[SUMMER-TYPE HYPERSENSITIVITY PNEUMONITIS CAUSED BY A HUMIDIFIER INDUCED IN SPRING, IN A 5-YEAR-OLD GIRL LIVING IN FUKUSHIMA-A CASE REPORT].

A 5-year-old girl living in Koriyama, Fukushima Prefecture was admitted in April with cough persisting for 1 month and fever. Chest X-ray showed diffuse ground-glass shadows in both lungs. After treatment with antibiotics, her fever went down on the 2nd day, and her cough subsided gradually. She was discharged on the 7th day, but her symptoms relapsed on the 8th day. Due to her worsening symptoms, she was readmitted on the 16th day. Chest CT scans showed enhancement of interstitial density. Serum anti-Trichosporon asahii antibody was positive. Her symptoms rapidly improved on a steroid regimen, and she was discharged on the 23th day. She was diagnosed as having summer-type hypersensitivity pneumonitis (SHP). She was instructed not to use a moldy humidifier and not to go to her grandmother's 57 years old wooden house. She has had no symptom after discharge. However, suspected mold was not found at her grandmother's house, and a provocation test there was negative. The HLA typing of the patient showed HLA-DQ8, which was previously described as SHP-sensitive.

A case report of a cystic fibrosis patient with repeated isolation of Trichosporon mycotoxinivorans identified by a novel short-extraction method.

BACKGROUND: Trichosporon mycotoxinivorans is a recently described yeast-like fungal organism and its association as a pathogen for patients with cystic fibrosis (CF) was reported previously. We show the clinical course of a CF patient over 9 years as well as the applications of modern molecular and proteomic identification techniques of this rare fungus. CASE PRESENTATION: We present the case of a 32-year-old male CF patient with sputum cultures continuously positive with the anamorphic yeast T. mycotoxinivorans during 9 years. Furthermore, susceptibility testing of T. mycotoxinivorans to different antifungals were performed. In addition, a rapid identification method of this novel fungal pathogen with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was applied using a simple extraction protocol. CONCLUSIONS: Our case presentation confirms T. mycotoxinivorans as a potential emerging pathogen in patients with CF. However, our CF patient showed mild symptoms over a very long time period of 9 years. A short MALDI-TOF MS procedure allows reliable and rapid identification of T. mycotoxinivorans and therefore should facilitate further study on the clinical relevance and epidemiology of this unusual fungal organism.

Catheter-related bloodstream infections caused by Trichosporon species.

Trichosporonosis is an emerging invasive opportunistic fungal infection in immunocompromised patients. We report 5 catheter related blood stream infections caused by Trichosporon species over a five-year period at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. All the patients were immunocompromised, had received broad-spectrum antibiotics and had a central venous catheter or arterial line inserted for a mean duration of 16.2 days (range 10-30 days). Four patients developed disseminated infection and only 2 survived, giving a mortality rate of 60%. Because of the prevalence of Trichosporon catheter related blood stream infections at our institute, health care providers should have a high index of suspicion for Trichosporon species infections in patients with risk factors and prolonged presence of a central venous catheter.

[A case of rheumatoid arthritis involving disseminated torichosporonosis].

A 75-year-old man who developed disseminated trichosporonosis had a long history of immunosuppressive therapy with weekly methotrexate and low-dose prednisolone for rheumatoid arthritis (RA). He had been administered 30 mg of prednisolone per day for organizing pneumonia, probably due to the RA, for about 3 months before admission for a lumbar compression fracture. He then developed bilateral aspiration pneumonia with pleural effusion, treated successfully with broad-spectrum antibiotics meropenem and ciprofloxacin, and fluid management. He then developed acute, progressive respiratory failure with changes in both lung lobes in chest computed tomography (CT). Meropenem, ciprofloxacin, micafungin, and pulsed steroid administration were ineffective. He died of respiratory failure, after which Trichosporon asahii was first detected in blood and urine culture. Disseminated trichosporonosis was determined based on positive blood culture, elevated serum glucuronoxylomannan antigen and beta-D glucan, and the man's lack of clinical progress. He had numerous risk factors for trichosporonosis, including neutrophilic dysfunction due to prolonged steroid therapy, administration of broad-spectrum antibiotics and micafungin, and central venous catheterization. Disseminated trichosporonosis is a chiefly hematological infection and case reports without hematological disorders are rare, so we report this instructive case.

A case report of catheter-related bloodstream infection due to Trichosporon coremiiforme in a patient with secondary neutropenia to HIV.

Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.

[Trichosporon asahii sepsis associated with urinary catheter in a pediatric burn unit: 2 case reports]. / Sepsis secundaria a infección urinaria asociada a sonda vesical por Trichosporon asahii en una unidad pediátrica de quemados: reporte de 2 casos.

Trichosporon asahii is a ubiquitous fungus that has been isolated as part of human microbiota. There has been an emergence of this pathogen in recent years, causing superficial and deep seated infections. There are scarce reports of urinary tract infections in pediatric intensive care burn units caused by this agent. We describe the cases of 2 pediatric patients with prolonged hospitalization due to severe burns that had received several antibiotic courses for previous infections. Both presented sepsis secondary to catheter related urinary tract infection by Trichosporon asahii. Both patients underwent urinary catheter replacement and were treated effectively with voriconazole for 10 days. In the cases presented, sepsis was assumed to be due to Trichosporon asahii since no other microorganism was identified and the patients showed favorable outcome with the prescribed treatment with voriconazole and replacement of the urinary catheter.

Trichosporon asahii es un hongo ubicuo que se ha aislado como parte de la microbiota humana. Recientemente, se ha visto una emergencia de este patógeno en infecciones tanto localizadas como sistémicas. En unidades de cuidados intensivos pediátricos para quemados, existen escasos reportes de infecciones del tracto urinario por este microorganismo. Se describen 2 pacientes pediátricos con internación prolongada por quemaduras extensas y múltiples tratamientos antibióticos previos. Ambos presentaron sepsis por infección del tracto urinario asociada a sonda vesical por Trichosporon asahii. En ambos pacientes, se realizó el recambio de la sonda vesical y tratamiento con voriconazol por 10 días, con buena evolución. En los casos presentados, debido a la ausencia de otros aislamientos microbiológicos y a la buena respuesta al tratamiento antifúngico junto con el recambio de la sonda vesical, se asumió al Trichosporon asahii como el probable agente causal de la sepsis.

[Nosocomial infection due to Trichosporon asahii in a critical burned patient]. / Infección nosocomial por Trichosporon asahii en un paciente quemado crítico.

BACKGROUND: Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. CASE REPORT: A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. CONCLUSIONS: Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection.

[Fungemia due to Trichosporon asahii in a patient with hematological malignancy]. / Fungemia por Trichosporon asahii en un paciente con neoplasia hematológica.

BACKGROUND: Trichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals. CASE REPORT: We describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily. CONCLUSIONS: Trichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection.

Sepsis secundaria a infección urinaria asociada a sonda vesical por Trichosporon asahii en una unidad pediátrica de quemados: reporte de 2 casos / Trichosporon asahii sepsis associated with urinary catheter in a pediatric burn unit: 2 case reports

Trichosporon asahii es un hongo ubicuo que se ha aislado como parte de la microbiota humana. Recientemente, se ha visto una emergencia de este patógeno en infecciones tanto localizadas como sistémicas. En unidades de cuidados intensivos pediátricos para quemados, existen escasos reportes de infecciones del tracto urinario por este microorganismo. Se describen 2 pacientes pediátricos con internación prolongada por quemaduras extensas y múltiples tratamientos antibióticos previos. Ambos presentaron sepsis por infección del tracto urinario asociada a sonda vesical por Trichosporon asahii. En ambos pacientes, se realizó el recambio de la sonda vesical y tratamiento con voriconazol por 10 días, con buena evolución. En los casos presentados, debido a la ausencia de otros aislamientos microbiológicos y a la buena respuesta al tratamiento antifúngico junto con el recambio de la sonda vesical, se asumió al Trichosporon asahii como el probable agente causal de la sepsis.

Trichosporon asahii is a ubiquitous fungus that has been isolated as part of human microbiota. There has been an emergence of this pathogen in recent years, causing superficial and deep seated infections. There are scarce reports of urinary tract infections in pediatric intensive care burn units caused by this agent. We describe the cases of 2 pediatric patients with prolonged hospitalization due to severe burns that had received several antibiotic courses for previous infections. Both presented sepsis secondary to catheter related urinary tract infection by Trichosporon asahii. Both patients underwent urinary catheter replacement and were treated effectively with voriconazole for 10 days. In the cases presented, sepsis was assumed to be due to Trichosporon asahii since no other microorganism was identified and the patients showed favorable outcome with the prescribed treatment with voriconazole and replacement of the urinary catheter.