Invasive Trichosporon beigelii infection in immunosuppressed rats

Summary. Fulminant systemic mycoses were seen as complications in rats undergoing drug trials for the treatment of Pneumocystis carinii pneumonia. Rats were immunosuppressed with corticosteroids and by feeding with a low-protein diet. Homogenized pulmonary tissue from a rat with pneumocystosis was inoculated transtracheally. Secondary invasive mycosis was found in 56 of 59 rats examined. Trichosporon beigelii was identified as the causative agent in the majority of cases. After examining possible sources of infection, a Pneumocystis inoculum contaminated with fungi was found to be the obvious source. T. beigelii infections are becoming increasingly significant in immunocompromised human patients. The need for suitable and reproducible animal models is therefore also increasing. Observations described in this paper may help in the further development of such models.
Zusammenfassung. In einem Versuchsansatz, in dem am Rattenmodell der Pneumocystis carinii -Pneumonie neue Medikamente getestet werden sollten, traten als unerwartete Komplikationen fulminant verlaufende Systemmykosen auf. Bei 56 von 59 untersuchten Ratten, die durch Kortisonbehandlung und mittels einer proteinarmen Diät immunsupprimiert wurden und denen transtracheal ein Lungenhomogenat von einer Pneumocystosis-erkrankten Ratte inokuliert worden war, bildeten sich sekundär invasive Mykosen aus. Überwiegend konnte Trichosporon beigelii als verursachender Keim identifiziert werden. Wie die Überprüfung möglicher Infektionsquellen ergab, waren die Pilze offensichtlich durch kontaminiertes Inokulum übertragen worden. T. beigelii -Infektionen gewinnen bei Patienten mit Abwehrschwächen zunehmend an Bedeutung und folglich auch der Bedarf an geeigneten und reproduzierbaren Tiermodellen, für deren Entwicklung die hier beschriebenen Beobachtungen eine weiterführende Chance bieten.     

Trichosporon beigelii als Erreger einer Paronychie:Paronychia Caused by Trichosporon beigelii

Zusammenfassung: Es wird über eine chronische Paronychie der Fingernägel berichtet. Als Erreger wurde Trichosporon beigelii Küchenmeister et Rabenhorst Vuillemin, 1902 isoliert Temperaturmaximum 37°C. Im Nativpräparat wurden massenhaft Sporen gefunden. Die Mikromorphologie wird besprochen; die Art ist leichtzu bestimmen, wenn es in der Altkultur zu Chlamydosporenbildung kommt. Therapeutisch wird die Anwendung von Ketoconazol 200 mg/die und Ciclopiroxolamin-Creme empfohlen.
Summary: A case of a chronic paronychia of fingernails caused by Trichosporon beigelii Küchenmeister et Rabenhorst Vuillemin, 1902 maximum of temperature 37°C is reported. In the potassium hydroxide KOH preparation spores could be found in large quantities. The micro-morphology is discussed; the species can easily be determined if chlamydospores develop in older cultures. Therapy with ketoconazole 200 mgldaily and ciclopiroxolamine cream is recommended.     

Two cases of disseminated Trichosporon beigelii infection treated with combination antifungal therapy

Two patients with acute leukemia in whom disseminated Trichosporon beigelii infection developed are reported. The T. beigelii infection developed in the first patient while he was receiving 5-fluorocytosine. He was treated with amphotericin B in addition to 5-fluorocytosine. Despite the continued antifungal therapy, multiple organs were invaded by the organisms at autopsy. The second patient was treated with miconazole and norfloxacin. Although this combination antifungal therapy seemed to be effective, this patient required splenectomy for cure of the infection.     

Chronic meningitis caused by Trichosporon beigelii in India

Summary. A 36-year-old woman developed fatal meningitis following a myelogram. Trichosporon beigelii could be grown from the cerebro-spinal fluid (CSF) on two occasions. This represents the first culture-proven case of meningitis due to Trichosporon beigelii .
Zusammenfassung. Nach Erhebung eines Myelogramms entwickelte eine 36-Jahre alte Frau eine tödliche Meningitis. Aus dem Liquor konnte zweimal Trichosporon beigelii isoliert werden. Dies stellt die erste kulturell gesicherte Trichosporon beigelii -Meningitis dar.     

Trichosporon beigelii: Increased Occurrence in Homosexual Men: Trichosporon beigelii: Erhöhtes Vorkommen unter homosexuellen Männern

Summary: Trichosporon beigelii was isolated from rectal cultures in 45 of 290 homosexual men (15.5%), compared to four positive cultures in 161 heterosexual men (2.5%). A sexual transmission in homosexual men may explain the statistically significant difference in the frequencies of isolation of Trichosporon beigelii.
Zusammenfassung: Trichosporon beigelii wurde in Kulturen von Rektalabstrichen bei 45 aus 290 homosexuellen Männern isoliert (15.5%), dies im Vergleich zu vier positiven Kulturen von 161 heterosexuellen Männern (2.5%). Eine sexuelle Übertragung unter homosexuellen Männem könnte den statistisch signifikanten Unterschied in der Häufigkeit des Vorkommens von Trichosporon beigelii erklären.     

Successful treatment of disseminated Trichosporon beigelii (cutaneum) infection with associated splenic involvement

Fungemia caused by Trichosporon beigelii (cutaneum) has been recently recognized as a fatal infection afflicting immunocompromised patients. The authors report the case of a leukemic patient who developed splenic infection from disseminated T. beigelii. Treatment with amphotericin B, 5-fluorocytosine, and splenectomy proved successful. The etiology of disseminated T. beigelii infection, visceral seeding, and combination antifungal therapy also are discussed.     

Trichosporon beigelii Pneumonia in a Patient with Malignant Histiocytosis

A 30-year-old previously healthy housewife presented with bilateralpulmonary infiltrates. She was treated with various antibioticsbut died with disseminated intravascular coagulation. Culturesof tracheal aspirates obtained prior to her death yielded Trichosporonbeigelii. Postmortem examination revealed T. beigelii pneumoniawith fungal dissemination in other organs. In addition, manyorgans were found to be infiltrated with atypical mononuclearcells which exhibited cytochemical properties of histiocytes.It was considered, therefore, that T. beigelii pneumonia developedon the basis of underlying malignant histiocytosis. T. beigeliiin her lung sections was fluorescently stained with rabbit antiserumto the fungus isolated from the patient. This is the first reportof Trichosporon beigelii pneumonia associated with malignanthistiocytosis.     

In Vitro Susceptibility of Trichosporon beigelii to Antifungal Agents

Abstract

The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of amphotericin B, flucytosine, miconazole, fluconazole and itraconazole against 21 isolates of Trichosporon beigelii in RPMI-1640 medium were determined using National Committee for Clinical Laboratory Standards (NCCLS) methodology in microdilution method. Most isolates were sensitive to miconazole (MIC₉₀ 0.78 μ/ml), fluconazole (MIC₉₀ 6.25 μ/ml), and itraconazole (MIC₉₀ 0.19 μ/ml), with the former being the most active agent tested (MFC₉₀ 3.12 μ/ml). Although amphotericin B inhibited most strains (MIC range, 0.78-3.12 μ/ml), poor fungicidal activity was observed (MFC range, 1.56 -12.5 μ/ml) showing a pattern of relative resistance In Vitro. Flucytosine showed generally poor activity against most isolates tested. These In Vitro findings confirm the resistance of T.beigelii to amphotericin B and suggest that azoles may be an alternative to the former for the treatment of disseminated trichosporonosis. However, in vivo studies would better validate these In Vitro findings.     

Trichosporon beigelii Infection in an Immunocompromised Host Trichosporon beigelii-Infektion bei einem abwehrgeschwächten Wirt

Summary: A case of Trichosporon beigelii infection in a patient with non-Hodgkins lymphoma that illustrates some of the associated diagnostic and chemotherapeutic problems, is described. Despite prolonged isolation of the yeast from blood cultures, the patient recovered from the infection after treatment with amphotericin B and flucytosine. Presenting features, diagnosis and monitoring of antifungal therapy in renal failure are discussed.
Zusammenfassung: An einer Trichosporon beigelii- Infektion bei einem Patienten mit Non-Hodgkin-Lymphom werden einige diagnostische und therapeutische Proble-me aufgezeigt. Trotz wiederholter Isolie-rung der Hefe aus Blutkulturen erholte sich der Patient unter einer Therapie mit Amphotericin B und Flucytosin. Symptomatik, Diagnose und das Vorgehen bei der antimy-kotischen Therapie unter Nierenversagen werden diskutiert.     

Colonization of a bovine burn wound by Trichosporon beigelii.

Trichosporon beigelii, an emerging opportunistically zoopathogenic fungus, was demonstrated both by culture and by direct microscopy in the chronic, ulcerated burn wound of a 3-month-old Jersey cow. The fungus was probably limited to the cutaneous tissues since it was not isolated from blood, urine or faeces, nor from nasal, eye or ear swabs. It is suggested that etiological significance of Tr. beigelii should be considered when the organism is isolated from animals that are immunosuppressed either due to some underlying disease or due to the prolonged use of cytotoxic drugs.     

Systemic infections with Trichosporon beigelii (cutaneum). Report of three new cases

Three new cases of systemic mycosis due to Trichosporon cutaneum are reported and compared with the 23 previous reports. Two patients had acute leukemia and one patient had a lymphoblastic lymphoma. Blood cultures in two patients and cerebrospinal fluid in the third patient were positive for T. cutaneum. Only one patient recovered after antimycotic therapy and concomitant remission of his leukemia. At autopsy, the two other patients showed widespread infection with T. cutaneum. The authors conclude that diagnosis and management of such infection in the immunosuppressed host are difficult and the prognosis is poor.     

软组织肉瘤术后放射治疗及其预后分析

目的：分析软组织肉瘤术后放射治疗的疗效和预后因素。方法：64例软组织肉瘤经部分切除,完整切除和扩大切除术后接受体外放射治疗,其中常规分割放射治疗48例（1．8－2．0Gy/次,5次／周,DT40-72Gy,中位剂量60Gy),超分割放射治疗16例（1．2－1．5Gy/次,2次／d,间隔6h,DT64.8-85.0Gy,中位剂量66．5Gy),采用Kaplan-Meier法计算5年生存率并经Logrank检验,采用Cox回归分析预后因素的统计学意义。结果：全组5年生存率,局部控制率分别为60．2％、57．9％,其中常规分割组与超分割组分别为54．3％、61．9％、42．9％。多因素 回归分析显示组织学分级,病变大小,病变部位,分割方式是影响生存率的独立预后因素。结论：软组织肉瘤经完整或扩大切除术加术后放射治疗可以获得良好疗效,组织学分级,病变大小,病变部位,分割方式是影响生存率的因素。     

Postoperative radiotherapy in the treatment of extremity soft tissue sarcomas

From 1966 to 1983, 50 patients with extremity soft tissue sarcomas were treated with wide local excision and postoperative radiotherapy at the Mallinckrodt Institute of Radiology. The median follow-up was 70 months (range 28 to 168). Grade was the most significant factor affecting survival: all 11 patients with well differentiated tumor survived versus 6/8 patients with moderate and 17/31 patients with poorly differentiated tumors (p less than 0.01). In addition, lymph node involvement at diagnosis conferred a worse prognosis with only 2/5 patients alive after treatment (p less than 0.05). Eleven of 50 (22%) failed locally. Factors affecting local control included gross residual tumor after operation and limited treatment volume. Among the 35 patients who did not have gross residual tumor or limited treatment volume, two patients who received less than 5000 cGy failed locally versus 1/18 patients who received between 5000-6000 cGy and 2/15 patients who received more than 6000 cGy. Microscopically positive margins and a volume encompassing less than the total muscular compartment was not associated with an increase in the incidence of local failure. Eight patients developed local complication: five due to retreatment for local recurrence. Overall, 24/26 patients who are alive have had their limbs preserved with normal function.     

Disseminated infection with Trichosporon asahii

Summary. Trichosporon fungaemia and disseminated, purpuric, papular skin lesions developed on the head, trunk and extremities of a 5-year-old female with acute lymphocytic leukaemia. Histopathologically, the skin lesions demonstrated dermal budding yeasts. She died despite treatment with antifungal drugs. The isolate from the blood was further identified morphologically and physiologically as Trichosporon asahii , based on the revision of the genus Trichosporon by Guého et al. (1992). According to the new revision. T. asahii is the only taxon regularly involved in systemic mycoses, so that most of the isolates previously reported as T. beigelii (formerly, T. cutaneum ) in human deep mycoses are now thought to belong to T. asahii.
Zusammenfassung. Bei einem fünfjährigen Mädchen mit akuter lymphatischer Leukämie entwickelte sich eine Trichosporon -Fungämie mit disse-minierten, papulösen Hautläsionen und Purpura an Kopf, Stamm und Extremitäten. Histopathologisch wurden in den Hautläsionen sprossende Hefezellen nachgewiesen. Die Patientin verstarb trotz antimykotischer Chemotherapie. Der aus dem Blut isolierte Erreger wurde als Trichosporon asahii identifiziert. Im von Guého et al. revidierten Genus Trichosporon ist T. asahii die einzige Art, die regelmäßig an der Entstehung systemischer Mykosen beteiligt ist. Die meisten der bisher aus tiefen Mykosen des Menschen isolierten Trichosporon -Stämme, die früher als T. beigelii bzw. T. cutaneum bezeichnet wurden, werden nunmehr als zu T. asahii gehörend angesehen.     

术后放射治疗在原发肢体软组织肉瘤治疗中的作用

分析本院收治的原发于肢体的软组织肉瘤的治疗情况 ,评价术后放射治疗的作用。方法　本院共收治 15 1例 ,可供分析的 139例 ,分析影响生存和局控的因素及术后放射治疗的意义。生存率和局控率用Kaplan Meier方法计算 ,单因素分析用Logrank检验 ,多因素分析用Cox回归方法。结果　全组 5年生存率为 70 .2 % ,10年为 5 0 .4% ;5年无瘤生存率为 5 2 .9% ,10年为41.2 %。单因素分析对全组病例生存率有影响的因素 :肿瘤大小、年龄和治疗方式 (P值分别为0 .0 0 8,0 .0 0 7和 0 .0 40 )。多因素分析只有治疗方式对生存有影响 (P =0 .0 40 )。首次治疗方式对局控影响差异有极显著性 (P <0 .0 1)。手术方式对单纯手术组局控影响差异有极显著性 (P <0 .0 1) ;肿瘤 <5cm时 ,射野大小对术后放射治疗组局控影响差异有极显著性 (P <0 .0 1)。结论　术后放射治疗能提高局部控制率 ,初始射野应相对大 ,并采用缩野技术。对恶性度低、肿瘤 <5cm、手术切缘阴性患者第 1次术后可不做放射治疗。     

快中子加光子术后放疗软组织肉瘤

目的：回顾分析快中子加光子术后放疗软组织肉瘤的疗效。方法：1991年12月至1997年6月用快中子及光子术后放疗软组织肉瘤36例。结果：3、5年生存率分别为86.1%（31/36）及69.6%（16/23）。3、5年局控率分别为97.2%(35/36)及95.6%(22/23)。远处转移率为13.9%（5/36）。结论：快中子术后放疗是治疗软组织肉瘤的有效方法。     

Cervical necrotizing soft tissue infection — A case report

A small but nevertheless important part of a surgeons experience comprises necrotizing soft tissue infections of the head and neck. These infections are characterized by their fulminating, devastating, and rapid-progressing course resulting in extensive necrosis of fascia, subcutaneous tissues, skin and muscle. Although necrotizing facilities is a more frequently used terminology, the authors prefer to use the term necrotizing soft tissue infection to describe this potentially fatal condition. A case of cervical necrotizing soft tissue infection of dental origin is reported here. The purpose of this report is to heighten awareness of necrotizing soft tissue infections in any patient with an infection of the neck. The article also outlines an appropriate management strategy for use in such patients with emphasis on prompt diagnosis and early radical surgical debridement.     

90例软组织肉瘤术后放疗临床分析

目的回顾分析软组织肉瘤术后放射治疗的疗效。方法１９８８年５月～１９９５年５月间收治９０例软组织肉瘤（多次术后复发４０例,首次术后复发５０例）,全部用６０Ｃｏ或加深层Ｘ线外照射,常规照射４５～５０Ｇｙ／５ｗ,然后缩野再用６０Ｃｏ或改用深层Ｘ线照射,总剂量低度恶性肉瘤６０Ｇｙ／６ｗ,中度恶性６５Ｇｙ／６．５ｗ,高度恶性７０Ｇｙ／７ｗ。结果３、５年生存率分别为８３．３％（７０／９０）和６１．３％（３８／６２）。局部复发率为５．６％（５／９０）,远处转移率为１１．１％（１０／９０）。影响软组织肉瘤的预后因素包括肿瘤大小、恶性程度、临床分期、术后放疗间隔时间。结论放射治疗能大幅度降低软组织肉瘤术后局部复发率。