Hematogenous trichosporonosis in cancer patients: report of 12 cases including 5 during prophylaxis with itraconazol

Twelve cases of Trichosporon spp. fungemias occurring in a national cancer institution within 10 years are described. The trend of hematogenous tricho sporonosis within the last 10 years is increasing. While no cases occurred in 1988-1991, after 1991, Trichosporon spp. was the most common species amo ng non-Candida spp. fungemias in 1993-1997. The 12 cases of fungemia includ ed 5 that started while the patients were receiving prophylaxis with oral i traconazole, and 2 appeared despite empiric therapy with amphotericin B. Fi ve 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 re ceiving antineoplastic chemotherapy All but 2 of the patients died of syste mic 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 cu lture was found to be positive for T. beigelii, before antifungals were adm inistered. 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 II: beigelii. Only 2 pati ents were cured, I with a combination therapy with amphotericin B plus fluc onazole, and 1 with amphotericin B monotherapy. Several risk factors (neutr openia, acute leukemia, prior therapy or prophylaxis with antifungals and c atheter as source of fungemia, breakthrough fungemia) were significantly as sociated with Trichosporon spp. fungemia, in comparison to 63 C. albicans c andidemia occurring in the same period at the same institution. Attributabl e mortality of hematogenous trichosporonosis was also significantly higher (83.3% vs 15.8%, P<0.001) than that of hematogenous candidiasis.