title: Trichosporon asahii infection presenting as chronic meningo-ventriculitis and intra ventricular fungal ball: a case report and literature review.
abstract: Central nervous system trichosporonosis is a rare clinical entity and so far only six cases including three each of brain abscess and meningitis has been on record. We report a rare case of chronic meningo-ventriculitis and intraventricular fungal ball due to Trichosporon asahii in an 18-year-old immunocompetent male from Burundi, east Africa. Neuroendoscopy showed multiple nodules and a fungal ball within the ventricle, which on culture grew T. asahii. He was initially empirically treated with liposomal amphotericin B. However, the antifungal susceptibility testing of T. asahii isolate revealed high minimum inhibitory concentration for amphotericin B (2 μg ml⁻¹), flucytosine (16 μg ml⁻¹) and caspofungin (2 μg ml⁻¹) but exhibited potent activity for voriconazole, posaconazole, itraconazole and fluconazole. The patient rapidly succumbed to cardiac arrest before antifungal therapy could be changed. Although disseminated trichosporonosis has been increasingly reported the diagnosis represents a challenge especially in rare clinical settings such as intraventricular fungal ball in the present case, which has not been described previously.
authors.affiliation: Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Kumar
authors.forename: Suhas
authors.initials: S
authors.lastname: Udayakumaran
authors.forename: Rachana
authors.initials: R
authors.lastname: Babu
authors.forename: Bindhu M
authors.initials: BM
authors.lastname: Rajamma
authors.forename: Anupam
authors.initials: A
authors.lastname: Prakash
authors.forename: Dilip
authors.initials: D
authors.lastname: Panikar
authors.forename: Shamsul
authors.initials: S
authors.lastname: Karim
authors.forename: Anuradha
authors.initials: A
authors.lastname: Chowdhary
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D058565:Cerebral Ventriculitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D007194:India; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D014250:Trichosporon / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D060586:Trichosporonosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy
chemical_list: D000935:Antifungal Agents
keywords: India; Trichosporon asahii; antifungal susceptibility; central nervous system infection; sequencing