Trichosporon pullulans infection in 2 patients with chronic granulomatous disease: an emerging pathogen and review of the literature.
BACKGROUND
Chronic granulomatous disease is a genetically determined primary immunodeficiency disease in which phagocytic cells are unable to kill certain bacteria and fungi after ingestion. Manifestations include recurrent pyogenic infections caused by catalase-positive microbes. Trichosporon species are emerging as opportunistic agents that cause systemic disease in immunocompromised patients. Typically disease has been described in association with T beigelii in patients with secondary immunodeficiency, such as underlying malignancy.


OBJECTIVE
The objective was to report the first 2 cases of T pullulans infection in 2 male children with chronic granulomatous disease.


METHODS
The records of the 2 patients were reviewed. In addition, all cases of T pullulans infection reported in the English language literature are presented.


RESULTS
This report brings to 7 the total number of cases of T pullulans reported and the first in patients with chronic granulomatous disease, one with invasive pneumonia and the other with an infected paronychium and localized cellulitis. In the 5 additional cases malignancy was the principal risk factor.


CONCLUSIONS
T pullulans has rarely been reported as a fungal pathogen. The most prominent risk factor for the development of trichosporonosis is immunocompromise, most notably with neutropenia. Abnormally functioning neutrophils, such as with chronic granulomatous disease, may also predispose individuals to this opportunistic pathogen.
Moylett
Edina H
EH
Section of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, MC:FC330.01, Houston, TX 77030, USA.
Chinen
Javier
J
Shearer
William T
WT
D002648:Child; D006105:Granulomatous Disease, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014250:Trichosporon / Q000472:pathogenicity*