Disseminated mucocutaneous trichosporonosis in a patient with histiocytic sarcoma

Abstract Trichosporon asahii is the causal agent of trichosporonosis. Patients with immunosuppression or hematological malignancies are at higher risk of infection. Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers. Internal organ dissemination is lethal. Therapeutic success depends on the underlying disease. Here, the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma, a rare and aggressive haematolymphoid neoplasm. Regretfully, death occurred despite treatment with liposomal amphotericin B and supportive measures, showcasing the fatality of both diseases.

Trichosporon isolation from human ungueal infections: is there a pathogenic role?

Abstract BACKGROUND: Although dermatophytes are considered the major cause of onychomycosis, many reports have incriminated non-dermatophyte moulds and yeasts in the disease’s etiology. Successive Trichosporon isolation from onychomycosis has led to the genus being suspected as a nail primary pathogen. OBJECTIVE: To determine the prevalence of Trichosporon isolation in onychomycosis patients who attended a mycology diagnostic service in Rio de Janeiro, Brazil, between January 2003 and December 2006. The study also includes a worldwide review on Trichosporon isolation prevalence in ungueal disease, emphasizing T. ovoides. METHODS: This retrospective study was conducted with the support of staff from the Mycology Laboratory at the Dermatological Service of Rio de Janeiro’s Santa Casa da Misericórdia (MLDS). RESULTS: Mycological analysis provided positive results equaling 47/5036 (0.93%) for Trichosporon spp.; obtained mainly as a single agent (72.35%), and from mixed cultures (27.65%; X2= 6.397; p= 0.018). The great majority belongs to the T. ovoides species (91.5%; n=43), obtained as a single isolate (74.41%; n= 32/43; X2 = 7.023; p= 0.014). CONCLUSIONS: Although T. ovoides is classically associated as an etiologic agent of white piedra, this study highlights its potential as a human nail disease pathogen. Our study opens doors for future epidemiologic and virulence factors aimed at determining whether T. ovoides is an important causative agent of onychomycosis in Brazil.

Disseminated trichosporonosis due to Trichosporon asahii in a diabetic patient.

Trichosporon asahii (formerly known as Trichosporon beigelii) is an emerging, life-threatening opportunistic pathogen and has been found to be invariably associated with disseminated or deep-seated trichosporonosis, more so among the patients with granulocytopenia or hematological malignancies. We here report a successfully treated case of disseminated trichosporonosis in a known diabetic, 14-year-old girl, admitted to our hospital with chief complaints of fever, chills, and burning micturition since 3 weeks. Disseminated trichosporonosis is usually an insidious disease with poor prognosis. Early diagnosis is crucial for successful treatment. High index of clinical suspicion and extensive microbiological investigations can clinch the diagnosis.

A nested PCR assay to diagnose disseminated trichosporonosis in murine model / 第三军医大学学报

Objective To explore the feasibility of the nested PCR technique to detect the Trichosporon asahii DNA in the blood and liver samples from the murine model of disseminated trichosporonosis.Methods On day 3,7,14 after intravenous inoculation of Trichosporon asahii suspension,blood and liver samples of 30 BALB/c mice were collected.Another ten normal mice serve as control.DNA was amplified by nested PCR,with a pair of primer.Fungal culture was done as control.Results On day 3,7,14 after inoculation,the positive rate of the serum fungal cultivation were 0,20%,0;the positive rate of the serum after nested PCR assay was 80%,90%, 88.9%;the positive rate of liver fungal cultivation were 50%,40%,22.2%;the positive rate of liver after nested PCR assay was 90%,90%,88.9%.There were statistical differences between the positive rate by nested PCR assay and fungal cultivation to check the serum and liver samples on day 3,7,14 after inoculation.The survival mice to the 14~(th) day were too less to make statistical analysis.Conclusion The results suggest that T.asahii DNA assay by nested PCR is more specific,more sensitive,and faster than fungal cultivation.The nested PCR assay could be a potential assay for the diagnosis of disseminated trichosporonosis.

Study on Disseminated Trichosporonosis Caused by Trichosporon asahii in Murine Model / 中华皮肤科杂志

Objective To investigate the pathogenic factors and the visceral involvement in murine disseminated trichosporonosis caused by Trichosporon asahii. Methods Forty-five mice were immunosuppressed with cyclophospamide 3 days hefore and 7 days after inoculation of T. asahii, and were divided into intravenously inoculated group (n = 15), intradermal inoculated group (n = 7), gastrointestinal infusion group (n = 8), intravenously inoculated + treatment group (n = 15). In the control groups the mice were not immunosuppressed, and were also divided into intravenous, intradermal, and G.I. infusion groups with the same number of mice respectively. In the treatment group the mice were given both liposomal amphotericin B and fluconazole. The main viscera of the mice were examined by mycologic culture and pathologic sections. Results In the intravenous inoculation group of immunized mice, Trichosporon asahii were isolated from at least one organ in 10/12 mice, while T. asahii were only isolated in 2/14 mice in the control group; in 2/7 mice of the intradermal group of immunosuppressed mice, skin lesion appeared at the inoculation site, but no visceral infection was observed. No visceral infection was found in the groups that T. asahii was inoculated by non-intravenous injection in both immunosuppressed and non-immunosuppressed mice. The number of mice died, the number of visceral organs involved and the incidence of systemic infection were significantly less in the treatment group than those in the non-treatment groups (P

Chronic granulomatous disease with disseminated trichosporonosis: A case report.

A case of a two year and three month old Thai boy with a history of recurrent bacterial infections since aged 2 months. A definite absence of superoxide activity in the patient' s granulocytes detected by nitroblue tetrazolium test indicated the diagnosis of chronic granulomatous disease. He suffered from septicemia and systemic fungal infection, resulting in death despite rigorous medical care. The postmortem findings showed extensive granulomatous inflammation in several internal organs. Tissue culture led to diagnosis of disseminated Trichosporonosis, an uncommon infection in immunocompromised patients. This is the first case report of disseminated trichosporonosis in a chronic granulomatous disease patient.

Disseminated Trichosporonosis:The First Case Report in China / 中华皮肤科杂志

Objective To report the first case of disseminated trichosporonosis in China.Methods A series of clinical,histopatholog ic,and mycologic studies were carried out in a 20year-old-female patien t,who had no definite underlying disease.The causative fungus was identified according to culture,biochemical t est and DNA sequencing.Results Abundant fungal spores,yeasts and h yphae were shown in the specimens tak en from infectious granulomas.The fungal c olonies in the culture of skin lesion s or crusts,liver,oral psedomembra ne,vagina,nasal cavity,urine,and sto ol were the same.The colonies exhibi ted creamy white to yellowish in colo r,rugose on the surface,and hyphae at t he periphery.Under microscopy,there were a lot of rectangular arthrospores,round or oval spores w ith or without buddings,as well as br anched and septate filaments.The isolated fungus was unanimously identified as Trichosporon asahii(No.AS 2.2174)through culture,bio-chemistry and molecular biology tests.The patient's condition was impr oved obviously after the combinatio n treatment of amphotericin B liposom e(Amphotec)and fluconazole.Conclusion The extensive and lasting systemic impairments caused by T.asahii have scarcely been reported at home a nd abroad.Combination therapy with amphotericin B and fluconazole is effective.