Invasive infection due to Trichosporon cutaneum in patients with hematologic malignancies

BACKGROUND. Invasive infection due to Trichosporon is a rare but often fatal disease in immunocompromised patients. In this study, data on patients with hematologic malignancies who had an invasive infection due to Trichosporon diagnosed at the Tokyo Metropolitan Komagome Hospital in Tokyo, Japan, were analyzed. METHODS. Positive blood cultures obtained between 1986 and 1996 were reviewed. Medical records of all patients who were positive for Trichosporon in their blood culture or autopsy material were then examined. RESULTS. A total of nine patients with hematologic malignancies were reported positive for Trichosporon cutaneum in their blood culture or at the time of autopsy. The average age was 52 years, and all patients except 2 had acute leukemia. All 8 patients with positive blood cultures were neutropenic, and the average duration of neutropenia before the positive blood cultures were obtained was 43 (range, 0-101) days. For prophylaxis of fungal infection, eight patients were kept in a laminar air flow room and also received nebulization with amphotericin B. Five patients received oral amphotericin B. All 9 patients died of the infection an average of 9 days after their blood cultures turned positive. Minimal inhibitory concentrations were evaluated in six available strains obtained from the patients. They were all resistant to amphotericin B and azoles. CONCLUSIONS. More effective antifungal agents are required for the treatment of infections with this organism. (C) 1998 American Cancer Society.