title: [Trichosporon asahii an emerging etiologic agent of fungal infection and colonization in heart failure patients in intensive care unit: case report and literature review].
abstract: OBJECTIVE
  Infection with the non-Candida yeast species Trichosporon have been recognized with increasing frequency over the last two decades. Invasive disease due to trichosporonosis has been reported from neutropenic patients with cancer and the mortality is high. Recently, others groups of patients have become susceptible to this rare fungi. We report the emerging of infection with pathogenic Trichosporon asahii in severely ill heart failure patients in a tertiary cardiological intensive care unit (CICU). We describe our data, and report a fatal case of disseminated trichosporonosis in a patient with heart failure. We also review literature pertaining to T. asahii infections.
  
  
  METHODS
  An 85 year-old woman with a history of hypertension, heart failure (ejection fraction (EJ): 30%) and pulmonary embolism was admitted to a medical cardiological ICU after cardiac arrest (ventricular fibrillation) resuscitated during a routine consultation. There were no neurological sequelae and the echocardiogram revels no changes, neither the cardiac biomarkers. Ventricular fibrillation was considered secondary to heart failure. The patient had extubation failure and difficult weaning needing long term mechanical ventilation even after tracheostomy. Her hospital course was complicated by acute renal failure and recurrent respiratory, urinary and systemic bacterial infections, which responded to broad-spectrum antibiotics. After a temporary improvement she developed urinary infection and subsequent septic shock. Cultures of urine and blood specimens grew T. asahii. Treatment with liposome amphotericin B (5 mg/kg/day) was started. Despite receiving vancomycin and imipenem, the clinical condition of the patient deteriorates. Blood taken for culture on the seventh day of amphotericin B therapy were negative but urine specimen still grew T. asahii. On the eighteenth day of antifungal therapy, the patient died with multiorgan failure.
  
  
  CONCLUSIONS
  The increasing of severely ill patients, and the use of broad spectrum antibiotics, has predisposed the emerging of invasive infections by rare and new opportunistic fungal pathogens. Severe infection related to T. asahii, until recently restricted to neutropenic patients with cancer, has been frequently identified in heart failure patients with advanced age. The mortality is high. These data highlights the importance of considering this group of patients as a risk group for T. asahii infection.
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Antônio Aurélio de Paiva
authors.initials: AA
authors.lastname: Fagundes Júnior
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Ricardo Tavares de
authors.initials: RT
authors.lastname: Carvalho
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Focaccia
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Juliana Gabriela
authors.initials: JG
authors.lastname: Fernandez
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Hélia Beatriz Nunes de
authors.initials: HB
authors.lastname: Araújo
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Tânia Mara Varejão
authors.initials: TM
authors.lastname: Strabelli
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Liliane
authors.initials: L
authors.lastname: Kopel
authors.affiliation: Instituto do Coração, HC, FM, USP, São Paulo, SP.
authors.forename: Silvia G
authors.initials: SG
authors.lastname: Lage