Trichosporonosis

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Takashi Sugita - One of the best experts on this subject based on the ideXlab platform.

Issei Tokimatsu - One of the best experts on this subject based on the ideXlab platform.

  • Successful Treatment of Breakthrough Trichosporon asahii Fungemia by the Combination Therapy of Fluconazole and Liposomal Amphotericin B in a Patient with Follicular Lymphoma
    Mycopathologia, 2021
    Co-Authors: Kazuhiro Itoh, Issei Tokimatsu, Hiromichi Iwasaki, Eiju Negoro, Hiroko Shigemi, Hiroshi Tsutani, Takahiro Yamauchi
    Abstract:

    Invasive Trichosporonosis is a rare and lethal fungal infection that occurs in immunocompromised patients. Breakthrough Trichosporonosis can occur in patients treated with echinocandins since Trichosporon spp. are resistant to these antifungal agents. We report a case of breakthrough Trichosporon asahii fungemia. A 62-year-old Japanese woman with relapsed follicular lymphoma was treated empirically with broad-spectrum antibiotics and micafungin due to an intermittent fever during reinduction chemotherapy. After four cycles of anti-cancer chemotherapy, she experienced a high neutropenic fever and T. asahii was subsequently detected from a blood culture. The patient was not given voriconazole due to the contraindication for use with carbamazepine, and she was successfully treated with fluconazole plus liposomal amphotericin B without any serious complications. The combined therapy of fluconazole and liposomal amphotericin B may therefore be useful in treating T. asahii fungemia, especially in patients receiving antiepileptic agents.

  • Antifungal susceptibility and drug-resistant mechanism of Trichosporon
    Medical mycology journal, 2015
    Co-Authors: Hisako Kushima, Issei Tokimatsu, Hiroshi Ishii, Jun-ichi Kadota
    Abstract:

    Most cases of deep-seated Trichosporonosis develop in patients with neutropenia, but it has recently been reported that breakthrough infections with Trichosporon species can develop during the use of candin family of antifungal agents. This is due to the primary resistance of the causal fungus, Trichosporon asahii (T. asahii), to the candin agents. On the other hand, there has been a case report of infection with Trichosporon that presented high-level resistance to the azole family of antifungal agents. Therefore, the possibility that the frequent use of azole agents may lead to secondary resistance to these agents is a cause for concern. Since Trichosporonosis is a relatively rare infectious disease, there has been no established breakpoint for this fungus to various antifungal agents, wherein we cannot precisely confirm its sensitivity or resistance to the agents. However, our experiment demonstrated one of the processes for acquired drug resistance, wherein the minimal inhibitory concentration of fluconazole for T. asahii was markedly elevated after its long-term in vitro exposure to the drug. Although the mechanisms for drug-resistance of Trichosporon species are unknown, it is supposed that they are the same as the mechanisms found in Candida and Aspergillus species, namely, modification of target molecules or decrease of access to the molecules. Since cases of Trichosporonosis are likely to increase in the future, we believe that there is an urgent need to establish the breakpoint for T. asahii based on large-scale drug sensitivity tests, as well as to elucidate its drug-resistance mechanisms.

  • Quantitative PCR assay used to monitor serum Trichosporon asahii DNA concentrations in disseminated Trichosporonosis
    The Pediatric infectious disease journal, 2008
    Co-Authors: Yoichiro Tsuji, Takashi Sugita, Issei Tokimatsu, Masatoshi Nozaki, Daisuke Kobayashi, Kohsuke Imai, Kazuhiro Kogawa, Shigeaki Nonoyama
    Abstract:

    A bone marrow transplant recipient with disseminated Trichosporonosis was successfully treated with voriconazole. Quantitative PCR assay results for Trichosporon asahii DNA in the sera were well correlated with the patient's clinical course. Based on the in vitro susceptibility test, the organism was susceptible to voriconazole.

  • the prophylactic effectiveness of various antifungal agents against the progression of Trichosporonosis fungemia to disseminated disease in a neutropenic mouse model
    International Journal of Antimicrobial Agents, 2007
    Co-Authors: Issei Tokimatsu, Hisako Kushima, Kazuhiko Hashinaga, Kenji Umeki, Minoru Ohama, Hiroshi Ishii, Kenji Kishi, Kazufumi Hiramatsu, Jun-ichi Kadota
    Abstract:

    Neutropenic mice with latent trichosporonemia were given various antifungal agents (amphotericin B, fluconazole, itraconazole) or saline to determine which antifungal agent could be useful for prophylaxis. The 3-week-survival rate was 80% in the fluconazole group, 50% in the amphotericin B group, 45% in the itraconazole group, and 30% in the saline group. Compared with the other antifungal agents, fluconazole offered superior prophylaxis against the progression of Trichosporonosis fungemia to disseminated disease (P<0.05). These results suggest that clinical studies are warranted to investigate fluconazole prophylaxis of Trichosporonosis progression in neutropenic patients, such as people receiving chemotherapy and patients who have received solid organ transplants.

  • The prophylactic effectiveness of various antifungal agents against the progression of Trichosporonosis fungemia to disseminated disease in a neutropenic mouse model.
    International journal of antimicrobial agents, 2007
    Co-Authors: Issei Tokimatsu, Hisako Kushima, Kazuhiko Hashinaga, Kenji Umeki, Minoru Ohama, Hiroshi Ishii, Kenji Kishi, Kazufumi Hiramatsu, Jun-ichi Kadota
    Abstract:

    Neutropenic mice with latent trichosporonemia were given various antifungal agents (amphotericin B, fluconazole, itraconazole) or saline to determine which antifungal agent could be useful for prophylaxis. The 3-week-survival rate was 80% in the fluconazole group, 50% in the amphotericin B group, 45% in the itraconazole group, and 30% in the saline group. Compared with the other antifungal agents, fluconazole offered superior prophylaxis against the progression of Trichosporonosis fungemia to disseminated disease (P

Guilherme Maranhão Chaves - One of the best experts on this subject based on the ideXlab platform.

  • exploring the resistance mechanisms in trichosporon asahii triazoles as the last defense for invasive Trichosporonosis
    Fungal Genetics and Biology, 2019
    Co-Authors: Ana Carolina Barbosa Padovan, Walicyranison P. Silva-rocha, Guilherme Maranhão Chaves, Ana Caroline De Moraes Toti, Daniel Felipe Freitas De Jesus, Arnaldo Lopes Colombo
    Abstract:

    Trichosporon asahii has recently been recognized as an emergent fungal pathogen able to cause invasive infections in neutropenic cancer patients as well as in critically ill patients submitted to invasive medical procedures and broad-spectrum antibiotic therapy. T. asahii is the main pathogen associated with invasive Trichosporonosis worldwide. Treatment of patients with invasive Trichosporonosis remains a controversial issue, but triazoles are mentioned by most authors as the best first-line antifungal therapy. There is mounting evidence supporting the claim that fluconazole (FLC) resistance in T. asahii is emerging worldwide. Since 2000, 15 publications involving large collections of T. asahii isolates described non-wild type isolates for FLC and/or voriconazole. However, very few papers have addressed the epidemiology and molecular mechanism of antifungal resistance in Trichosporon spp. Data available suggest that continuous exposure to azoles can induce mutations in the ERG11 gene, resulting in resistance to this class of antifungal drugs. A recent report characterizing T. asahii azole-resistant strains found several genes differentially expressed and highly mutated, including genes related to the Target of Rapamycin (TOR) pathway, indicating that evolutionary modifications on this pathway induced by FLC stress may be involved in developing azole resistance. Finally, we provided new data suggesting that hyperactive efflux pumps may play a role as drug transporters in FLC resistant T. asahii strains.

  • Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature.
    BMC infectious diseases, 2018
    Co-Authors: Eveline Pipolo Milan, Walicyranison P. Silva-rocha, Jéssica Jacinto Salviano De Almeida, Tatiane Uetti Gomes Fernandes, André Luciano De Araújo Prudente, Matheus Firmino De Azevedo, Elaine Cristina Francisco, Analy Salles De Azevedo Melo, Arnaldo Lopes Colombo, Guilherme Maranhão Chaves
    Abstract:

    Background Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system Trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin.

  • Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature
    BMC, 2018
    Co-Authors: Eveline Pipolo Milan, Walicyranison P. Silva-rocha, Jéssica Jacinto Salviano De Almeida, Tatiane Uetti Gomes Fernandes, André Luciano De Araújo Prudente, Matheus Firmino De Azevedo, Elaine Cristina Francisco, Analy Salles De Azevedo Melo, Arnaldo Lopes Colombo, Guilherme Maranhão Chaves
    Abstract:

    Abstract Background Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system Trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin. Case presentation Here we report the first clinical case of meningoencephalitis due to this species in a female previously healthy patient under corticosteroids and antibiotics therapy for several months. She was submitted to an invasive procedure to remove a left sided acoustic neuroma and further developed a cerebrospinal fistula. After some days of the procedure, she presented a predominantly and intensive occipital holocranial headache, followed by vomiting, hyporexia, weight loss, asthenia, irritability, difficulty to concentrate and rotator vertigo. The patient further developed a cerebrospinal fistula in the occipital region and was submitted to a surgical correction. After several months of clinical interventions, she was diagnosed with CNS Trichosporonosis, after Magnetic Resonance Imaging and positive microbiological cultures obtained within two different occasions (2 weeks apart). Despite the antifungal therapy with Amphotericin B and Voriconazole, the patient did not survive. Conclusions Despite CNS Fungal infections are mostly due to Cryptococcus spp., other emergent yeasts, such as T. inkin may be considered as a likely etiological agent. This is the first case report of CNS Trichosporonosis, where species identification was performed with rDNA sequencing

  • Current Knowledge of Trichosporon spp. and Trichosporonosis
    Clinical microbiology reviews, 2011
    Co-Authors: Arnaldo Lopes Colombo, Ana Carolina Barbosa Padovan, Guilherme Maranhão Chaves
    Abstract:

    SUMMARY Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive Trichosporonosis. Disseminated Trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive Trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with Trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.

Kazuko Nishimura - One of the best experts on this subject based on the ideXlab platform.

  • Identification of the first isolates of Trichosporon asahii var asahii from disseminated Trichosporonosis in China.
    Diagnostic microbiology and infectious disease, 2002
    Co-Authors: Paride Abliz, Rongya Yang, Kazutaka Fukushima, Kayoko Takizawa, Kazuko Nishimura
    Abstract:

    Infection with Trichosporon asahii is a major cause of deep-seated and disseminated Trichosporonosis, which is associated with a high mortality rate. Disseminated Trichosporonosis in individuals with no underlying disease has not been reported. In this study, we report the identification of the first isolate of Trichosporon asahii var. asahii in China. Two isolates were obtained from the liver and skin of a patient with disseminated Trichosporonosis who displayed no evidence of underlying disease. The morphologic and physiologic characteristics of the two isolates differed slightly from those of usual strains of T. asahii var. asahii, including the type strain CBS 2479. Ubiquinone-9 was identified as the major ubiquinone in both isolates. Sequence analysis of the LSUrDNA D1/D2, ITS, and IGS1 regions from the two isolates showed them to be T. asahii var. asahii, and random amplified polymorphic DNA analysis strongly suggested that they were the same strain.

Arnaldo Lopes Colombo - One of the best experts on this subject based on the ideXlab platform.

  • exploring the resistance mechanisms in trichosporon asahii triazoles as the last defense for invasive Trichosporonosis
    Fungal Genetics and Biology, 2019
    Co-Authors: Ana Carolina Barbosa Padovan, Walicyranison P. Silva-rocha, Guilherme Maranhão Chaves, Ana Caroline De Moraes Toti, Daniel Felipe Freitas De Jesus, Arnaldo Lopes Colombo
    Abstract:

    Trichosporon asahii has recently been recognized as an emergent fungal pathogen able to cause invasive infections in neutropenic cancer patients as well as in critically ill patients submitted to invasive medical procedures and broad-spectrum antibiotic therapy. T. asahii is the main pathogen associated with invasive Trichosporonosis worldwide. Treatment of patients with invasive Trichosporonosis remains a controversial issue, but triazoles are mentioned by most authors as the best first-line antifungal therapy. There is mounting evidence supporting the claim that fluconazole (FLC) resistance in T. asahii is emerging worldwide. Since 2000, 15 publications involving large collections of T. asahii isolates described non-wild type isolates for FLC and/or voriconazole. However, very few papers have addressed the epidemiology and molecular mechanism of antifungal resistance in Trichosporon spp. Data available suggest that continuous exposure to azoles can induce mutations in the ERG11 gene, resulting in resistance to this class of antifungal drugs. A recent report characterizing T. asahii azole-resistant strains found several genes differentially expressed and highly mutated, including genes related to the Target of Rapamycin (TOR) pathway, indicating that evolutionary modifications on this pathway induced by FLC stress may be involved in developing azole resistance. Finally, we provided new data suggesting that hyperactive efflux pumps may play a role as drug transporters in FLC resistant T. asahii strains.

  • Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature.
    BMC infectious diseases, 2018
    Co-Authors: Eveline Pipolo Milan, Walicyranison P. Silva-rocha, Jéssica Jacinto Salviano De Almeida, Tatiane Uetti Gomes Fernandes, André Luciano De Araújo Prudente, Matheus Firmino De Azevedo, Elaine Cristina Francisco, Analy Salles De Azevedo Melo, Arnaldo Lopes Colombo, Guilherme Maranhão Chaves
    Abstract:

    Background Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system Trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin.

  • Trichosporon inkin meningitis in Northeast Brazil: first case report and review of the literature
    BMC, 2018
    Co-Authors: Eveline Pipolo Milan, Walicyranison P. Silva-rocha, Jéssica Jacinto Salviano De Almeida, Tatiane Uetti Gomes Fernandes, André Luciano De Araújo Prudente, Matheus Firmino De Azevedo, Elaine Cristina Francisco, Analy Salles De Azevedo Melo, Arnaldo Lopes Colombo, Guilherme Maranhão Chaves
    Abstract:

    Abstract Background Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Central nervous system Trichosporonosis is a very rare clinical manifestation. In fact, only a few cases have been published in the literature and none of them was caused by Trichosporon inkin. Case presentation Here we report the first clinical case of meningoencephalitis due to this species in a female previously healthy patient under corticosteroids and antibiotics therapy for several months. She was submitted to an invasive procedure to remove a left sided acoustic neuroma and further developed a cerebrospinal fistula. After some days of the procedure, she presented a predominantly and intensive occipital holocranial headache, followed by vomiting, hyporexia, weight loss, asthenia, irritability, difficulty to concentrate and rotator vertigo. The patient further developed a cerebrospinal fistula in the occipital region and was submitted to a surgical correction. After several months of clinical interventions, she was diagnosed with CNS Trichosporonosis, after Magnetic Resonance Imaging and positive microbiological cultures obtained within two different occasions (2 weeks apart). Despite the antifungal therapy with Amphotericin B and Voriconazole, the patient did not survive. Conclusions Despite CNS Fungal infections are mostly due to Cryptococcus spp., other emergent yeasts, such as T. inkin may be considered as a likely etiological agent. This is the first case report of CNS Trichosporonosis, where species identification was performed with rDNA sequencing

  • Current Knowledge of Trichosporon spp. and Trichosporonosis
    Clinical microbiology reviews, 2011
    Co-Authors: Arnaldo Lopes Colombo, Ana Carolina Barbosa Padovan, Guilherme Maranhão Chaves
    Abstract:

    SUMMARY Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive Trichosporonosis. Disseminated Trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive Trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with Trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.

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