Prosthetic valve endocarditis by Trichosporon mucoides: A case report and review of literature.

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.

[An overview on Trichosporon asahii and its infections]. / Trichosporon asahii ve Enfeksiyonlarina Genel Bakis

Trichosporon species cause systemic, mucosa associated and superficial infections which include white piedra. Disseminated fungal infections due to Trichosporon species have increased in the recent years. Hematologic malignancy, cytotoxic chemotherapy, and organ transplantation are the main risk factors for disseminated Trichosporon infections. Two most common species that cause the disseminated Trichosporon infections are Trichosporon asahii and Trichosporon mucoides. Diagnosis and treatment of Trichosporon infections are difficult. Invasive trichosporonosis caused by T.asahii has a high mortality rate and a very poor prognosis. Fungicidal activity of amphotericin B against T.asahii isolates is inadequate. For echinocandin group of drugs, high minimum inhibitory concentration (MIC, µg/ml) values are obtained. Currently, triazole antifungal agents are the preferred drugs for the treatment of Trichosporon infections. In this review article general characteristics of T.asahii and its infections were summarized.