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Author: admin, 30.11.2013While in the past the likelihood of fatal infection due to fungi was low, there has been an increasing incidence of such infections (particularly candidiasis and aspergillosis) with the advent of modern cancer chemotherapy.
Invasive infections caused by Trichosporon spp are collectively referred as trichosporonosis and can be divided into 3 forms: disseminated disease, disease localized to major organs and catheter-related infections without tissue invasion. Chronic hepatosplenic trichosporonosis, a disease mimicking chronic hepatosplenic candidiasis, has been described in few patients recovering from neutropenia (99). Renal involvement has been found in the majority of autopsies of patients with disseminated trichosporonosis (93). Skin lesions are a common clinical finding as they are present in about one-third of patients with disseminated trichosporonosis. Trichosporon infections of a single organ without disseminated disease have been described among non-neutopenic patients.
In patients with disseminated trichosporonosis, cultures of blood, urine, spinal fluid and tissue can yield the fungus. Trichosporon spp are isolated from blood in over 70% of invasive infections (25). If the patient has skin lesions biopsy and subsequent tissue culture and histopathology may be helpful in establishing the diagnosis in disseminated infection. As it was mentioned above, patients with disseminated trichosporonosis may have a positive Cryptococcus neoformans polysaccharide antigen assay due to cross-reactivity (55). Several murine models of experimental disseminated trichosporonosis have been developed (26,107,3).
In a murine model of disseminated trichosporonosis, micafungin in combination with AMB showed a synergistic effect and demonstrated a higher degree of efficacy in prolonging survival and reducing the kidney fungal burden than either agent alone (82). Disseminated trichosporonosis, especially in a neutropenic patient should be treated with voriconazole, which should be considered as drug of choice based on the existing limited data (25,67). Catheter removal and administration of colony stimulating factors might be of help (16) in neutropenic patients with disseminated infections with Trichosporon or B. The disseminated disease is called trichosporonosis, whereas the innocuous superficial hair infection is called trichosporosis by some authors.
The disseminated form is more common, affecting mainly neutropenic patients with hematological malignancies, although a shift to a predominance of catheter-related fungemia, without evidence of organ involvement, has been reported recently in a US hospital.
The cutaneous manifestations are similar to those of disseminated candidiasis and include macules, papules which can develop central necrosis and appear as eschars, vesicopustules, and nodules on the trunk, extremities, or over the entire body (66) (Figures 1 and 2). It has been shown that after inoculation of the neutropenic animal withTrichosporon arthroconidia the pathogen disseminated rapidly, involving numerous organs including the heart, brain, kidneys, lungs, and liver.
Abdala E, Lopes RI, Chaves CN, Heins-Vaccari EM, Shikanai-Yasuda MA. Trichosporon asahii fatal infection in a non-neutropenic patient after orthotopic liver transplantation. Microscopy shows disarticulating, nonbranching, septate, hyaline hyphae, and abundant, rectangular arthroconidia.
Liver and spleen can also be involved acutely, during disseminated trichosporonosis and the patient presents with fever, nausea, vomiting and right-quadrant discomfort (64,9).
Successful treatment of disseminated Trichosporon beigelii (cutaneum) infection with associated splenic involvement. Genotyping and antifungal susceptibility profile of Dipodascus capitatus isolates causing disseminated infection in seven hematological patients of a tertiary hospital. Detection and quantitation of the glucuronoxylomannan-like polysaccharide antigen from clinical and nonclinical isolates of Trichosporon beigelii and implications for pathogenicity. Detection of a Trichosporon beigelii antigen cross-reactive with Cryptococcus neoformans capsular polysaccharide in serum from a patient with disseminated Trichosporon infection. Demonstration of a cell wall antigen cross-reacting with cryptococcal polysaccharide in experimental disseminated trichosporonosis. The usefulness of magnetic resonance imaging (MRI) for disseminated trichosporosis of the gastrocnemius muscles. Disseminated infection withTrichosporon beigelii. Report of a case and review of the cutaneous and histologic manifestations. Invasive trichosporonosis due to Trichosporon asahii in a non-immunocompromised host: a rare case report.
Supplemental utility of nested PCR for the pathological diagnosis of disseminated trichosporonosis.
Efficacy of micafungin in combination with other drugs in a murine model of disseminated trichosporonosis. DisseminatedTrichosporon beigelii infection in patients with malignant diseases: immunohistochemical study and review.
Fatal, complete splenic infarction and hepatic infection due to disseminated Trichosporon beigelii infection: CT findings.
Multidrug-resistant Trichosporon asahii infection of nongranulocytopenic patients in three intensive care units.
Experimental model of progressive disseminated trichosporonosis in mice with latent trichosporonemia.
Endophthalmitis, brain abscess and myositis after disseminated trichosporonosis have been reported (31,102, 56).
Cardiac valve replacement in immunocompromised patients has also led to disseminated infections with this fungus (68). Recently, there has been a report of disseminated disease among non-neutropenic, ICU patients (106). Therefore, a positive galactomannan assay in a neutropenic patient with a clinical picture suggestive of disseminated candidiasis should raise the suspicion forB.
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