title: The basidiomycetous yeast Trichosporon may cause severe lung exacerbation in cystic fibrosis patients - clinical analysis of Trichosporon positive patients in a Munich cohort.
abstract: BACKGROUND
  The relevance of Trichosporon species for cystic fibrosis (CF) patients has not yet been extensively investigated.
  
  
  METHODS
  The clinical course of CF patients with Trichosporon spp. in their respiratory secretions was analysed between 2003 and 2010 in the Munich CF center. All respiratory samples of 360 CF patients (0 - 52.4 years; mean FEV1 2010 81.4% pred) were investigated.
  
  
  RESULTS
  In 8 patients (2.2%, 3 male, mean age 21.8 years) Trichosporon was detected at least once. One patient carried T. asahii. One patient carried T. mycotoxinivorans and one patient T. inkin as determined by DNA sequencing. As potential risk factors for Trichosporon colonization steroid treatment, allergic bronchopulmonary aspergillosis (ABPA) and CF associated diabetes were identified in 6, 5, and 2 patients respectively. For one patient, the observation period was not long enough to determine the clinical course. One patient had only a single positive specimen and exhibited a stable clinical course determined by change in forced expiratory volume in one second (FEV1), body-mass-index (BMI), C-reactive protein (CRP) and immunoglobulin G (IgG). Of 6 patients with repeatedly positive specimen (mean detection period 4.5 years), 4 patients had a greater decline in FEV1 than expected, 2 of these a decline in BMI and 1 an increase in IgG above the reference range. 2 patients received antimycotic treatment: one patient with a tormenting dry cough subjectively improved under Amphotericin B inhalation; one patient with a severe exacerbation due to T. inkin was treated with i.v. Amphotericin B, oral Voriconazole and Posaconazole which stabilized the clinical condition.
  
  
  CONCLUSIONS
  This study demonstrates the potential association of Trichosporon spp. with severe exacerbations in CF patients.
authors.forename: Carolin
authors.initials: C
authors.lastname: Kröner
authors.forename: Matthias
authors.initials: M
authors.lastname: Kappler
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Grimmelt
authors.forename: Gudrun
authors.initials: G
authors.lastname: Laniado
authors.forename: Benjamin
authors.initials: B
authors.lastname: Würstl
authors.affiliation: Pediatric Pneumology and Christiane Herzog Cystic Fibrosis Center, Dr, von Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstr, 4, 80337 Munich, Germany. matthias.griese@med.uni-muenchen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Griese
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000503:physiopathology; D015992:Body Mass Index; D002648:Child; D003550:Cystic Fibrosis / Q000097:blood / Q000382:microbiology* / Q000503:physiopathology*; D048909:Diabetes Complications / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D005858:Germany; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D013256:Steroids / Q000009:adverse effects; D014250:Trichosporon; D060586:Trichosporonosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007074:Immunoglobulin G; D013256:Steroids; D000666:Amphotericin B