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Febrile Neutropenia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Perrine Parize, Anne Pouvaret, Paul-Louis Woerther, Frédéric Pène, Olivier Lortholary
In a cohort of 3417 patients with candidemia in Paris (3666 isolates), 1164 (34.1%) had a solid tumor (45.7% digestive tract) and 586 (17.1%) had a hematological malignancy (41.8% lymphoma and 33.5% acute leukemia) [42]. The hematology patients were significantly younger, more often pre-exposed to antifungals, more often infected by C. tropicalis, C. krusei, or C. kefyr, and more often treated in the first instance with an echinocandin. Compared with inpatients who were not in CCU at the time of fungemia, those in CCU were less frequently infected by C. parapsilosis, had more recent surgery, and died more frequently before day 8 and day 30. An increase in crude mortality over time in CCU was observed only in oncology patients [42]. In the same cohort, 338 episodes of fungemia due to uncommon yeasts were also analyzed. Thirty-five different species were identified (27 ascomycetes and 8 basidiomycetes), of which 11 had caspofungin MIC 50 >0.25 mg/L and 15 had fluconazole minimal inhibitory concentration (MIC) 50 >4 mg/L. Hematological malignancies and prior exposure to antifungal drugs were independent predisposing factors for uncommon species. Infections due to C. kefyr-related species and Trichosporon spp. remained associated with hematological malignancies, those due to the Geotrichum group were associated with acute leukemia. Infections due to Trichosporon spp. or fungus of the Geotrichum group were associated with prior exposure to caspofungin but not to fluconazole [43].
Trichosporon
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
João Nobrega de Almeida Júnior
Microscopic examination may provide useful information for the diagnosis of a Trichosporon infection. The presence of blastoconidia and arthroconidia are very suggestive (Figure 5.1a). On SDA media, colonies are usually cream-colored, dry (exception Trichosporon dermatis/mucoides), farinose, and become cerebriform after 7 days at room temperature (Figure 5.2). On chromogenic media, T. asahii colonies develop a blue-dry aspect (Figure 5.3a).
Epidemiology of fungal infections: What, where, and when
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Frederic Lamoth, Sylvia F. Costa, Barbara D. Alexander
Trichosporon spp., saprophytic yeasts usually found in the soil, can be cultured from human skin, stool, and urine. These organisms have been implicated as the etiologic agent of white piedra, an infection of the distal end of the hair shaft, as well as causing cutaneous infections in immunocompetent patients [476–478]. In immunosuppressed patients, particularly in those with underlying malignancy, it has been implicated as the cause of fungemia, renal insufficiency, pulmonary infiltrates, cutaneous lesions, chorioretinitis, and chronic hepatic trichosporonosis [479–488]. An increasing incidence of trichosporonosis has been reported over the last decade [489,490]. Increasing use of echinocandins, to which Trichosporon spp. are intrinsically resistant, may be involved in this changing epidemiology. A recent review of 203 cases of invasive trichosporonosis reported in the literature since 1994 shows that the disease affects mainly patients with hematologic cancers (39%), especially those with neutropenia [490]. Other populations at risk include patients with other immunosuppressive conditions and newborns (21% and 12% of cases, respectively). T. asahii was the most frequent pathogenic agent (46.7% of cases), followed by T. inkin and T. mucoides/dermatis. Fongemia was present in 74% of cases. Other affected organs were skin, lung, liver/spleen, intestinal tract, brain and eye.
Management of osteoarticular fungal infections in the setting of immunodeficiency
Published in Expert Review of Anti-infective Therapy, 2020
Savvas G. Papachristou, Elias Iosifidis, Nikolaos V. Sipsas, Maria N. Gamaletsou, Thomas J. Walsh, Emmanuel Roilides
Non-Candida yeasts causing osteoarticular infections include primarily Cryptococcus spp. followed by less common pathogens, such as Trichosporon spp. and Saprochaete capitata (formerly Blastoschizomyces capitatus) [2,61–64]. Cryptococcus osteomyelitis has been reported to affect ages from 21 to 59 years according to one study, which included 40 cases [65], and from 1.3 to 84 years (mean 38.2 years) according to another study with 47 cases [2,66]. No gender predominated [2,66]. Identified risk factors for Cryptococcus osteomyelitis include sarcoidosis, tuberculosis, corticosteroid use, transplantation, malignancy, diabetes, and CD4+ lymphopenia [2,66,67]. Osteomyelitis due to the other aforementioned species has also been linked to severe immunodeficiency [2,61–64].
Promethazine inhibits efflux, enhances antifungal susceptibility and disrupts biofilm structure and functioning in Trichosporon
Published in Biofouling, 2023
Ana Luiza Ribeiro Aguiar, Bruno Nascimento da Silva, Nicole de Mello Fiallos, Lívia Maria Galdino Pereira, Maria Laína Silva, Pedro Freitas Santos Manzi de Souza, Fernando Victor Monteiro Portela, José Júlio Costa Sidrim, Marcos Fábio Gadelha Rocha, Débora Souza Collares Maia Castelo-Branco, Rossana de Aguiar Cordeiro
A total of 12 clinical strains of Trichosporon were evaluated in this study (Table 1). Isolates belong to the culture collection of the Specialized Medical Mycology Center of Federal University of Ceará, Brazil. Fungal strains were recovered from storage and maintained on potato dextrose agar (PDA; Himedia, Mumbai, India), at 35 °C for 48 h. Identification was based on analysis of micromorphology on malt agar (Himedia, Brazil, Mumbai, India) (De Hoog et al. 2000) and rDNA intergenic spacer (IGS) region sequencing (Rodriguez-Tudela et al. 2005). C. krusei ATCC 6258 and C. parapsilosis ATCC 22019 were used as quality controls for susceptibility assays (CLSI 2008).
Heterologous extracellular DNA facilitates the development of Trichosporon asahii and T. inkin biofilms and enhances their tolerance to antifungals
Published in Biofouling, 2022
Lívia Maria Galdino Pereira, Ana Raquel Colares de Andrade, Fernando Victor Monteiro Portela, Ana Luiza Ribeiro Aguiar, Bruno Nascimento da Silva, Santiago Gonçalves Bezerra Moura, Mariana Lara Mendes Pergentino, Marcos Fábio Gadelha Rocha, José Júlio da Costa Sidrim, Débora de Souza Collares Maia Castelo Branco, Rossana de Aguiar Cordeiro
Trichosporon spp. are prone to form biofilms on biotic and abiotic surfaces (Cordeiro et al. 2015; Kurakado et al. 2020). These are well structured communities encased by a self-produced, polymer-rich extracellular matrix (Sugimoto et al. 2018). Experimental studies have shown that Trichosporon biofilms present increased tolerance to antifungals, being the inhibitory concentrations up to hundreds or thousands of times higher than those for than planktonic cells (Cordeiro et al. 2015)