1
|
Kruschewsky WLL, Massaroni-Peçanha P, Maifrede SB, Leite MS, Pôssa TAL, Alberto-Lei F, Cayô R, Peçanha PM, Gonçalves SS. Trichosporon asahii causing subcutaneous mycoses in an immunocompetent patient: case report and a minireview. Braz J Microbiol 2022; 53:1221-1229. [PMID: 35378689 PMCID: PMC9433615 DOI: 10.1007/s42770-022-00737-x] [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: 08/23/2021] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Trichosporon spp. are a constituent of the normal flora of humans that can cause both superficial and invasive infections, mainly in immunocompromised and immunocompetent hosts, respectively. Herein, we a report of Trichosporon asahii causing subcutaneous fungal infection (SFI) in an immunocompetent patient after carpal tunnel surgery. Although susceptible to fluconazole, the treatment of SFI failed even using high doses of this azole. The skin lesion improved following the administration of voriconazole. We conducted a literature minireview searching reports on SFI in immunocompetent patients to check for epidemiological, diagnostic, therapeutic, and outcome characteristics. A total of 32 cases were reported. Despite being uncommon, the clinical suspicion and early diagnosis of SFI in immunocompetent patients undergoing previous surgery are important. Our study indicated that the azoles are the most active antifungal agents against Trichosporon spp., except for fluconazole, and voriconazole can be considered the first therapeutic option.
Collapse
Affiliation(s)
- Wdson Luis Lima Kruschewsky
- Hospital Universitário Cassiano Antônio de Moraes (HUCAM), Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil
| | | | - Simone Bravim Maifrede
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Av. Marechal Campos, 1468, Vitoria, ES, 29040-090, Brazil
| | | | | | - Felipe Alberto-Lei
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | - Rodrigo Cayô
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
- Laboratório de Imunologia E Microbiologia (LIB), Departamento de Ciências Biológicas (DCB), Universidade Federal de São Paulo (UNIFESP), Setor de Biologia Molecular, Microbiologia E Imunologia, Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), SP, Diadema, Brazil
| | - Paulo Mendes Peçanha
- Section of Infectious Diseases, Department of Medicine, Hospital Universitário Cassiano Antônio de Moraes (HUCAM), Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil
| | - Sarah Santos Gonçalves
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Av. Marechal Campos, 1468, Vitoria, ES, 29040-090, Brazil.
| |
Collapse
|
2
|
Marinelli K, Latif A, Tauseef A, Zafar M, Butt DN, Sood A, Nair S, Thirumalareddy J. Subcutaneous gluteal abscess from Trichosporon asahii in an immunocompetent adult. Proc (Bayl Univ Med Cent) 2021; 35:195-196. [DOI: 10.1080/08998280.2021.2000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kathleen Marinelli
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Azka Latif
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Abubakar Tauseef
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Maryam Zafar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Dua Noor Butt
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Akshat Sood
- Department of Hospital Medicine, CHI Health Bergan Mercy Hospital, Omaha, Nebraska
| | - Sunil Nair
- Department of Hospital Medicine, CHI Health Bergan Mercy Hospital, Omaha, Nebraska
| | | |
Collapse
|
3
|
Salazar J, Hardin KA, Wiederhold NP, Thompson GR. Trichosporonosis Presenting as an Exophytic Cutaneous Mass Lesion. Mycopathologia 2020; 185:705-708. [PMID: 32705416 DOI: 10.1007/s11046-020-00477-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
Opportunistic fungal pathogens have increased in frequency with the growing immunosuppressed population. New and emerging pathogens, including the rare yeasts, continue to cause significant morbidity and mortality and frequently develop despite prophylaxis with antifungal agents. We report a previously unreported manifestation of disseminated trichosporonosis. Our patient with underlying acute myeloid leukemia presented with as an exophytic toe lesion found secondary to Trichosporon asahii. We highlight the need for a high index of suspicion to diagnose breakthrough infections and the need for aggressive treatment.
Collapse
Affiliation(s)
- Jorge Salazar
- Department of Internal Medicine, University of California-Davis Health, Sacramento, CA, USA
| | - Kaitlyn A Hardin
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health, 4150 V Street, Suite G500, Sacramento, CA, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center At San Antonio, San Antonio, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health, 4150 V Street, Suite G500, Sacramento, CA, USA. .,Department of Medical Microbiology and Immunology, University of California-Davis, Sacramento, CA, USA.
| |
Collapse
|
4
|
Trichosporon asahii causing nosocomial urinary tract infections in intensive care unit patients: genotypes, virulence factors and antifungal susceptibility testing. J Med Microbiol 2012; 61:1750-1757. [PMID: 22956749 DOI: 10.1099/jmm.0.049817-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Trichosporon asahii is the causative agent of both superficial and deep-seated infections of increasing morbidity and mortality. Urinary tract infections (UTIs) due to T. asahii, frequently associated with indwelling medical devices, have been reported over the years. However, few studies have specifically focused on the genotypic diversity of T. asahii isolates from urine specimens from intensive care units (ICUs), let alone potential virulence factors and antifungal susceptibility testing. In the present study, 23 T. asahii isolates were collected from UTI patients in ICUs between January 2008 and January 2012. Three genotypes (I, III, IV) were determined based on the combination of internal transcribed spacer and intergenic spacer locus PCR. Protease, phospholipase and haemolysin production was assessed by halo formation on corresponding agar plates. Only haemolytic activity was observed to varying degrees. Neither protease nor phospholipase was detectable. Biofilm formation on polystyrene surfaces was detected through a formazan salt reduction assay. All clinical isolates had the ability to form biofilm. In contrast to the susceptibility of planktonic T. asahii cells to clinically used amphotericin B, 5-flucytosine, fluconazole, itraconazole and voriconazole, a remarkable rise in the MICs of these for biofilm T. asahii cells was observed. Our results suggested that genotype IV was the most prevalent genotype among T. asahii isolates from ICUs in China. Haemolysin and biofilm might contribute to the pathogenicity and recurrence of T. asahii-related UTIs. Although triazoles, especially voriconazole, were effective against planktonic T. asahii cells, they failed to treat preformed biofilms.
Collapse
|
5
|
Brown ML, Drinkwater CJ. Hematogenous infection of total hip arthroplasty with Actinomyces following a noninvasive dental procedure. Orthopedics 2012; 35:e1086-9. [PMID: 22784905 DOI: 10.3928/01477447-20120621-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article describes a case of an infected total hip arthroplasty following a dental procedure. A 59-year-old man underwent total hip arthroplasty for osteoarthritis and had a routine recovery. Approximately 9 months postoperatively, he underwent a dental cleaning without antibiotic prophylaxis. One month later, he reported gradually worsening right hip pain and a purulent discharge. After several unsuccessful interventions, the patient was referred to the authors' facility. The patient's history, draining sinus tract, and radiographic changes were considered diagnostic of a late chronic infection, and the patient underwent 2-stage revision. Intraoperatively, the sinus tract extended directly to the acetabular component. Actinomyces spp were isolated from 3 of 7 intraoperative anaerobic cultures, and the patient received penicillin G for 8 weeks. Two weeks after discontinuing antibiotics, with no clinical manifestation of recurrent infection and a negative hip aspiration, a new hip prosthesis was implanted. The patient was prescribed penicillin for 12 months postoperatively. Harris Hip Score was 100 at 52-month follow-up. The American Dental Association and the American Academy of Orthopaedic Surgeons issued consensus guidelines for chemoprophylaxis in orthopedic patients undergoing dental procedures in 1997 and 2003. Although the American Academy of Orthopaedic Surgeons issued a revised guideline in 2009 recommending more robust antibiotic prophylaxis, significant controversy exists because at least one professional organization representing dentists has repudiated the 2009 American Academy of Orthopaedic Surgeons guideline. The authors describe the implications from their experience and similar cases in the literature with regard to such guidelines.
Collapse
Affiliation(s)
- Matthew L Brown
- University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | | |
Collapse
|
6
|
Saglam N, Akpinar F. Intratendinous septic abscess of the Achilles tendon after local steroid injection. J Foot Ankle Surg 2009; 48:565-8. [PMID: 19700119 DOI: 10.1053/j.jfas.2009.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED In the treatment of pathological processes of the skeletal system, local injection of corticosteroid has become a common form of treatment. Although rare, pyogenic abscess can develop secondary to local corticosteroid injection. In this article, we describe the case of a patient who presented with pain, swelling, and hyperemia following local infiltration of corticosteroid about the Achilles tendon. Magnetic resonance image scanning of the Achilles tendon revealed a smoothly shaped intratendinous mass 3 x 1 cm in diameter, extending to the posterosuperior aspect of the calcaneus. A needle aspiration of the suspected abscess revealed S aureus, and subsequent surgical drainage and debridement revealed chronic inflammation secondary to infection at the site of previous local corticosteroid injection. Antibiotic therapy was used following incision and drainage, and recurrence of infection was not detected throughout the duration of follow-up. LEVEL OF CLINICAL EVIDENCE 4.
Collapse
Affiliation(s)
- Necdet Saglam
- Department of Orthopaedic Surgery, Teaching and Researching Hospital of Umraniye, Istanbul, Turkey.
| | | |
Collapse
|
7
|
Araujo Ribeiro M, Alastruey-Izquierdo A, Gomez-Lopez A, Rodriguez-Tudela JL, Cuenca-Estrella M. Identificación molecular y sensibilidad a los antifúngicos de cepas de Trichosporon aisladas en un hospital de Brasil. Rev Iberoam Micol 2008. [DOI: 10.1016/s1130-1406(08)70053-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
8
|
Kim SH, Kim DH, Joo SI, Yoo JI, Kim HB, Kim NJ, Lee YS, Oh MD, Kim EC, Eun HC, Choe KW. Chronic cutaneous disseminated Trichosporon asahii infection in a nonimmunocompromised patient. J Am Acad Dermatol 2008; 59:S37-9. [DOI: 10.1016/j.jaad.2007.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 06/12/2007] [Accepted: 08/11/2007] [Indexed: 10/21/2022]
|
9
|
Abstract
STUDY DESIGN A case report of Trichosporon asahii spondylodiscitis. OBJECTIVE To report the first case of T. asahii spondylodiscitis that developed in a healthy woman at the site of an open lumbar discectomy. SUMMARY OF BACKGROUND DATA Trichosporon is a genus of basidiomycetous yeasts that is common in nature and a member of the normal flora of the mouth, skin, and nails. It causes deep infections and fungemia mainly in immunocompromised patients or patients with underlying hematologic malignancies. To our knowledge, there is no reported case of bone and joint infections caused by T. asahii. METHODS A 42-year-old female gynecologist was transferred to our hospital with a chief complaint of severe lower back pain after an open L4-L5 discectomy. The infection indexes showed an elevated erythrocyte sedimentation rate and the C-reactive protein. Despite bed rest and antibiotic therapy, the lower back pain and tingling sensation on both lower extremities continued to worsen. The magnetic resonance imaging showed an abscess-like fluid collection compressing the thecal sac and showed a signal change in the bone marrow of the L4 and L5 vertebral bodies, suggesting spondylodiscitis. Laminectomy, curettage, and debridement of the infected discs were performed. Cultures of the abscess yielded yeasts that were sensitive to fluconazole. The yeast was identified as T. asahii. RESULTS She received fluconazole therapy for 5 months, and returned to her work after the fourth postoperative month. She has remained in a satisfactory condition since. CONCLUSION We present the first case of T. asahii spondylodiscitis, which developed unexpectedly in a healthy woman at the site of an open lumbar discectomy. We successfully treated the patient with surgical debridement and 5 months of fluconazole therapy.
Collapse
|