is an emerging yeast that causes invasive infections in immunocompromised patients experiencing prolonged hospitalisation, indwelling venous catheters and neutropenia. METHODS This retrospective observational cohort study analysed invasive Trichosporon infections (ITIs) occurring between January 2005 and December 2022 at three tertiary hospitals and compared the clinical characteristics and prognostic factors of ITIs caused by Trichosporon asahii and non-T. asahii spp. After evaluating 1067 clinical isolates, we identified 46 patients with proven ITIs, defined as cases in which Trichosporon was isolated from blood, cerebrospinal fluid, or sterile tissues. RESULTS The patients were separated into T. asahii and non-T. asahii groups containing 25 and 21 patients, respectively, all of which except one were immunocompromised. During this period, both the number of clinical isolates and patients with ITIs (mainly T. asahii) increased; whereas, cases involving non-T. asahii spp. decreased. Compared with the non-T. asahii group, the T. asahii group had more patients with multiple catheters (84% vs. 33%, p = .001) and those receiving renal replacement therapy (48% vs. 14%, p = .005). The all-cause 28-day mortality rate after ITI in the T. asahii group (44%) was significantly higher than in the non-T. asahii group (10%, Log-rank p = .014). The multivariate Cox regression model revealed that T. asahii (reference, non-T. asahii spp.; aHR = 4.3; 95% CI = 1.2-15.2, p = .024) and neutropenia for 5 days or more (aHR = 2.2, 95% CI = 1.5-3.6, p = .035) were independent factors in the 28-day mortality after ITI. CONCLUSION The proven ITIs due to T. asahii produced more unfavourable outcomes compared with ITIs caused by non-T. asahii spp.
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Affiliation(s)
- Eun Hwa Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Hyuk Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwa Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Han
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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4
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Gil Ó, Hernández-Pabón JC, Tabares B, Lugo-Sánchez C, Firacative C. Rare Yeasts in Latin America: Uncommon Yet Meaningful. J Fungi (Basel) 2023; 9:747. [PMID: 37504735 PMCID: PMC10381163 DOI: 10.3390/jof9070747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Systemic infections caused by rare yeasts are increasing given the rise in immunocompromised or seriously ill patients. Even though globally, the clinical significance of these emerging opportunistic yeasts is increasingly being recognized, less is known about the epidemiology of rare yeasts in Latin America. This review collects, analyzes, and contributes demographic and clinical data from 495 cases of infection caused by rare yeasts in the region. Among all cases, 32 species of rare yeasts, distributed in 12 genera, have been reported in 8 Latin American countries, with Trichosporon asahii (49.5%), Rhodotorula mucilaginosa (11.1%), and Saccharomyces cerevisiae (7.8%) the most common species found. Patients were mostly male (58.3%), from neonates to 84 years of age. Statistically, surgery and antibiotic use were associated with higher rates of Trichosporon infections, while central venous catheter, leukemia, and cancer were associated with higher rates of Rhodotorula infections. From all cases, fungemia was the predominant diagnosis (50.3%). Patients were mostly treated with amphotericin B (58.7%). Crude mortality was 40.8%, with a higher risk of death from fungemia and T. asahii infections. Culture was the main diagnostic methodology. Antifungal resistance to one or more drugs was reported in various species of rare yeasts.
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Affiliation(s)
- Óscar Gil
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
| | - Juan Camilo Hernández-Pabón
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
| | - Bryan Tabares
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
- Unidad de Extensión Hospitalaria, Hospital Universitario Mayor Méderi, Bogota 111411, Colombia
| | - Carlos Lugo-Sánchez
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
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5
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Francisco EC, Ebbing M, Colombo AL, Hagen F. Identification of Clinical Trichosporon asteroides Strains by MALDI-TOF Mass Spectrometry: Evaluation of the Bruker Daltonics Commercial System and an In-House Developed Library. Mycopathologia 2023; 188:243-249. [PMID: 37067663 DOI: 10.1007/s11046-023-00723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
Trichosporon asteroides is an emerging yeast-like pathogen commonly misidentified by commercial biochemical identification systems. We evaluated the performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of 21 clinical T. asteroides strains using the Bruker Daltonics database (BDAL) and an in-house developed library. Mass spectra were obtained by the FlexControl system v.3.4, and characterizations were performed in the Biotyper BDAL database v.4.1 and the developed in-house library. Species identification for T. asteroides failed as all 21 strains were misidentified as T. japonicum (log-scores 1.89-2.19). Extending the existing database was crucial to achieving 100% correct species-level identification and accurate distinction between species. Our results indicate that the commercial BDAL database has no discriminatory power to distinguish between T. japonicum and T. asteroides. Whereas improvement of the current BDAL database is pending, we strongly advise system users not to exclude the possibility of the failure to report T. asteroides.
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Affiliation(s)
- Elaine Cristina Francisco
- Division of Infectious Diseases, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, 04024-002, Brazil.
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.
| | - Mexx Ebbing
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, 04024-002, Brazil
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands.
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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6
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Quintana JL, Carreras X, Salcedo AS, Ruíz LT, Gonzales MM, Del Castillo Mory A, Cheng HC, Gonzalez AC. Mycotic aneurysms due to Trichosporon asahii in a patient with ulcerative colitis under immunosuppression. IDCases 2023; 32:e01794. [PMID: 37214183 PMCID: PMC10196954 DOI: 10.1016/j.idcr.2023.e01794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
Yeast fungi of the genus Trichosporon spp. can colonize the gastrointestinal tract in humans. In recent decades, the pathogenic role of Trichosporon asahii has been increasingly acknowledged especially in the setting of neutropenic patients with hematological malignancies. However, non-neutropenic patients who are immunosuppressed for other reasons are also at risk of developing invasive forms of this mycosis. We present the case of a 62-year-old male, with a history of ulcerative colitis under immunosuppressive treatment and previous exposure to antibiotics for various bacterial infections, who was admitted to the emergency department with a mycotic aneurysm of the abdominal aorta and left common iliac secondary to T. asahii infection. A multidisciplinary approach of the case (both early medical and surgical interventions) allowed the patient's favorable outcome. The patient was followed for more than two years with no evidence of relapse. We postulate that the diagnosis of invasive Trichosporonosis should be considered in patients with inflammatory bowel disease (IBD) under immunosuppressive treatment and with prior exposure to antibiotics.
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Affiliation(s)
| | | | | | - Lourdes Torres Ruíz
- Servicio de Cirugía Cardíaca, Torácica, Vascular y Endovascular, Clínica Angloamericana, Lima, Peru
| | | | | | - Hugo Cedrón Cheng
- Servicio de Gastroenterología, Clínica Angloamericana, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alfredo Chiappe Gonzalez
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
- Servicio de Infectología, Clínica Angloamericana, Lima, Peru
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7
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Francisco EC, Dieleman C, Hagen F, Colombo AL, Mendes AVA, de Oliveira Silva M, de Andrade Barberino MG, Neves RP, Botura MB, Hahn RC, de Almeida Junior JN, Ponzio V, de Tarso O e Castro P, Guimarães T, Santos DW, de Miranda BG, Silva ILAFE, Carlesse F, Ramos JF, Queiroz-Telles F, Aquino VR, Motta FA, Schwarzbold AV, Perozin JS. In vitro activity of isavuconazole against clinically relevant Trichosporon species: a comparative evaluation of EUCAST broth microdilution and MIC Test Strip methods. J Antimicrob Chemother 2023; 78:817-822. [PMID: 36702754 DOI: 10.1093/jac/dkad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the in vitro activity of isavuconazole on 154 clinical and reference strains of Trichosporon asahii, Trichosporon asteroides, Trichosporon coremiiforme, Trichosporon faecale and Trichosporon inkin by using the EUCAST broth microdilution method (BMD) and Liofilchem MIC Test Strips (MTS). METHODS Antifungal susceptibility testing for isavuconazole, fluconazole, voriconazole and posaconazole was assessed by EUCAST E.DEF 7.3.2. MIC values of isavuconazole obtained by BMD after 48 h of incubation were compared with MTS MICs after 24 and 48 h of incubation. RESULTS T. asahii and T. asteroides showed the highest isavuconazole MIC90 values (0.5 mg/L). In clinical isolates, T. asahii exhibited the highest MIC90 values (0.5 mg/L) compared with non-T. asahii (0.06-0.25 mg/L). The five non-WT T. asahii isolates for fluconazole, voriconazole and posaconazole also exhibited high MICs of isavuconazole (≥0.5 mg/L). A better correlation between MTS and BMD MICs was observed after 24 h incubation for all species tested. MTS measurements performed at 48 h increased by at least 122% the number of isolates with >2 dilutions compared with the standard method. CONCLUSIONS Isavuconazole exhibited variable in vitro activity among the Trichosporon species tested, showing higher or equal MICs than the other azoles. The five non-WT T. asahii clinical isolates tested also exhibited high isavuconazole MICs, suggesting the occurrence of triazole cross-resistance. Our MTS data indicate that there is no advantage in extended reading time for MTS from 24 to 48 h for Trichosporon yeasts.
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Affiliation(s)
- Elaine Cristina Francisco
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo 04024-002, Brazil.,Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Chendo Dieleman
- Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Ferry Hagen
- Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
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8
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Ohashi Y, Matono T, Suzuki S, Yoshino S, Alshahni MM, Komori A, Makimura K. The first case of clade I Candida auris candidemia in a patient with COVID-19 in Japan. J Infect Chemother 2023; 29:713-717. [PMID: 37001753 DOI: 10.1016/j.jiac.2023.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023]
Abstract
Candida auris is a health hazard because of its antifungal resistance and the potential to cause healthcare-associated outbreaks. To our knowledge, no previous cases of candidemia caused by C. auris have been reported in Japan. Herein, we report the first known case of clade I C. auris candidemia in a Japanese man with coronavirus disease 2019 (COVID-19) infection who was medically evacuated from the Philippines. A 71-year-old Japanese man traveled to Cebu Island in the Philippines 5 months before admission to our hospital. He contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Philippines and was admitted to the intensive care unit (ICU) in a local hospital. During his medical evacuation, we implemented precautions given his history of COVID-19 and pneumonia caused by multi-drug-resistant Acinetobacter baumannii complex. His blood culture revealed that C. auris infection was treated with antifungal agents but he did not survive. No evidence of nosocomial transmission was found among other patients in the ICU. This case study determines that accurate detection of C. auris, appropriate antifungal agent selection, precautions, and patient isolation are crucial to prevent nosocomial outbreaks, especially in patients with a history of multidrug-resistant organism (MDRO) colonization or international hospitalization. Medical professionals should recognize the risk of MDROs in international medical evacuation settings, considering the recent resumption of cross-border travel after the COVID-19 pandemic.
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Affiliation(s)
- Yusuke Ohashi
- Department of Infectious Diseases, Aso Iizuka Hospital, Japan
| | - Takashi Matono
- Department of Infectious Diseases, Aso Iizuka Hospital, Japan.
| | - Shotaro Suzuki
- Department of General Internal Medicine, Aso Iizuka Hospital, Japan
| | - Shumpei Yoshino
- Department of Intensive Care Medicine, Aso Iizuka Hospital, Japan
| | | | - Aya Komori
- Teikyo University Institute of Medical Mycology, Japan
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Mello López A, da Silva Neto LA, de Oliveira VF, de Carvalho VC, de Oliveira PRD, Lima ALLM. Orthopedic infections due to Trichosporon species: Case series and literature review. Med Mycol 2022; 61:6969423. [PMID: 36610725 DOI: 10.1093/mmy/myad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Reports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality.
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Affiliation(s)
- Andrés Mello López
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Alves da Silva Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vítor Falcão de Oliveira
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vladimir Cordeiro de Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ana Lúcia Lei Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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10
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ERG11 Analysis among Clinical Isolates of Trichosporon asahii with Different Azole Susceptibility Profiles. Antimicrob Agents Chemother 2022; 66:e0110122. [PMID: 36374073 PMCID: PMC9765002 DOI: 10.1128/aac.01101-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We analyzed a cohort of Trichosporon asahii strains with different MICs of fluconazole and voriconazole and evaluated the presence of ERG11 mutations. ERG11 mutation conferring an amino acid change was found and its resistance potential was evaluated by cloning into Saccharomyces cerevisiae susceptible host strain. Transformants were not resistant to either fluconazole nor voriconazole. Our results suggest that ERG11 variants exist among T. asahii isolates, but are not responsible for resistance phenotypes.
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11
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Malacrida AM, Corrêa JL, Barros ILE, Veiga FF, Pereira EDCA, Negri M, Svidzinski TIE. Hospital Trichosporon asahii isolates with simple architecture biofilms and high resistance to antifungals routinely used in clinical practice. J Mycol Med 2022; 33:101356. [PMID: 36563454 DOI: 10.1016/j.mycmed.2022.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Infections by Trichosporon spp. are increasing worldwide and its treatment remains a challenge. Colonization of medical devices has been considered as a predisposing factor for trichosporonosis, which is related to fungal biofilm production. Thus, this study aimed to evaluate the ability of six hospital T. asahii isolates to form biofilm on abiotic surface, as well as to investigate the impact of three classic antifungals on both planktonic and biofilm forms. The fungal identification was based on macro and micromorphological characteristics, biochemical tests and confirmation by mass spectrometry assisted by the flight time desorption/ionization matrix (MALDI-TOF MS). Antifungal susceptibility assay of planktonic cells showed inhibitory and fungicidal concentrations ranging from 2.5 to 10 µg/mL for voriconazole, 2 to 8 µg/mL for fluconazole, and 1 to 4 µg/mL for amphotericin B. All T. asahii strains were able to form biofilms on the polystyrene microplates surface within 24 h, showing a simple architecture when compared with Candida spp. biofilm. On the other hand, the same antifungals did not show action in neither the inhibition of biofilm formation nor on the formed biofilm. Concluding, the present study reinforced the relevance of the MALDI-TOF MS methodology for a safe identification of T. asahii. Classic antifungals were active on the planktonic form, but not on the biofilms. All isolates formed biofilms on the polystyrene microplates and showed a simple architecture.
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Affiliation(s)
- Amanda Milene Malacrida
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Jakeline Luiz Corrêa
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Isabella Letícia Esteves Barros
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Flávia Franco Veiga
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Elton da Cruz Alves Pereira
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
| | - Melyssa Negri
- Department of Clinical Analysis and Biomedicine, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil
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12
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Francisco EC, Hagen F. JMM Profile: Trichosporon yeasts: from superficial pathogen to threat for haematological-neutropenic patients. J Med Microbiol 2022; 71. [PMID: 36748684 DOI: 10.1099/jmm.0.001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Trichosporon yeasts are classical agents of superficial mycoses, and they are ranked as the first to second predominant basidiomycetous yeast able to cause invasive infections. The clinical presentation of Trichosporon infections varies with the affected anatomical site, with fungaemia present in the majority of invasive trichosporonosis cases. Only a limited number of antifungal compounds can be used to treat Trichosporon infections. Azoles are the first choice due to their intrinsic resistance to echinocandins. Better laboratory methods and up-to-date databases of commercial platforms are required to improve identification, susceptibility testing and surveillance of this potentially threating infection.
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Affiliation(s)
- Elaine Cristina Francisco
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo 04039-032, Brazil.,Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, Netherlands
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands.,Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Science Park 904, 1012 WX, Amsterdam,, Netherlands
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Wongsuk T, Boonsilp S, Pumeesat P, Homkaew A, Sangsri T, Chongtrakool P. Genotyping, antifungal susceptibility testing, and biofilm formation of Trichosporon spp. isolated from urine samples in a University Hospital in Bangkok, Thailand. Acta Microbiol Immunol Hung 2022; 69:247-257. [PMID: 35976734 DOI: 10.1556/030.2022.01797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
Abstract
The basidiomycetes yeast Trichosporon is widespread in the natural environment, but can cause disease, mainly in immunocompromised patients. However, there have been only few studies about this infection in Thailand. In this study, we characterized 53 Trichosporon spp. isolated from urine samples from patients admitted to a single hospital in Bangkok, Thailand over a one-year period from 2019 to 2020. The strains were identified using colony morphology, microscopy, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and nucleotide sequence analysis of intergenic spacer 1 (IGS1). Fifty-one isolates were Trichosporon asahii, and the remaining isolates were Trichosporon inkin and other Trichosporon species. Three genotypes of IGS1-1, 3, and 7 were observed among T. asahii. The sensitivity of the yeasts to the antifungal drugs amphotericin B, fluconazole, and voriconazole ranged from 0.25 to >16 μg ml-1, 0.5-8 μg ml-1, and 0.01-0.25 μg ml-1, respectively. We investigated biofilm formation by the isolates, and no biofilm production was found in one isolate, low biofilm production in forty-four isolates, and medium biofilm production in six isolates. T. inkin produced biofilms at low levels, and Trichosporon spp. produced biofilms at medium levels. This research increases our understanding of the molecular epidemiology of Trichosporon spp. isolated from one university hospital in Bangkok, Thailand, and reveals their genetic diversity, antifungal susceptibility profiles, and capacity for in vitro biofilm production.
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Affiliation(s)
- Thanwa Wongsuk
- 1 Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Siriphan Boonsilp
- 1 Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Potjaman Pumeesat
- 2 Department of Medical Technology, Faculty of Science and Technology, Bansomdejchaopraya Rajabhat University, Bangkok, Thailand
| | - Anchalee Homkaew
- 3 Microbiological Unit, Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanes Sangsri
- 4 Department of Microbiology, Faculty of Medicine, Princess of Naradhiwas University, Narathiwat, Thailand
| | - Piriyaporn Chongtrakool
- 5 Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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14
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Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders. Pathogens 2022; 11:pathogens11020242. [PMID: 35215184 PMCID: PMC8875650 DOI: 10.3390/pathogens11020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Trichosporon species have emerged as important opportunistic fungal pathogens, with Trichosporon asahii being the leading and most frequent cause of invasive disease. (2) Methods: We performed a global review focused on invasive trichosporonosis in neonates and pediatric patients with malignancies or hematologic disorders. We reviewed case reports and case series of trichosporonosis due to T. asahii published since 1994, the year of the revised taxonomic classification. (3) Results: Twenty-four cases of invasive trichosporonosis were identified in neonates with the presence of central venous catheter and use of broad-spectrum antibiotics recognized as the main predisposing factors. Thirty-two cases were identified in children with malignancies or hematologic disorders, predominantly with severe neutropenia. Trichosporon asahii was isolated from blood in 24/32 (75%) pediatric cases. Cutaneous involvement was frequently observed in invasive trichosporonosis. Micafungin was the most commonly used prophylactic agent (9/22; 41%). Ten patients receiving prophylactic echinocandins were identified with breakthrough infections. A favorable outcome was reported in 12/16 (75%) pediatric patients receiving targeted monotherapy with voriconazole or combined with liposomal amphotericin B. Overall mortality in neonates and children with malignancy was 67% and 60%, respectively. (4) Conclusions: Voriconazole is advocated for the treatment of invasive trichosporonosis given the intrinsic resistance to echinocandins and poor susceptibility to polyenes.
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15
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Sprute R, Bethe U, Chen SCA, Cornely OA. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1779-1784. [PMID: 35325146 PMCID: PMC9155625 DOI: 10.1093/jac/dkac085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Invasive infections due to Trichosporon spp. are life-threatening opportunistic fungal infections that require complex clinical management. Guidelines assist clinicians but can be challenging to comply with. Objectives To develop a scoring tool to facilitate and quantify adherence to current guideline recommendations for invasive trichosporonosis. Methods We reviewed the current guideline for managing rare yeast infections (ECMM, ISHAM and ASM). The most important recommendations for diagnosis, treatment and follow-up were assembled and weighted according to their strength of recommendation and level of evidence. Additional items considered highly relevant for clinical management were also included. Results The resulting EQUAL Trichosporon Score 2022 comprises 18 items, with a maximum score of 39 points. For diagnostics, seven or eight items, depending on whether organ involvement is present or not, apply, resulting in a maximum of 18 or 21 points. Recommendations on diagnostics include imaging, infectious diseases expert consultation, culture, microscopy, molecular techniques, histopathology, and susceptibility testing. For treatment, six recommendations with a maximum of ten points were identified, with two additional points for organ involvement and one point for second-line treatment in uncontrolled disease. Treatment recommendations include immediate initiation, source control, pharmacological treatment, therapeutic drug monitoring, treatment duration and surgical intervention. Follow-up comprises two items with five points maximum, covering follow-up blood cultures and imaging. Conclusions The EQUAL Trichosporon Score weighs and aggregates factors recommended for optimal management of Trichosporon infections. It provides a tool for antifungal stewardship as well as for measuring guideline adherence, but remains to be correlated with patient outcomes.
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Affiliation(s)
- Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, NRW, Germany
| | - Ullrich Bethe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, Sydney, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, Australia
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital MC), Cologne, Germany
- Corresponding author. E-mail:
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16
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Chang CC, Hall V, Cooper C, Grigoriadis G, Beardsley J, Sorrell TC, Heath CH. Consensus guidelines for the diagnosis and management of cryptococcosis and rare yeast infections in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:118-142. [PMID: 34937137 DOI: 10.1111/imj.15590] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cryptococcosis caused by the Cryptococcus neoformans-Cryptococcus gattii complex is an important opportunistic infection in people with immunodeficiency, including in the haematology/oncology setting. This may manifest clinically as cryptococcal meningitis or pulmonary cryptococcosis, or be detected incidentally by cryptococcal antigenemia, a positive sputum culture or radiological imaging. Non-Candida, non-Cryptococcus spp. rare yeast fungaemia are increasingly common in this population. These consensus guidelines aim to provide clinicians working in the Australian and New Zealand haematology/oncology setting with clear guiding principles and practical recommendations for the management of cryptococcosis, while also highlighting important and emerging rare yeast infections and their recommended management.
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Affiliation(s)
- Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Therapeutic and Vaccine Research Programme, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu Natal, South Africa
| | - Victoria Hall
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Celia Cooper
- Department of Microbiology and Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - George Grigoriadis
- Monash Haematology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Haematology, Alfred Hospital, Prahran, Victoria, Australia
| | - Justin Beardsley
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Infectious Diseases and Sexual Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Christopher H Heath
- Department of Microbiology, Fiona Stanley Hospital Network, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Murdoch, Western Australia, Australia
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17
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Akaslan Kara A, Çay Ü, Yalçınkaya R, Erdeniz EH, Tural Kara T, Özdemir H, Güner Özenen G, Polat M, Gayretli Aydın ZG, Alkan G, Kepenekli E, Gündeşlioğlu ÖÖ, Kıymet E, Birinci A, Kibar F, Böncüoğlu E, Şahbudak Bal Z, Alabaz D, Çiftçi E, Tanır G, Bayram N, Cengiz AB, Devrim İ. Bloodstream infections due to Trichosporon species in paediatric patients: Results from the first national study from Turkey. J Mycol Med 2021; 32:101229. [PMID: 34911023 DOI: 10.1016/j.mycmed.2021.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey. METHODS The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates. RESULTS A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms CONCLUSIONS: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens.
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Affiliation(s)
- Aybüke Akaslan Kara
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
| | - Ümmühan Çay
- Department of Pediatric Infectious Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Rumeysa Yalçınkaya
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Tuğçe Tural Kara
- Department of Pediatric Infectious Diseases, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gizem Güner Özenen
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Meltem Polat
- Department of Pediatric Infectious Diseases, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Zeynep Gökçe Gayretli Aydın
- Department of Pediatric Infectious Diseases, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Gülsüm Alkan
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Eda Kepenekli
- Department of Pediatric Infectious Diseases, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Özlem Özgür Gündeşlioğlu
- Department of Pediatric Infectious Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Elif Kıymet
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Asuman Birinci
- Department of Microbiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Filiz Kibar
- Department of Microbiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Elif Böncüoğlu
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Zümrüt Şahbudak Bal
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Diseases, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gönül Tanır
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nuri Bayram
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Ali Bülent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, İzmir, Turkey
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18
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Nobrega de Almeida J, Moreno L, Francisco EC, Noronha Marques G, Mendes AV, Barberino MG, Colombo AL. Trichosporon asahii superinfections in critically ill COVID-19 patients overexposed to antimicrobials and corticosteroids. Mycoses 2021; 64:817-822. [PMID: 34091966 PMCID: PMC8242571 DOI: 10.1111/myc.13333] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 01/02/2023]
Abstract
Objectives To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID‐19 patients. Methods From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID‐19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. Results Five critically ill COVID‐19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad‐spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30‐day mortality was 80%. The five T asahii strains from the COVID‐19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross‐transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. Conclusions Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID‐19 patients to prevent infections by hard‐to‐treat fungi like T asahii.
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19
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Arastehfar A, de Almeida Júnior JN, Perlin DS, Ilkit M, Boekhout T, Colombo AL. Multidrug-resistant Trichosporon species: underestimated fungal pathogens posing imminent threats in clinical settings. Crit Rev Microbiol 2021; 47:679-698. [PMID: 34115962 DOI: 10.1080/1040841x.2021.1921695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Species of Trichosporon and related genera are widely used in biotechnology and, hence, many species have their genome sequenced. Importantly, yeasts of the genus Trichosporon have been increasingly identified as a cause of life-threatening invasive trichosporonosis (IT) in humans and are associated with an exceptionally high mortality rate. Trichosporon spp. are intrinsically resistant to frontline antifungal agents, which accounts for numerous reports of therapeutic failure when echinocandins are used to treat IT. Moreover, these fungi have low sensitivity to polyenes and azoles and, therefore, are potentially regarded as multidrug-resistant pathogens. However, despite the clinical importance of Trichosporon spp., our understanding of their antifungal resistance mechanisms is quite limited. Furthermore, antifungal susceptibility testing is not standardized, and there is a lack of interpretive epidemiological cut-off values for minimal inhibitory concentrations to distinguish non-wild type Trichosporon isolates. The route of infection remains obscure and detailed clinical and environmental studies are required to determine whether the Trichosporon infections are endogenous or exogenous in nature. Although our knowledge on effective IT treatments is rather limited and future randomized clinical trials are required to identify the best antifungal agent, the current paradigm advocates the use of voriconazole, removal of central venous catheters and recovery from neutropenia.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - João N de Almeida Júnior
- Laboratorio de Micologia Medica (LIM 53), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil.,Laboratório Central (LIM 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Macit Ilkit
- Division of Mycology, University of Çukurova, Adana, Turkey
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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