Fatal Trichosporon fungemia in patients with hematologic malignancies.
OBJECTIVE
Invasive Trichosporon infection has been increasingly recognized in patients with hematologic malignancies. Our study aims to clarify the clinical characteristics of this disease and factors influencing patient prognosis.


METHODS
We retrospectively analyzed 33 cases of Trichosporon fungemia (TF) in patients with hematologic malignancies treated at our collaborating five hospitals in Japan between 1992 and 2007.


RESULTS
The majority of these patients had acute leukemia (82%), neutropenia (85%), and a history of intensive chemotherapy (91%). TF occurred as a breakthrough infection during antifungal therapy in 30 patients (91%), 18 of whom were receiving micafungin. The surveillance cultures of most patients were negative for Trichosporon. Only a few patients exhibited elevated levels of 1,3-beta-d-glucan before positive blood culture. Twenty-five patients (76%) died of this infection. The resolution of infection was associated with neutrophil recovery (P = 0.0001), absence of hyperglycemia (P = 0.023), and azole inclusive therapy (P = 0.031). Survival was significantly longer in patients receiving antifungal therapies containing azole than in those who did not receive azole (P = 0.0034).


CONCLUSIONS
At present, the diagnosis of invasive trichosporonosis depends on blood culture studies, and the mortality of this disease is high; however, azole therapy and control of blood glucose level, together with hematopoietic recovery could help in improving the clinical outcome. When we use antifungals lacking anti-Trichosporon activity, sufficient care should be taken to prevent the development of breakthrough trichosporonosis.
Suzuki
Kei
K
Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Nakase
Kazunori
K
Kyo
Taiichi
T
Kohara
Tadahiro
T
Sugawara
Yumiko
Y
Shibazaki
Tetsunori
T
Oka
Kouji
K
Tsukada
Tetsuya
T
Katayama
Naoyuki
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D014250:Trichosporon / Q000302:isolation & purification*; D055815:Young Adult
D000935:Antifungal Agents