Infección nosocomial por Trichosporon asahii: revisión clínica de 22 casos / Nosocomial infection due to Trichosporon asahii: clinical revision of 22 cases

RESUMEN

Presentamos una serie de 22 casos de infección nosocomial por Trichosporon asahii, detectados en un periodo de seis años (1999-2005). Los pacientes presentaron edades entre 6 y 72 años, con un promedio de 47,3 años y con leve predominio de hombres. Las enfermedades subyacentes, fueron insuficiencia respiratoria, cáncer, diabetes, insuficiencia renal crónica, cirrosis y sida. Las condiciones predisponentes fueron antibioterapia,ventilación mecánica, sonda vesical, catéter, corticoides, trasplantes, inmunosupresores, quimioterapia, granulocitopenia, procedimiento quirúrgico y diálisis peritoneal ambulatoria continua. Los antifúngicos más utilizados fueron el fluconazol y la anfotericina B. Algunos pacientes recibieron varios antifúngicos. Cinco pacientes no fueron tratados con antifúngicos y un paciente recibió factor de estimulación de colonias granulocíticas (G-CSF). De los 22 pacientes, nueve presentaron mejoría clínica, otros nueve pacientes fallecieron y de cuatro pacientes de desconoce su evolución(AU)

ABSTRACT

Twenty two cases of nosocomial infection caused by Trichosporon asahii, detected during a period of six years (1999-2005) is described. The patients were predominantly males with an average age of 47.3 years-old. The predominant diseases in the study group were respiratory insufficiency, cancer, diabetes, chronic renal insufficiency, cirrhosis and AIDS. The main predisposing conditions were antibiotic therapy, mechanical ventilation, urethral catheterization, catheter, corticoids, transplant, immunosuppressive therapy, chemotherapy, granulocytopenia, surgical procedures and continuous ambulatory peritoneal dialysis. The most used antifungal drugs were fluconazole and amphotericin B. In some cases several antifungals were administered. Five patients did not receive antifungal treatment, and one patient received granulocyte colony stimulating factor (G-CSF). Nine patients showed clinical improvement, nine died and the progress of four patients is unknown. T. asahii is an emergent pathogen in patients with immunodeficiency and its presence in these type hosts can not be considered colonization, as there is an important risk of invasive infection. So, in susceptible patients to develop trichosporonosis it is advisable to take into consideration this disease especially in intensive clinical care units(AU)