Twelve cases of Trichosporon spp. fungemias occurring in a national
cancer institution within 10 years are described. The trend of hematogenous
trichosporonosis within the last 10 years is increasing. While no cases occurred in 1988-1991, after 1991, Trichosporon spp. was the most common species among non-Candida spp. fungemias in 1993-1997. The 12 cases of
fungemia included 5 that started while the patients were receiving prophylaxis with oral
itraconazole, and 2 appeared despite empiric
therapy with
amphotericin B. Five of the 12 fungemias were
catheter associated. Risk factors for
fungemia were:
central venous catheter, broad-spectrum
antibiotics (
third-generation cephalosporins plus
aminoglycoside); all but 1 had
neutropenia and were receiving
antineoplastic chemotherapy. All but 2 of the patients died of systemic
fungal infection (83.3% mortality).
Amphotericin B was administered to all but 1 patient, who was not treated because he died the day after his culture was found to be positive for T. beigelii, before antifungals were administered. All cases infected with T. pullulans were
catheter related, and all these patients died. One of the remaining 9 fungemias was caused by T. capitatum (Blastoschizomyces capitatus), and 8 by T. beigelii. Only 2 patients were cured, 1 with a combination
therapy with
amphotericin B plus
fluconazole, and 1 with
amphotericin B monotherapy. Several risk factors (
neutropenia, acute
leukemia, prior
therapy or prophylaxis with antifungals and
catheter as source of
fungemia, breakthrough
fungemia) were significantly associated with Trichosporon spp.
fungemia, in comparison to 63 C. albicans
candidemia occurring in the same period at the same institution. Attributable mortality of hematogenous
trichosporonosis was also significantly higher (83.3% vs. 15.8%, P<0.001) than that of hematogenous
candidiasis.