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.     

Molecular characterisation and antifungal susceptibility of clinical Trichosporon isolates in India

In Asian countries, Trichosporon infection is a well‐known disease in Japan. In India, the infection is increasingly recognised. The study was conducted to characterise the clinical Trichosporon isolates from India by phenotypic and molecular techniques. A total of 31 Trichosporon clinical isolates, recovered from patients of 14 hospitals across India were sequenced (ITS and IGS1 regions of rDNA). In vitro drug susceptibility testing of the isolates was performed against amphotericin‐B, fluconazole, itraconazole, voriconazole and posaconazole. IGS1, rather than ITS sequences, correctly identified the isolates: Trichosporon asahii, 20; Trichosporon ovoides, 3; Trichosporon inkin, 2; Trichosporon asteroides, 1; Trichosporon mucoides, 1; Trichosporon loubieri, 1; Trichosporon debeurmannianum, 1; and Trichosporon dermatis, 1. Trichosporon asahii genotype III was the most common type, followed by genotype I and VII. Both these targets did not help to identify one Trichosporon to the species level. Trichosporon debeurmannianum, T. dermatis and T. asteroides were isolated for the first time from a human disease in India. The minimum inhibitory concentrations for voriconazole and posaconazole were within effective range. The study highlights the presence of wide range of Trichosporon species causing infection in India. Voriconazole or posaconazole may be the better drugs to treat such patients.     

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.     

Disseminated Trichosporon capitatum infection in a patient with acute leukemia

Disseminated Trichosporon capitatum infection in a 14-year-old boy with acute lymphoblastic leukemia is described. T. capitatum causes opportunistic infection in immunocompromised hosts.     

Postoperative Trichosporon beigelii soft tissue infection

A case of postsurgical cutaneous infection with Trichosporon beigelii in an apparently immunocompetent individual is reported. This is a rare surgical complication and the first report of localized skin infection by this organism postoperatively.     

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.     

The Yeast flora of Egyptian Butter

All the 200 butter samples examined were found to contain yeasts. The species isolated were Trichosporon, Candida, Endomycopsis and Saccharomyces. Trichosporon species constituted most of the isolates (56.9 %), while Saccharomyces species was less met with (1.1 %).
Spoilage of butter by yeasts is caused by the breakdown of carbohydrates and fats liberating gases and acids which change the flavour and cause its rancidity.
The importance of antibiotics as predisposing factor for yeast infection of the udder was discussed.     

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.     

Systemic mycosis due to Trichosporon cutaneum: a report of two additional cases

Two additional cases of systemic mycosis due to Trichosporon cutaneum are reported and are compared with the previously published case of Rivera and Cangir. Both patients (a four-year-old male and a 57-year-old female) had acute leukemia for which they were receiving chemotherapy, and both presented with fever that was unresponsive to conventional antibiotics. Both had positive blood cultures for Trichosporon cutaneum. The disease was further documented in the four-year-old male by renal biopsy and by bone marrow culture; he was treated with apparent success with amphotericin B. However, the 57-year-old female died shortly after the begining of similar treatment, and autopsy demonstrated involvement of the left kidney, spleen, bone marrow, and liver. The organism in both these cases, as well as the case of Rivera and Cangir, exhibited both hyphal and yeastlike forms in tissue sections. We believe that the therapeutic success in the case of the four-year-old male was primarily related to his remission from leukemia.     

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.     

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.     

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.     

Disseminated trichosporonosis in China

A 20-year-old female patient presented with erythematous plaques on the nose which were progressively spreading to the trunk and the extremities, sometimes with erosions and scars. The patient was misdiagnosed as having seborrhoeic dermatitis and subacute cutaneous lupus erythematosus. The histopathological biopsy revealed mycotic infectious granuloma. Samples taken from skin lesions and other locations grew Trichosporon asahii in cultures. The identification was confirmed by molecular biological methods. The patient was treated successfully with liposomal amphotericin B in combination with fluconazole orally.     

Evaluation of the microdilution, Etest and disk diffusion methods for antifungal susceptibility testing of clinical strains of Trichosporon spp

Trichosporon spp are well recognized as pathogens capable of causing invasive disease. Despite the increasing frequency and severity of trichosporonosis, data on the antifungal susceptibility of Trichosporon spp. are limited and recommendations for in vitro testing of this fungus are not included in the guidelines of the National Committee for Clinical Laboratory Standards. The purpose of this study was to determine the in vitro susceptibility of clinical Trichosporon isolates to systemic antifungals. We evaluated the in vitro activity of amphotericin B, fluconazole, itraconazole and voriconazole against 27 clinical isolates of Trichosporon spp. (14 T. mucoides and 13 T. asahii) using NCCLS M27-A2 reference microdilution, Etest and disk diffusion methods. In the microdilution and Etest methods Trichosporon spp. demonstrated relatively high minimum inhibitory concentrations (MICs) for fluconazole (MIC90 4 and 6 microg/ml, respectively) and relatively low MICs for voriconazole (MIC90 0.125 and 0.125 microg/ml, respectively). MICs for amphotericin B determined on antibiotic medium 3 were lower (MIC90 0.06 microg/ml) than those on RPMI (MIC90 1 microg/ml). Observed agreements were 81-100% according to these drugs. Disk diffusion zone diameters correlate inversely with MICs from dilution tests except for amphotericin B. Validation of the clinical significance of these observations demands determination of MIC breakpoints for Trichosporon and in vitro- in vivo correlation studies.     

Trichosporon asahii as a prospective pathogen in solid organ transplant recipients

Trichosporon spp. is not an important factor of mycotic infections in immunocompetent patients. It may be a cause of invasive mycoses with a high mortality rate in patients undergoing solid organ transplantation. We have analysed the antifungal agents' susceptibility of Trichosporon asahii and its frequency of occurrence as a prospective etiological agent of infections in liver, kidney and simultaneous pancreas–kidney transplant recipients. Clinical specimens (urine, blood, peritoneal fluid and swabs) were obtained from patients hospitalised in the Institute of Transplantation Medicine, Department of General and Transplantation Surgery, Medical University of Warsaw in 2005 and 2006. Microbiological tests were performed in Mycological Laboratory, Department of Microbiology, Medical University of Warsaw. A total of 475 strains of yeast-like fungi were isolated from clinical specimens taken from 263 liver, kidney and simultaneous pancreas–kidney transplant recipients and from 26 organ donors. Trichosporon asahii was found in 26 clinical samples taken from 18 patients and one organ donor. Positive cultures were obtained from 22 urine samples, one stoma fluid, one wound swab, one tracheal aspirate and one ejaculate. Isolates of Trichosporon asahii were found in 6% of total positive mycological cultures in the solid organ transplant recipients. Among cultured strains, 11 isolates were resistant to fluconazole, four to itraconazole and three of them demonstrated resistance to amphotericin B.     

The aetiological agents of superficial cutaneous mycoses in Jos, Plateau State of Nigeria

Summary. A survey of superficial skin mycoses was carried out among miners and office workers employed in different establishments in Jos, Nigeria. Mycotic infection was demonstrable by microscopy and culture in 45 (10.4%) subjects: 20 males and 25 females. Malassezia furfur was the predominant aetiological agent, followed by Candida albicans andTrichophyton soudanense. Other aetiological agents frequently recovered were T. rubrum., T. mentagrophytes., Microsporum audouiniiand Trichosporon beigelii.
ZUSAMMENFASSUNG. An Grubenarbeitern und Büropersonal, in verschiedenen Einrichtungen in Jos, Nigeria, beschäftigt, wurde eine Studie über oberflächliche Hautmykosen durchgeführt. Mikroskopisch und kulturell wurden bei 45 Personen (10.4%) Pilzinfektionen nachgewiesen, davon bei 20 Mänern und 25 Frauen. Malassezia furfur war das dominierende ätiologische Agens, gefolgt von Candida albicans und Trichophyton soudanense . Andere, weniger häufig gefundene Erreger waren T. rubrum, T. mentagrophytes, Microsporum audouinii und Trichosporon beigelii .     

Transmission of Trichosporon asahii oesophagitis by a contaminated endoscope

Two cases of oesophageal trichosporonosis due to a suspected nosocomial infection are reported. Both the patients were immunocompetent and had undergone an endoscopic examination on the same day. Six strains of Trichosporon were isolated: three strains from the oesophageal biopsy of the first patient, one strain from the endoscopic forceps, one from the air in the endoscopy room, and one from the oesophageal biopsy of the second patient. The nosocomial nature of the infection and the role of the endoscopic forceps in transporting the micro-organism was suspected, but the morphology and physiology of the isolated strains did not confirm such hypothesis. To elucidate the nature of the infection and the genetic similarities of the strains isolated, all strains were typed with RFLPs of the rDNA fragment and with RAPD. The results of RAPD using primer (GTG)5 (GACA)4, M13 core sequence, and the 15-mer oligonucleotide GAGGGTGGXGGXTCT indicated the molecular identity of three strains supporting the hypothesis concerning a transport of the aetiological agent from the first patient to the second and that the carrier was the forceps of the endoscopic device.     

Isoconazole nitrate in the treatment of tropical dermatomycoses

Summary. A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum , two with candidoses of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (Travogen^R, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3–4 weeks. In 15 (31%) of the remaining patients treatment was required for 5–6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.
Zusammenfassung. Insgesamt 54 Patienten mit kulturell gesicherter Dermatomykose, (23 unterschiedliche Dermatophytosen, eine Trichosporon beigelii - und eine Geotrichum candidum -Fußinfektion, 2 Candidosen der Leistengegend und 27 Pityriasis versicolor) wurden in einer klinischen Wirksamkeits-studie mit 1% iger Isoconazol-Creme (Travogen^R, Schering, Berlin, Deutschland) behandelt. Fünf Patienten waren nicht auswertbar. Eine klinische und mykologische Heilung wurde bei 47 von 49 Patienten (96%) erreicht. Bei 29 patienten (59%) wurde die Heilung bereits nach 3–4 Wochen Behandlung erreicht. Weitere 15 Patienten (31%) benötigten 5–6 Wochen und drei Patienten 8 Wochen Behandlungsdauer. Zwei Mykosesituationen erwiesen sich als therapieresistent.     

Primäre Magenmykose,durch Trichosporon cutaneum verursacht: Primary Gastric Mycosis,Caused by Trichosporon cutaneum

Zusammenfassung: Eine durch gastroskopische, histologische und mykologische Untersuchung bewiesene, von Trichosporon cutaneum verursachte isolierte primäre Mykose kommt zur Demonstration. Im Einklang mit literarischen Angaben betonen die Verfasser die Wichtigkeit der komplexen Behandlung und der planmäßigen Nachprüfung. Summary: A case of primary gastric mycosis caused by Trichosporon cutaneum is demonstrated. It was verified by gastroscopic, histologic and mycologic examinations. In accordance with data from the literature, the authors point to the importance of complex treatment and systemic follow-up investigations.     

Mykophobie — eine neue Krankheit?

Zusammenfassung. In den letzten 18 Monaten untersuchten wir 13 Patienten wegen einer angeblich therapieresistenten Darm-Candidose. Als Symptome wurden Blähungen, Verdauungsbeschwerden, Leistungsschwäche, Gelenkschmerzen, Herzbeschwerden u. a. angegeben. Bei vier Patienten konnte Candida albicans und bei drei weiteren C. parapsilosis, C. lusitaniae, Trichosporon cutaneum und Geotrichum candidum nachgewiesen werden. Serologische Untersuchungen ergaben Normalbefunde. Bei keinem der 13 Patienten bestan-den Anhaltspunkte für eine behandlungsbedürftige Mykose. Acht Patienten wiesen Anzeichen einer Depression bzw. Neurose auf. Bei allen 13 Patienten wurde der gelegentliche oder wiederholte Nachweis von Hefen in den Faeces bzw. in der Mundhöhle mit einer Pilzinfektion verwechselt und dadurch bei einigen Patienten eine Phobie induziert.
Summary. In the recent 18 months we analysed 13 patients with so-called therapy-resistant intestinal candidosis. Symptoms like flatulence, digestive trouble, intestinal inefficiency, arthralgia, heart trouble, etc., were declared. From four patients Candida albicans and in further three patients C. parapsilosis, C. lusitaniae, Trichosporon cutaneum , and Geotrichum candidum could be isolated. Serological tests were normal. In none of the 13 patients a mycosis which needed therapy was proven. Eight patients had signs of a depression or neurosis. In all 13 patients the occasional or repeated isolation of yeasts from faeces or the oral cavity was falsely interpreted as a fungal infection and thus became the inductor of a phobia.