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

Antecedentes. La tricosporonosis es una infección oportunista debida a hongos levaduriformes del género Trichosporon. La mayoría de los casos de tricosporonosis invasiva acontecen en individuos inmunodeficientes. Caso clínico. Describimos un caso de infección diseminada por Trichosporon asahii en un paciente hematológico. Se trata de un varón de 52 años diagnosticado de leucemia linfoblástica aguda que desarrolla un cuadro febril durante el tercer ciclo de quimioterapia de inducción. A las 24 h de incubación se observó positividad en los hemocultivos extraídos, visualizándose en la tinción de Gram estructuras alargadas compatibles con elementos fúngicos. La identificación del hongo como Trichosporon asahii se llevó a cabo mediante la asimilación de compuestos de carbono y la amplificación y secuenciación de los dominios D1/D2 y la región espaciadora interna transcrita del ADN ribosómico. El hongo se aisló además de unas lesiones pustulosas que presentaba el paciente en la región pectoral. Tras tratamiento con anfotericina B, el paciente evolucionó favorablemente de las lesiones y del proceso febril. Conclusiones. Trichosporon asahii es un patógeno emergente en pacientes inmunodeprimidos y su presencia no debe ser considerada como colonización, pues existe riesgo de infección invasiva (AU)

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 24 h 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 (AU)

[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.

Epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole for six Candida species as determined by the colorimetric Sensititre YeastOne method.

In the absence of clinical breakpoints (CBP), epidemiological cutoff values (ECVs) are useful to separate wild-type (WT) isolates (without mechanisms of resistance) from non-WT isolates (those that can harbor some resistance mechanisms), which is the goal of susceptibility tests. Sensititre YeastOne (SYO) is a widely used method to determine susceptibility of Candida spp. to antifungal agents. The CLSI CBP have been established, but not for the SYO method. The ECVs for four azoles, obtained using MIC distributions determined by the SYO method, were calculated via five methods (three statistical methods and based on the MIC50 and modal MIC). Respectively, the median ECVs (in mg/liter) of the five methods for fluconazole, itraconazole, posaconazole, and voriconazole (in parentheses: the percentage of isolates inhibited by MICs equal to or less than the ECVs; the number of isolates tested) were as follows: 2 (94.4%; 944), 0.5 (96.7%; 942), 0.25 (97.6%; 673), and 0.06 (96.7%; 849) for Candida albicans; 4 (86.1%; 642), 0.5 (99.4%; 642), 0.12 (93.9%; 392), and 0.06 (86.9%; 559) for C. parapsilosis; 8 (94.9%; 175), 1 (93.7%; 175), 2 (93.6%; 125), and 0.25 (90.4%; 167) for C. tropicalis; 128 (98.6%; 212), 4 (95.8%; 212), 4 (96.0%; 173), and 2 (98.5; 205) for C. glabrata; 256 (100%; 53), 1 (98.1%; 53), 1 (100%; 33), and 1 (97.9%; 48) for C. krusei; 4 (89.2%; 93), 0.5 (100%; 93), 0.25 (100%; 33), and 0.06 (87.7%; 73) for C. orthopsilosis. All methods included ≥94% of isolates and yielded similar ECVs (within 1 dilution). These ECVs would be suitable for monitoring emergence of isolates with reduced susceptibility by using the SYO method.

[Pantoea agglomerans: a new pathogen at the neonatal intensive care unit?]. / Pantoea agglomerans: ¿un nuevo patógeno en la unidad de cuidados intensivos neonatales?

Late-onset sepsis is very frequent among preterm infants and cases due to Gram negative pathogens have elevated morbidity and mortality. Pantoea agglomerans is a Gram negative organism which has been rarely reported causing disease in humans. We present a case of P. agglomerans late-onset fulminant sepsis in a preterm newborn at a neonatal intensive care unit. Up to date none P. agglomerans sepsis has been reported among this population in our country.

Pantoea agglomerans: ¿un nuevo patógeno en la unidad de cuidados intensivos neonatales?: a new pathogen at the neonatal intensive care unit? / Pantoea agglomerans

La sepsis tardía es especialmente frecuente en los recién nacidos pretérmino, y los bacilos gramnegativos son responsables de los casos más graves con una elevada mortalidad asociada. Pantoea agglomerans es un bacilo gramnegativo que pocas veces se ha descrito como patógeno en el ser humano, menos aún en el recién nacido. Se presenta el caso clínico de un recién nacido pretérmino que sufrió una sepsis fulminante por Pantoea agglomerans en una unidad de cuidados intensivos neonatales. Hasta la fecha no se ha descrito ningún caso de sepsis por P. agglomerans en esta población en España.

Late-onset sepsis is very frequent among preterm infants and cases due to Gram negative pathogens have elevated morbidity and mortality. Pantoea agglomerans is a Gram negative organism which has been rarely reported causing disease in humans. We present a case of P. agglomerans late-onset fulminant sepsis in a preterm newborn at a neonatal intensive care unit. Up to date none P. agglomerans sepsis has been reported among this population in our country.

Pantoea agglomerans: ¿un nuevo patógeno en la unidad de cuidados intensivos neonatales?: a new pathogen at the neonatal intensive care unit? / Pantoea agglomerans

La sepsis tardía es especialmente frecuente en los recién nacidos pretérmino, y los bacilos gramnegativos son responsables de los casos más graves con una elevada mortalidad asociada. Pantoea agglomerans es un bacilo gramnegativo que pocas veces se ha descrito como patógeno en el ser humano, menos aún en el recién nacido. Se presenta el caso clínico de un recién nacido pretérmino que sufrió una sepsis fulminante por Pantoea agglomerans en una unidad de cuidados intensivos neonatales. Hasta la fecha no se ha descrito ningún caso de sepsis por P. agglomerans en esta población en España.(AU)

Late-onset sepsis is very frequent among preterm infants and cases due to Gram negative pathogens have elevated morbidity and mortality. Pantoea agglomerans is a Gram negative organism which has been rarely reported causing disease in humans. We present a case of P. agglomerans late-onset fulminant sepsis in a preterm newborn at a neonatal intensive care unit. Up to date none P. agglomerans sepsis has been reported among this population in our country.(AU)