Print this page Email this page
Users Online: 158
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 29  |  Issue : 3  |  Page : 174-176

Disseminated infection with Trichosporon asahii in an immunocompetent patient: A rare case report


1 Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication1-Dec-2015

Correspondence Address:
Kshetrimayum Mamta Devi
Department of Microbiology, Regional Institute of Medical Sciences, Lamphel Pat, Imphal - 795 004, Manipur
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.170802

Rights and Permissions
  Abstract 

A rare case of disseminated infection with Trichosporon asahii (T. asahii) in a fifty year old immunocompetent male patient with tetraplegia with history of fever for ten days. Blood culture and urine culture showed growth of Trichosporon asahii. Identification was based on microscopic picture, colony morphology, conventional biochemical test and by means of Vitek 2 Compact System version: 06.01 (bioMerieux, France). Antifungal susceptibility testing was done by disk diffusion method. It was found sensitive to fluconazole, voriconazole and amphotericin B. Patient responded well to intravenous fluconazole treatment. To the best of our knowledge, this is the first case of disseminated Trichosporon asahii in immunocompetent patient in Eastern India.

Keywords: Disseminated infection, immunocompetent, Trichosporon asahii


How to cite this article:
Devi KM, Mate PH, Singh L N, Devi KR, Devi KS. Disseminated infection with Trichosporon asahii in an immunocompetent patient: A rare case report. J Med Soc 2015;29:174-6

How to cite this URL:
Devi KM, Mate PH, Singh L N, Devi KR, Devi KS. Disseminated infection with Trichosporon asahii in an immunocompetent patient: A rare case report. J Med Soc [serial online] 2015 [cited 2022 Jan 27];29:174-6. Available from: https://www.jmedsoc.org/text.asp?2015/29/3/174/170802


  Introduction Top


Trichosporon species are soil inhabitants and can be a part of normal flora of human skin and gastrointestinal tract. [1]

Trichosporon asahii
(T.asahii) formerly called T.bigelli is an emerging fungal pathogen seen particularly in immunocompromised patients. Trichosporon species have been reported as a cause of fungemia and fatal life threatening invasive infections in patients with neutropenia and cancer. [2] Trichosporonosis has been recognized with increased frequency during the past 10-15 years and may resemble candidiasis both clinical presentation and histological appearance. [3] In immunodeficient hosts it has been isolated from blood, skin and viscera causing various localized or disseminated deep infections. [4]

Disseminated trichonosporosis is rare in immunocompetent individual. We therefore report this case to alert the other clinical microbiologists and clinicians to avoid life threatening complications of trichonosporosis. To the best of our knowledge this is the first case of disseminated trichonosporosis with T.asahii in immunocompetent individual in eastern India.


  Case Report Top


A 50 years old male was admitted in our hospital after complaining of fever for ten days. He was tetraplegic after road traffic accident and neck surgery in a private hospital. He was unable to pass urine and stool voluntarily and was on urinary catheter. He was treated with broad spectrum antibiotics (ceftriaxone/sulbactum and azithromycin) for a week but the fever was not controlled.

The laboratory findings at the time of admission were: Peripheral WBC blood count 8000/cumm of which 72% were neutrophils, 25% lymphocytes, 2% eosinophils and 1% monocytes, haemoglobin 6.3 gms, ESR 35 mm/hour, platelet count 2.95 lakh/cumm. IgM and IgG test (typhidot test) and widal test for typhoid fever were negative, Serological test for HIV was nonreactive. The serum bilirubin was 0.4 mg%, protein 6.6 gms%, albumin: Globulin = 2.7:3.9, SGOT = 36U/L, SGPT = 28 U/L, ALP = 89 U/L, blood urea = 32 mg/dl, serum creatinine 0.6 mg/dl, serum sodium 138 meq/L, serum potassium 4 meq/L.

The patient's urine sample and blood culture sample was sent for routine culture and sensitivity testing. On two repeated blood culture no bacterial pathogen was isolated but was found to have yeast growing. The same fungi grew in urine culture in two repeated samples. It grew rapidly on blood agar and Mac Conkey agar. The colony on blood agar was tiny, white to cream coloured smooth which later on become dry folded [Figure 1]. The Gram stain of the colony revealed the presence of septate hyaline hyphae with arthrospores and few budding yeast cells [Figure 2]. T. asahii was identified by morphological features seen on Gram stain, lactophenol cotton blue, colony characters and biochemical tests. It hydrolyzed urea. It did not ferment any sugar but assimilated maltose, sucrose, lactose, cellulobiose, ionositol, raffinose and trehalose. T. asahii was confirmed by means of Vitek 2 Compact System version: 06.01 (bioMerieux, France) lot umber 243250310. Antifungal susceptibility testing was done by disk diffusion method for amphotericin B, fluconazole and voriconazole using reference for Candida species as given in Clinical and Laboratory Standards Institute (CLSI) document M44-A [5] (as CLSI document doesnot specifically address the Genus Trichosporon). It was sensitive to amphotericin B, fluconazole and voriconazole [Figure 3]. The patient responded well to treatment with intravenous infusion of 200mg fluconazole twice daily, became afebrile on fifth day of antifungal treatment. Blood culture and urine drawn on tenth day of treatment became sterile.
Figure 1: Colony morphology of Trichosporon asahii on blood agar media showing white — creamy colony

Click here to view
Figure 2: Gram stained smear showing hyphae, arthrospores and yeast cells

Click here to view
Figure 3: Disk diffusion method of antifungal susceptibility testing showing sensitive to fluconazole, amphotericin B and voriconazole

Click here to view



  Discussion Top


T.asahii is a ubiquitous yeast like fungi which inhabits soil, but may be present in human skin and gastrointestinal tract and have been recognized as emerging fungal pathogens in immunocompromised host. [1] Although uncommon, pathogenic species of Trichosporon are being increasingly reported in patients with malignant diseases, organ transplant recipient and patients with HIV infection.

In immunodeficient hosts it has been isolated from blood, skin and viscera causing various localized or disseminated deep infections but very rare in immunocompetent patients. There are few reports of invasive infections of T.asahii in non neutropenic cases. John R reported a case of disseminated infection of T.asahii in a patient without cancer or neutropenia causing fatal septic shock, [6] Rastogi VL reported trichonosporosis due to T.asahii in young healthy male presenting as meningoencephalitis and pneumonia. [7] Our case is immunocompetent (no neutropenia, HIV seronegative, no detectable malignancy, not on chemotherapy or immunosuppression). T. asahii infection in six non granulocytopenic patients was reported by Woolf DG. [8]

The fungus can cause invasive disease at a single organ site or in disseminated form in which lungs, kidneys, skin and eyes are the main targets. T. asahii can cause invasive infections even in immunocompetent individuals though very rare. In these cases, the infection is related either to the presence of a foreign body such as a prosthetic heart valve, an indwelling catheter or to intravenous drug abuse. [9] Factors that enhance mucosal colonization and subsequent invasion of Trichosporon species, include broad spectrum antibiotic treatment and breaks in mucosal barrier. [8] The likely routes of infection of trchosporonosis are the respiratory tract, the alimentary tract and the urinary tract, which are known to be frequent sites of colonization, leading to haematogenous dissemination. [10] The patient in our case was on urinary catheter and this may be portal of entry.

SDA is not routinely used for urine culture as primary culture media in diagnostic laboratories but this did not affect the isolation of T. asahii as this was shown to grow well on Mac Conkey agar and blood agar. The macroscopic and microscopic picture, colony morphology, biochemical test and physiological characteristic confirmed it to be T. asahii.

Azoles are shown to be more effective in the treatment of trichosporonosis than amphotericin B. [8] In the present case, T. asahii was sensitive to fluconazole, voriconazole and amphotericin B and the patient responded well to fluconazole therapy.

Isolation of same yeast in two consecutive blood culture and urine culture samples and the fact that no bacteria were isolated establishes T. asahii as an etiological agent of the infection in our patient. The fact that there was clearance of fungus of urinary tract and blood with the recovery of the patient following antifungal treatment strongly associates the yeast as the cause of disseminated infection.

Diagnosis relies on clinical suspicion with microbiological confirmation. T. asahii can no longer be linked up with trichonosprosis in immmunocompromised patient alone. This case emphasizes the need to have high index of clinical suspicion and careful microbiological evaluation for fungal pathogens even in immunocompetent individuals specially on device for earlier institution of antifungal therapy which can decrease the mortality rate and improve outcome for patients with disseminated trichonosporosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Haupt HM, Merz WG, Beschorner WE, Vaughan WP, Saral R. Colonization and infection with Trichosporon species in immunosuppressed host. J Infect Dis 1983;147:199-203.  Back to cited text no. 1
[PUBMED]    
2.
Girmenia C, Pagano L, Martino B, D'Antonio D, Fanci R, Specchia G, et al.; GIMEMA Infection Program. Invasive Infections caused by Trichosporon species and Geotrichum capitatum in patients with hematological malignancies: A retrospective multicenter study from Italy and review of the literature. J Clin Microbiol 2005;43:1818-28.   Back to cited text no. 2
    
3.
Kremery V, Krupova I, Denning DW. Invasive yeast infections other than Candida spp. in acute leukemia. J Hosp Infect 1999;41:181-94.  Back to cited text no. 3
    
4.
Panagopoulou P, Evdoridou J, Bibashi E, Filioti J, Sofianou D, Kremenopoulos G, et al. Trichosporon asahii an unusual cause of invasive infection in neonates. Pediatr Infect Dis J 2002;21:169-70.  Back to cited text no. 4
    
5.
Method for antifungal disk diffusion susceptibility testing of yeast; proposed guideline. CLSI document M44-A. Pennsylvannia, USA: Clinical Laboratory and Standard Institute Methods; 2003.  Back to cited text no. 5
    
6.
Ebright JR, Fairfax MR, Vazquez JA. Trichosporon asahii, a non-candida yeast that caused fatal septic shock in a patient without cancer or neutropenia. Clin Infect Dis 2001;33:e28-30.   Back to cited text no. 6
    
7.
Rastogi VL, Nirwan PS. Invasive trichosporonosis due to Trichosporon asahii in a nonimmunocompromised host: A rare case report. Indian J Med Microbiol 2007;25:59-61.   Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Woolf DG, Falk R, Hacham M, Theelen B, Boekhout T, Scorzetti G, et al. Multidrug-resistant Trichosporon asahii infection of nongranulocytopenic patients in three intensive care units. J Clin Microbiol 2001;39:4420-5.   Back to cited text no. 8
    
9.
Keay S, Denning DW, Stevens DA. Endocarditis due to Trichosporon bigelii: In vitro susceptibility of isolates and review. Rev Infect Dis 1991;13:383-6.  Back to cited text no. 9
    
10.
Herbrecht R, Koenig H, Walter J, Liu KL, Guého E. Trichosporon infections: Clinical manifestations and treatment. J Mycol Med 1993;3:129-36.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 3]
 
 
    Tables

  [Figure 2]


This article has been cited by
1 Disseminated Trichosporon asahii infection in a combined liver-kidney transplant recipient successfully treated with voriconazole
Ranjit Sah,Arbindra singh Soin,Sony Chawla,Teena Wadhwa,Neha Gupta
Immunity, Inflammation and Disease. 2019;
[Pubmed] | [DOI]
2 Status of Scheduled Tribes in Telangana State Problems and Perspectives
Devath Suresh
SSRN Electronic Journal. 2017;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed3876    
    Printed59    
    Emailed0    
    PDF Downloaded228    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]