Skip to main content

Advertisement

SpringerLink
Log in

Fatal Disseminated Infection by Trichosporon asahii Under Voriconazole Therapy in a Patient with Acute Myeloid Leukemia: A Review of Breakthrough Infections by Trichosporon spp.

  • Case Report
  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Introduction

Cases of invasive Trichosporon infections have increasingly emerged; it is now the second leading cause of yeast bloodstream infections after Candida spp., particularly in the immunosuppressed population, where it often causes breakthrough fungemia with high mortality.

Methods

We present a case report of a breakthrough Trichosporon asahii infection in a patient with acute myeloid leukemia and review all of the cases of breakthrough Trichosporon spp. infections published in the literature to date.

Results

We extracted 68 cases of breakthrough Trichosporon spp. infections, wherein 95.5% patients had hematological malignancy, 61.8% of them occurred in the presence of echinocandins, 22% of triazoles, 13.2% of amphotericin and 3% of other combinations of antifungals. The most prevalent manifestation was fungemia (94%); 82.8% of these were associated with the presence of a central venous catheter. The overall mortality was 68.7%; the patients who survived recovered from the neutropenic event.

Conclusions

Invasive trichosporonosis is an acute fatal condition that occurs in immunosuppressed patients, usually under antifungal selective pressure. Typically, neutropenia and its underlying diseases are associated with adverse outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Leventakos K, Lewis RE, Kontoyiannis DP. Fungal infections in leukemia patients: how do we prevent and treat them? Clin Infect Dis. 2010;50(3):405–15.

    Article  Google Scholar 

  2. Halpern AB, Lyman GH, Walsh TJ, Kontoyiannis DP, Walter RB. Primary antifungal prophylaxis during curative-intent therapy for acute myeloid leukemia. Blood. 2015;126(26):2790–7.

    Article  CAS  Google Scholar 

  3. Biehl LM, Vehreschild JJ, Liss B, Franke B, Markiefka B, Persigehl T, et al. A cohort study on breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis. J Antimicrob Chemother. 2016;71(9):2634–41.

    Article  Google Scholar 

  4. Sun HY, Singh N. Characterization of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review. Int J Antimicrob Agents. 2010;35(3):211–8.

    Article  CAS  Google Scholar 

  5. Bouchara JP, Chaturvedi V. The curious case of ‘‘case report’’ of infections caused by human and animal fungal pathogens: an educational tool, an online archive, or a format in need of retooling. Mycopathologia. 2018;183(6):879–91.

    Article  Google Scholar 

  6. Cornely OA, Hoeingl M, Lass-Flörl C, Chen SC, Kontoyiannis D, Morrissey CO, et al. Defining breakthrough invasive fungal infection-position paper of the mycoses study group education and research consortium and the European confederation of medical mycology. Mycoses. 2019;62(9):716–29.

    PubMed  Google Scholar 

  7. Denning DW. Echinocandin antifungal drugs. Lancet. 2003;362:1142–51.

    Article  CAS  Google Scholar 

  8. Spánik S, Kollár T, Gyarfás J, Kunová A, Krcméry V. Successful treatment of catheter-associated fungemia due to Candida krusei and Trichosporon beigelii in a leukemic patient receiving prophylactic itraconazole. Eur J Clin Microbiol Infect Dis. 1995;14(2):148–9.

    Article  Google Scholar 

  9. Kcrmery V, Oravcova E, Spanik S, Mrazovatudena M, Trupl J, Kunova A, et al. Nosocomial breakthrough fungaemia during antifungal prophylaxis or empirical antifungal therapy in 41 cancer patients receiving antineoplastic chemotherapy: analysis of aetiology risk factors and outcome. J Antimicrob Chemother. 1998;41(3):373–80.

    Article  Google Scholar 

  10. Krcmery V, Mateicka F, Kunová A, Spánik S, Gyarfás J, Sycová Z, et al. Hematogenous trichosporonosis in cancer patients: report of 12 cases including 5 during prophylaxis with itraconazol. Support Care Cancer. 1999;7(1):39–43.

    Article  Google Scholar 

  11. Goodman D, Pamer E, Jakubowski A, Morris C, Sepkowitz K. Breakthrough trichosporonosis in a bone marrow transplant recipient receiving caspofungin acetate. Clin Infect Dis. 2002;35(3):E35–6.

    Article  Google Scholar 

  12. Matsue K, Uryu H, Koseki M, Asada N, Takeuchi M. Breakthrough trichosporonosis in patients with hematologic malignancies receiving micafungin. Clin Infect Dis. 2006;42(6):753–7.

    Article  CAS  Google Scholar 

  13. Akagi T, Yamaguti K, Kawamura T, Nakumura T, Kubo K, Takemori H. Breakthrough trichosporonosis in patients with acute myeloid leukemia receiving micafungin. Leuk Lymphoma. 2006;47(6):1182–3.

    Article  CAS  Google Scholar 

  14. Asada N, Uryu H, Koseki M, Takeuchi M, Komatsu M, Matsue K. Successful treatment of breakthrough Trichosporon asahii fungemia with voriconazole in a patient with acute myeloid leukemia. Clin Infect Dis. 2006;43(4):e39–41.

    Article  Google Scholar 

  15. Miura Y, Kaneko M, Nishizawa M, Okamoto K, Hirai M, Kaneko H, et al. Breakthrough infection of Trichosporon asahii in a patient with chronic lymphocytic leukemia. Int J Hematol. 2007;85(2):177–8.

    Article  Google Scholar 

  16. Rieger C, Geiger S, Herold T, Nickenig C, Ostermann H. Breakthrough infection of Trichosporon asahii during posaconazole treatment in a patient with acute myeloid leukaemia. Eur J Clin Microbiol Infect Dis. 2007;26(11):843–5.

    Article  CAS  Google Scholar 

  17. Bayramoglu G, Sonmez M, Tosun I, Aydin K, Aydin F. Breakthrough Trichosporon asahii fungemia in neutropenic patient with acute leukemia while receiving caspofungin. Infection. 2008;36(1):68–70.

    Article  CAS  Google Scholar 

  18. Hosoki K, Iwamoto S, Kumamoto T, Azuma E, Komada Y. Early detection of breakthrough trichosporonosis by serum PCR in a cord blood transplant recipient being prophylactically treated with voriconazole. J Pediatr Hematol Oncol. 2008;30(12):917–9.

    Article  CAS  Google Scholar 

  19. Suzuki K, Nakase K, Kyo T, Kohara T, Sugawara Y, Shibazaki T, et al. Fatal Trichosporon fungemia in patients with hematologic malignancies. Eur J Haematol. 2010;84(5):441–7.

    Article  Google Scholar 

  20. Liao Y, Hartmann T, Zheng T, Yang R-Y, Ao J-H, Wang W-L. Breakthrough trichosporonosis in patients receiving echinocandins: case report and literature review. Chin Med J (Engl). 2012;125(14):2632–5.

    Google Scholar 

  21. Hashino S, Takahashi S, Morita R, Kanamori H, Onozawa M, Kawamura T, et al. Fungemia due to Trichosporon dermatis in a patient with refractory Burkitt’s leukemia. Blood Res. 2013;48(2):154.

    Article  Google Scholar 

  22. Chen J, Chen F, Wang Y, Yang L-Y, Miao M, Han Y, et al. Use of combination therapy to successfully treat breakthrough Trichosporon asahii infection in an acute leukemia patient receiving voriconazole. Med Mycol Case Rep. 2014;6:55–7.

    Article  Google Scholar 

  23. Yang M, Gao H, Li L. A fatal case of Trichosporon asahii fungemia and pneumonia in a kidney transplant recipient during caspofungin treatment. Ther Clin Risk Manag. 2014;10:759–62.

    Article  Google Scholar 

  24. Nachabur D, Angelova O, Orth-Höller D, Ditilbacher A, Lackner M, Auberger J, et al. Primary antifungal prophylaxis with micafungin in patients with haematological malignancies: real-life data from a retrospective single-centre observational study. Eur J Haematol. 2015;93(3):258–64.

    Article  Google Scholar 

  25. Yilmaz Karapinar D, Karadaş N, Önder Siviş Z, Yazici P, Duyu M, Metin D, et al. Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia. Braz J Infect Dis. 2015;19(5):549–52.

    Article  Google Scholar 

  26. Oliveira dos Santos C, Zijlstra JG, Porte RJ, Kampinga GA, van Diepeningen AD, Sinha B, et al. Emerging pan-resistance in Trichosporon species: a case report. BMC Infect Dis. 2016;16:148.

    Article  Google Scholar 

  27. Thien SY, Chung SJ, Tan AL, Hwang WY, Tan BH, Tan TT. Recurrent trichosporonosis with central nervous system involvement in an allogeneic hematopoietic stem cell transplant recipient. Transpl Infect Dis. 2016;18(5):768–72.

    Article  CAS  Google Scholar 

  28. Foster CE, Edwards MS, Brackett J, Schady DA, Healy CM, Baker CJ. Trichosporonosis in pediatric patients with a hematologic disorder. J Pediatr Infect Dis Soc. 2018;7(3):199–204.

    Article  Google Scholar 

  29. Karigane D, Sakurai M, Matsuyama E, Ide K, Yamamoto-Takeuchi S, Inazumi T, et al. Successful treatment of breakthrough disseminated Trichosporon asahii fungemia in a patient with acute myeloid leukemia receiving itraconazole prophylaxis. Med Mycol Case Rep. 2018;20:1–3.

    Article  Google Scholar 

  30. Kimura M, Araoka H, Yamamoto H, Nakamura S, Nagi M, Yamagoe S, et al. Micafungin breakthrough fungemia in patients with hematological disorders. Antimicrob Agents Chemother. 2018;62(5):e02183-17.

    Article  Google Scholar 

  31. Walsh TJ, Melcher GP, Rinaldi MG, Lecciones J, McGough DA, Kelly P, et al. Trichosporon beigelii, an emerging pathogen resistant to amphotericin B. J Clin Microbiol. 1990;28(7):1616–22.

    Article  CAS  Google Scholar 

  32. Arendrup MC, Boekhout T, Akova M, Meis JF, Cornely OA, Lortholary O. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect. 2014;20(S3):76–98.

    Article  CAS  Google Scholar 

  33. Iturrieta-González IA, Padovan ACB, Bizerra FC, Hahn RC, Colombo AL. Multiple species of Trichosporon produce biofilms highly resistant to triazoles and amphotericin B. PLoS ONE. 2014;9(10):e109553.

    Article  Google Scholar 

  34. Di Bonaventura G, Pompilio A, Picciani C, Iezzi M, D’Antonio D, Piccolomini R. Biofilm formation by the emerging fungal pathogen Trichosporon asahii: development, architecture, and antifungal resistance. Antimicrob Agents Chemother. 2006;50(10):3269–76.

    Article  Google Scholar 

  35. Liao Y, Lu X, Yang S, Luo Y, Chen Q, Yang R. Epidemiology and outcome of Trichosporon fungemia: a review of 185 reported cases from 1975 to 2014. Open Forum Infect Dis. 2015;2(4):ofv141.

    Article  Google Scholar 

  36. De Almeida Júnior JN, Hennequin C. Invasive Trichosporon infection: a systematic review on a re-emerging fungal pathogen. Front Microbiol. 2016;7:1629.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Infectious Diseases, Internal Medicine, Hospital Pablo Tobón Uribe, Universidad de Antioquia, calle 78B#69-240, Cra. 51d#62-29, Medellín, Colombia

    I. Ramírez

  2. Infectious Diseases, Internal Medicine, Hospital Universitario San Vicente Fundación Universidad de Antioquia, Cra. 51d#62-29, Medellín, Colombia

    D. Moncada

Authors
  1. I. Ramírez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Moncada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Ramírez.

Ethics declarations

Conflict of interest

The other authors have no conflict of interest to disclose.

Ethical Approval

The study was approved by the Institutional Committee on Research Ethics.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Handling Editor: Takashi Sugita.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramírez, I., Moncada, D. Fatal Disseminated Infection by Trichosporon asahii Under Voriconazole Therapy in a Patient with Acute Myeloid Leukemia: A Review of Breakthrough Infections by Trichosporon spp.. Mycopathologia 185, 377–388 (2020). https://doi.org/10.1007/s11046-019-00416-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-019-00416-w

Keywords

Search

Navigation