title: Invasive Trichosporon Infection: a Systematic Review on a Re-emerging Fungal Pathogen.
abstract: Objectives:This review aimed to better depict the clinical features and address the issue of therapeutic management ofTrichosporondeep-seated infections.Methods:We comprehensively reviewed the cases of invasiveTrichosporoninfection reported in the literature from 1994 (date of taxonomic modification) to 2015. Data from antifungal susceptibility testing (AST) studies were also analyzed.Results:Two hundred and three cases were retained and split into four groups: homeopathy (n= 79), other immunodeficiency conditions (n= 41), miscellaneous (n= 58) and newborns (n= 25).Trichosporon asahiiwas the main causative species (46.7%) and may exhibit cross-resistance to different antifungal classes. The unfavorable outcome rate was at 44.3%. By multivariate analysis, breakthrough infection (OR 2.45) was associated with unfavorable outcome, whilst the use of an azole-based therapy improved the prognosis (OR 0.16). Voriconazole-based treatment was associated with favorable outcome in hematological patients (73.6 vs. 41.8%;p= 0.016). Compiled data from AST demonstrated that (i)T. asahiiexhibits the highest MICs to amphotericin B and (ii) voriconazole has the bestin vitroefficacy against clinical isolates ofTrichosporonspp.Conclusions:Trichosporoninfection is not only restricted to hematological patients. Analysis of compiled data from AST and clinical outcome support the use of voriconazole as first line therapy.
authors: Central Laboratory Division-LIM03, Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Laboratory of Medical Mycology-LIM53, Instituto de Medicina Tropical da Universidade de São PauloSão Paulo, Brazil.
authors: João N
authors: JN
authors: de Almeida Júnior
authors: Service de Parasitologie-Mycologie-AP-HP, Hôpital St AntoineParis, France; Institut National de la Santé et de la Recherche Médicale UMR 1135, Centre National de la Recherche Scientifique ERL 8255, Sorbonne Universités, University Pierre and Marie Curie (UPMC)Paris, France; Centre d'Immunologie et des Maladies Infectieuses, Bd de l'hôpitalParis, France.
authors: Christophe
authors: C
authors: Hennequin
keywords: Trichosporon species; antifungal resistance; diagnosis; invasive infection; prognosis; risk factors; treatment