TRICHOSPORON BEIGELII, A NEW NEONATAL PATHOGEN

Trichosporon beigelii is an uncommon cause of sepsis in low-birth-weig ht infants. We present two cases of neonatal trichosporonosis and two cases of neonatal trichosporon colonization to familiarize neonatologi sts with this entity and to discuss management considerations. A 23-we ek-gestation male developed clinical evidence of sepsis on day 10 and was found to have ''yeast'' growing in a blood culture on day 12. Desp ite receiving amphotericin B, he expired within 2 days, at which time the organism was identified as T. beigelii. A 23-week-gestation female developed fungal septicemia in the second week of life, while being t reated for persistent bacterial sepsis. Candida albicans grew from blo od culture, while T. beigelii grew from suprapubic urine, tracheal asp irate, and umbilical catheter tip cultures. She died 2 days later desp ite therapy with amphotericin B, at which time the fungal isolates wer e correctly identified. Two other infants were found to have colonizat ion of central vascular catheters, without evidence of invasive diseas e. Trichosporon infections in neonates have been almost uniformly fata l. Most strains of T. beigelii are relatively resistant to amphoterici n B and may be confused with Candida sp. on initial culture examinatio ns. Therefore, delays in appropriate treatment may occur. We discuss t reatment options, including alternative antifungal drugs, as well as p ossibilities for combination therapy.