The basidiomycetous yeast Trichosporon may cause severe lung exacerbation in cystic fibrosis patients – clinical analysis of Trichosporon positive patients in a Munich cohort

BMC Pulmonary Medicine

Matthias Griese²  Benjamin Würstl¹  Gudrun Laniado²  Ann-Christin Grimmelt²  Matthias Kappler²  Carolin Kröner² 

[1] Max von Pettenkofer Institute, Ludwig-Maximilians University, Pettenkoferstr. 9a, 80336 Munich, Germany;Pediatric Pneumology and Christiane Herzog Cystic Fibrosis Center, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, Lindwurmstr. 4, 80337 Munich, Germany

关键词: Exacerbations;    Respiratory pathogens;    Trichosporon species;    Cystic fibrosis;   

Others  :  1109648
DOI  :  10.1186/1471-2466-13-61

 received in 2013-02-08, accepted in 2013-10-28,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Kröner et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Pritchard RC, Muir DB: Trichosporon Beigelii - survey of isolates from clinical material. Pathology 1985, 17(1):20-23.
• [2]Walsh TJ, Melcher GP, Lee JW, Pizzo PA: Infections due to Trichosporon species: new concepts in mycology, pathogenesis, diagnosis and treatment. Curr Top Med Mycol 1993, 5:79-113.
• [3]Molnar O, Schatzmayr G, Fuchs E, Prillinger H: Trichosporon mycotoxinivorans sp. nov., a new yeast species useful in biological detoxification of various mycotoxins. Syst Appl Microbiol 2004, 27(6):661-671.
• [4]Miceli MH, Diaz JA, Lee SA: Emerging opportunistic yeast infections. Lancet Infect Dis 2011, 11(2):142-151.
• [5]Fleming RV, Walsh TJ, Anaissie EJ: Emerging and less common fungal pathogens. Infect Dis Clin North Am 2002, 16(4):915-933. vi-vii
• [6]Agirbasli H, Bilgen H, Ozcan SK, Otlu B, Sinik G, Cerikcioglu N, Durmaz R, Can E, Yalman N, Gedikoglu G, et al.: Two possible cases of Trichosporon infections in bone-marrow-transplanted children: the first case of T. japonicum isolated from clinical specimens. Jpn J Infect Dis 2008, 61(2):130-132.
• [7]Girmenia C, Pagano L, Martino B, D'Antonio D, Fanci R, Specchia G, Mei L, Buelli M, Pizzarelli G, Venditti M, et al.: 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(4):1818-1828.
• [8]Ruan SY, Chien JY, Hsueh PR: Invasive trichosporonosis caused by Trichosporon asahii and other unusual Trichosporon species at a Medical Center in Taiwan. Clin Infect Dis 2009, 49(1):E11-E17.
• [9]Chagas TC, Chaves GM, Colombo AL: Update on the genus Trichosporon. Mycopathologia 2008, 166(3):121-132.
• [10]Tashiro T, Nagai H, Kamberi P, Goto Y, Kikuchi H, Nasu M, Akizuki S: Disseminated Trichosporon-beigelii infection in patients with malignant diseases - immunohistochemical study and review. Eur J Clin Microbiol 1994, 13(3):218-224.
• [11]Gondor M, Michaels MG, Finder D: Non-aspergillus allergic bronchopulmonary mycosis in a pediatric patient with cystic fibrosis. Pediatrics 1998, 102(6):1480-1482.
• [12]Hickey PW, Sutton DA, Fothergill AW, Rinaldi MG, Wickes BL, Schmidt HJ, Walsh TJ: Trichosporon mycotoxinivorans, a novel respiratory pathogen in patients with cystic fibrosis. J Clin Microbiol 2009, 47(10):3091-3097.
• [13]Hirschi S, Letscher-Bru V, Pottecher J, Lannes B, Jeung MY, Degot T, Santelmo N, Sabou AM, Herbrecht R, Kessler R: Disseminated Trichosporon mycotoxinivorans, aspergillus fumigatus, and Scedosporium apiospermum coinfection after lung and liver transplantation in a cystic fibrosis patient. J Clin Microbiol 2012, 50(12):4168-4170.
• [14]Levy H, Kalish LA, Huntington I, Weller N, Gerard C, Silverman EK, Celedon JC, Pier GB, Weiss ST: Inflammatory markers of lung disease in adult patients with cystic fibrosis. Pediatr Pulmonol 2007, 42(3):256-262.
• [15]Wheeler WB, Williams M, Matthews WJ Jr, Colten HR: Progression of cystic fibrosis lung disease as a function of serum immunoglobulin G levels: a 5-year longitudinal study. J Pediatr 1984, 104(5):695-699.
• [16]De Boeck K, Vermeulen F, Wanyama S, Thomas M: Inhaled corticosteroids and lower lung function decline in young children with cystic fibrosis. Eur Respir J 2011, 37(5):1091-1095.
• [17]Stevenson LG, Drake SK, Shea YR, Zelazny AM, Murray PR: Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinically important yeast species. J Clin Microbiol 2010, 48(10):3482-3486.
• [18]Bader O, Weig M, Taverne-Ghadwal L, Lugert R, Gross U, Kuhns M: Improved clinical laboratory identification of human pathogenic yeasts by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Clin Microbiol Infect 2011, 17(9):1359-1365.
• [19]Pfaller MA: Epidemiology of fungal infections: the promise of molecular typing. Clin Infect Dis 1995, 20(6):1535-1539.
• [20]Sugita T, Nishikawa A, Ikeda R, Shinoda T: Identification of medically relevant Trichosporon species based on sequences of internal transcribed spacer regions and construction of a database for Trichosporon identification. J Clin Microbiol 1999, 37(6):1985-1993.
• [21]Sugita T, Nishikawa A, Shinoda T: Rapid detection of species of the opportunistic yeast Trichosporon by PCR. J Clin Microbiol 1998, 36(5):1458-1460.
• [22]Liu JC, Modha DE, Gaillard EA: What is the clinical significance of filamentous fungi positive sputum cultures in patients with cystic fibrosis? J Cyst Fibros 2013, 12(3):187-193.
• [23]Chotirmall SH, O'Donoghue E, Bennett K, Gunaratnam C, O'Neill SJ, McElvaney NG: Sputum Candida albicans presages FEV(1) decline and hospital-treated exacerbations in cystic fibrosis. Chest 2010, 138(5):1186-1195.
• [24]Amin R, Dupuis A, Aaron SD, Ratjen F: The effect of chronic infection with aspergillus fumigatus on lung function and hospitalization in patients with cystic fibrosis. Chest 2010, 137(1):171-176.
• [25]Reihill JA, Moore JE, Elborn JS, Ennis M: Effect of aspergillus fumigatus and Candida albicans on pro-inflammatory response in cystic fibrosis epithelium. J Cyst Fibros 2011, 10(6):401-406.
• [26]Rose HD, Kurup VP: Colonization of hospitalized patients with yeast-like organisms. Sabouraudia 1977, 15(3):251-256.
• [27]Haupt HM, Merz WG, Beschorner WE, Vaughan WP, Saral R: Colonization and infection with trichosporon species in the immunosuppressed host. J Infect Dis 1983, 147(2):199-203.
• [28]Tashiro T, Nagai H, Kamberi P, Goto Y, Kikuchi H, Nasu M, Akizuki S: Disseminated trichosporon beigelii infection in patients with malignant diseases: immunohistochemical study and review. Eur J Clin Microbiol Infect Dis 1994, 13(3):218-224.
• [29]Tummler B, Storrs T, Dziadek V, Dork T, Meitinger T, Golla A, Bertele-Harms RM, Harms HK, Schroder E, Claass A, et al.: Geographic distribution and origin of CFTR mutations in Germany. Hum Gen 1996, 97(6):727-731.