Mixed Infection of Toe Nail Caused by Trichosporon asahii and Rhodotorula mucilaginosa

  • Nur Fazleen Binti Idris
  • Guowang Huang
  • Qianying Jia
  • Lin Yuan
  • Yimin Li
  • Zeng TuEmail author
Short Communication


Trichosporon asahii and Rhodotorula mucilaginosa are important fungal species causing disseminated disease in immunocompromised patients. Onychomycosis prevalence rate ranges from 2 to 30%, which were 50% of nail diseases and 30% of superficial mycosis, respectively. Although important, little is known about the co-habitation of T. asahii and R. mucilaginosa in the causation of onychomycosis. Here, we present the co-habitation of T. asahii and R. mucilaginosa as causative agents of onychomycosis in a healthy 41-year-old male in China. Direct microscopic examination, fungal culture and MALDI-TOF MS were employed in isolated pathogens; hence, antifungal susceptibility test was evaluated. T. asahii was sensitive to posaconazole, voriconazole and itraconazole, whereas R. mucilaginosa was sensitive to both 5-flucytosine and amphotericin B. This report highlights the co-habitation of T. asahii and R. mucilaginosa in the causation of onychomycosis and to raise the awareness of this infection among dermatologists.


Onychomycosis Mixed infection Trichosporon asahii Rhodotorula mucilaginosa Morphology 



We are thankful for the funds provided by Basic Medical College of Chongqing Medical University (Grant No. 4101070003] and Chongqing Research Program of Basic Research and Frontier Technology (No. cstc2015jcyjA10006). We also thank the patient and Professor Xia Yun from Clinical Department, First Affiliated Hospital of Chongqing Medical University, for their technical support of fungi identification.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Yue X, Wang A. The role of scanning electron microscopy in the direct diagnosis of onychomycosis. Scanning. 2018. Scholar
  2. 2.
    Oliveira CD, Rodrigues F, Gonçalves S, et al. The cell biology of the Trichosporon-host interaction. Front Cell Infect Microbiol. 2017. Scholar
  3. 3.
    Velasquez-agudelo V, Cardona-arias JA. Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis. BMC Infect Dis. 2017. Scholar
  4. 4.
    Wang AP, Yu J, Wan Z, Li FQ, et al. Multi-center epidemiological survey of pathogenic fungi of onychomycosis in China. Chin J Mycol. 2015. Chinese).CrossRefGoogle Scholar
  5. 5.
    Colombo AL, Padovan ACB, Chaves GM. Current knowledge of Trichosporon spp. and trichosporonosis. Clin Microbiol Rev. 2011;24:682–700.CrossRefGoogle Scholar
  6. 6.
    Mariné M, Brown NA, Riaño-Pachón DM, et al. On and under the skin: emerging basidiomycetous yeast infections caused by Trichosporon species. PLoS Pathog. 2015. Scholar
  7. 7.
    Zhang E, Sugita T, Tsuboi R, et al. The opportunistic yeast pathogen Trichosporon asahii colonizes the skin of healthy individuals: analysis of 380 healthy individuals by age and gender using a nested polymerase chain reaction assay. Microbiol Immunol. 2011. Scholar
  8. 8.
    Uludag Altun H, Meral T, Turk Aribas E, Gorpelioglu C, et al. A case of onychomycosis caused by Rhodotorula glutinis. Case Rep Dermatol Med. 2014. Scholar
  9. 9.
    da Cunha MML, Dos Santos LPB, Dornelas Ribeiro M, et al. Identification, antifungal susceptibility and scanning electron microscopy of a keratinolytic strain of Rhodotorula mucilaginosa: a primary causative agent of onychomycosis. FEMS Immunol Med Microbiol. 2009. Scholar
  10. 10.
    Zhou J, Chen M, Chen H, Pan W, et al. Rhodotorula minuta as onychomycosis agent in a Chinese patient: first report and literature review. Mycoses. 2014. Scholar
  11. 11.
    Azambuja CVDA, Pimmel LA, Klafke GB, et al. Onychomycosis: clinical, mycological and in vitro susceptibility testing of isolates of Trichophyton rubrum. An Bras Dermatol. 2014. Scholar
  12. 12.
    Canton E, Pemán J, Espinel-Ingroff A, et al. Comparison of disc diffusion assay with the CLSI reference method (M27-A2) for testing in vitro posaconazole activity against common and uncommon yeasts. J Antimicrob Chem. 2008. Scholar
  13. 13.
    Choudhary DK, Johri BN. Basidiomycetous yeasts: current status. Yeast Biotechnol Divers Appl. 2009. Scholar
  14. 14.
    Biegańska MJ, Rzewuska M, Dąbrowska I, Malewska-Biel B, et al. Mixed infection of respiratory tract in a dog caused by Rhodotorula mucilaginosa and Trichosporon jirovecii: a case report. Mycopathologia. 2018. Scholar
  15. 15.
    Dyanne P, Westerberg DO, Michael J, Yoyack DO. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88:762–70.Google Scholar
  16. 16.
    Gupta AK, Ryder JE, Johson AM. Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis. Br J Dermatol. 2004. Scholar
  17. 17.
    Taj-Aldeen SJ, Al-Ansari HI, Boekhout T, Theelen B. Co-isolation of Trichosporon inkin and Candida parapsilosis from a scalp white piedra case. Med Mycol. 2004. Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Microbiology, College of Basic Medical SciencesChongqing Medical UniversityChongqingChina
  2. 2.Department of Infectious DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina

Personalised recommendations