Bloodstream infection due to Trichosporon asahii in a neurological patient: case report

Introduction: Trichosporon spp is a fungus found in soil, water, plants, mammals and birds. In humans it can be found as an opportunistic yeast on the skin or in the mouth. Trichosporon spp can cause superficial and deep-seated infections, referred to as trichosporonosis. T. asahii is one of the causative species and thus represents an emerging pathogen which can cause severe life threatening infections in immunocompromised hosts. Case report: A 70 year old woman was admitted to the General Hospital Pula on September 25, 2008 because of symptoms due to intracerebral and subarachnoidal hemorrhage. The bleeding was caused by a rupture of a cerebral aneurysm, confirmed by a computed tomography scan. The patient was transferred to the Clinical Center Rijeka for neurosurgery. On October 30, she was returned to the General Hospital Pula. At that time she was febrile (39ºC) and in poor general conditions, with central vascular and urinary catheters. Sepsis caused by Pseudomonas aeruginosa was diagnosed and then piperacillin + tazobactam therapy was administered. Yeast colonies grew in cultures from two blood samples and from a catheter tip, all taken on November 19. The yeast was identified as Trichosporon asahii by the API ID 32C system (BioMerieux), and the identification was confirmed by ribosomal DNA sequence determination of ITS 1-5.8S-ITS2 regions. According to the susceptibility testing results, fluconazole (200 mg twice a day) was added to the antibiotic therapy. The patient’s clinical condition gradually improved. Blood cultures taken on November 25 and 26 were negative, as were cultures of stool and urine. On December 5 the patient was transferred to a nursing centre.