title: Trichosporonosis in a tertiary care cancer center: risk factors, changing spectrum and determinants of outcome.
abstract: To assess the spectrum and outcome of trichosporonosis (TS) in cancer patients, we reviewed the medical records of 17 such patients with TS. TS presented most commonly as fungemia (n = 10, including 7 with central-venous-catheter-related infection) and either pulmonary or soft tissue infection (n = 3, each). Most patients (65%) had acute leukemia, 11 (65%) had neutropenia, and 9 (53%) had received high doses of corticosteroids. 10 patients had breakthrough TS during therapy with at least 1 of the following: amphotericin B, fluconazole, itraconazole, and voriconazole. The 30-d crude mortality rate was 53%. Predictors of mortality by using univariate analysis included: high median APACHE II score (p < 0.01), use of high dose of corticosteroids (p = 0.01), and admission to the intensive care unit (p < 0.01). TS is associated with a high mortality rate in cancer patients. The spectrum of infection at our institution has shifted from a predominance of disseminated infection to CVC-related fungemias without evidence of tissue invasion.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. dkontoyi@mdanderson.org
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Harrys A
authors.initials: HA
authors.lastname: Torres
authors.forename: Marlon
authors.initials: M
authors.lastname: Chagua
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tarrand
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Bodey
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016469:Fungemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009369:Neoplasms / Q000276:immunology*; D016522:Oncology Service, Hospital; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014250:Trichosporon / Q000302:isolation & purification*; D014481:United States
chemical_list: D000935:Antifungal Agents