Henry Ford Hospital Medical Journal Volume 24 | Number 1 Article 5 3-1976 Infections Due to Trichosporon cutaneum, an Uncommon Systemic Pathogen Tom Madhavan John Eisses Edward L. Quinn Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Madhavan, Tom; Eisses, John; and Quinn, Edward L. (1976) "Infections Due to Trichosporon cutaneum, an Uncommon Systemic Pathogen," Henry Ford Hospital Medical Journal : Vol. 24 : No. 1 , 27-30. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol24/iss1/5 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Henry Ford Hosp. Med. Journal Vol. 24, No. 1, 1976 Infections Due to Trichosporon cutaneum^ an Uncommon Systemic Pathogen Tom Madhavan, MD,* John Eisses, PhD,** and Edward L. Quinn, MD* Trichosporon cutaneum is a yeast-like fungus, which may cause a superficial infec­ tion, limited to the hair shaft and adjacent skin, and known as "white piedra".' This fungus has also been isolated from fecal and sputum specimens in healthy miners,^ but Multiple Isolations of T. Cutaneum from systemic infections are rarely encountered. the blood stream of two patients enabled the T. cutaneum is recognized in the laboratory authors to characterize the morphology, bio­ by its ability to grow at28°C as well as 37°C, chemical reactions and antibiotic suscep­ by raised white colonies on Sabouraud's tibility of T. Cutaneum. This organism dextrose agar (Figure 1), by the presence of appears to be an opportunistic pathogen and arthrospores and blastospores (Figure 2); responds promptly to intravenous also, urease production, assimilation of dex­ Amphotericin B or oral 5-Fluorocytoslne. trose, galactose, lactose, and variable assim­ ilation of maltose, sucrose and raffinose — but no assimilation of nitrate. Watson and Kallichuram reported one 39-year-old Af­ rican woman with rapidly fatal brain ab­ scess^ in whom postmortem histopathology and fungus culture demonstrated 7. cut­ aneum. We describe here two cases of fungemia caused by T. cutaneum, one oc­ curring after mitral valve replacement and the other in an immunosuppressed patient after a renal transplant. Report of cases * Department of Medicine Case I ** Department of Pathology On December 1, 1965, a 55-year-old white Presented at the 102nd annual meeting of the woman underwent replacement of her mitral American Public Health Association and Related valve with an artificial valve for intractable con­ Organizations, Oct. 24, 1974, New Orleans. Also gestive heart failure secondary to mitral stenosis. presented at the fall meeting of the College of Chemoprophylaxis was carried out with meth- American Pathologists, ASCP, in Washington, DC, icillin intravenously and streptomycin intra­ 1974. muscularly during and immediately after cardiac surgery. Her immediate postoperative course was Address reprint requests to Dr. Madhavan at uneventful. On the 12th postoperative day she Henry Ford Hospital, 2799 West Grand Boule­ began to have fever with spikes ranging from 99° vard, Detroit Ml 48202 to 102°E There were no localizing signs. 7. cut- 27 Madhavan, Eisses & Quinn Figure 1 Appearance of Tr/c/iosporor; cutaneum colonies after 14 days of incubation on Sabouraud's dextrose agar at 28°C. 28 Infections due to Trichosporon / ^^pi^i^ Figure 2 Microscopic (390x) appearance of Trichosporon cutaneum on Sabouraud's dextrose agar at 28°C. Stained with lactophenol cotton blue. 29 Madhavan, Eisses & Quinn aneum was cultured from three blood specimens also causes opportunistic infection in post- taken on the 13th postoperative day. No mucosal transplant, immunosuppressed individuals, or cutaneous infections were evident; the patient was not receiving intravenous therapy. A diag­ as illustrated by the second patient. The nosis of postcardiotomy fungal endocarditis was route of invasion of this organism is not made, and the patient was treated with 20-40 mg known. Both reported patients had received of amphotericin B daily intravenously for 42 days intravenous therapy, although in the first to a total of 1300 mg. The patient tolerated the patient, infusions were given only pre- and amphotericin B well, her temperature returned to normal, and 7, cutaneum could not be cultured postoperatively. Of the available antifungal from subsequent blood specimens. The patient agents, amphotericin B appears to be effec­ was discharged three months later in fair condi­ tive in treating infections due to this organ­ tion. She was followed for the next five years ism. Five-fluorocytosine, a new synthetic without recurrence. oral antifungal agent, is known to be effec­ Case 2 tive against infections caused by Cryptococ- cus neoformans, Candida sp., and The second patient was a 43-year-old white woman with a longstanding pyelonephritis, who Torulopsis glabrata.^ Prior to this report. underwent a renal transplantation on |une 19, Steer et al successfully treated one patient 1973. The patient tolerated the procedure well. with peritonitis and septicemia due to 7. She was maintained on 150 mg of prednisone, 125 cutaneum with 5-fluorocytosine, 50 mg/kg mg of azathioprine, and antilymphocyte serum. for five days.' Further experience in the On the third post-transplant day, the patient de­ veloped mild hypotension, oliguria, and acute treatment of systemic 7. cutaneum infections pulmonary edema, which were successfully man­ with 5-fluorocytosine is recommended. aged with digitalization and diuretics. On the fourth post-transplant day, the patient became Acknowledgements febrile. She was initially treated with ampicillin for Escherichia coli urinary tract infection, but her The authors wish to thank Smith Shad- low grade fever continued. Urine specimens on omy, Ph.D., Professor of Medicine and Mi­ the 8th, 9th and 10th post-transplant days revealed crobiology, Medical College of Virginia, yeasts in moderate amounts. Subsequently, 7. VirginiaCommonwealth University, for per­ cutaneum was cultured from three blood speci­ mens. This patient did not have indwelling intra­ forming the antifungal sensitivity testing and venous catheters during that time. A con­ determining 5-fluorocytosine serum levels. centration of 0.78/ug/ml amphotericin B and 25 /u.g/ml 5-fluorocytosine were sufficient to in­ References hibit the fungus, but concentrations of 3.13 ng/m\ amphotericin B and 100 /u,g/ml 5-fluorocytosine 1. Smith JD, Murtishaw WA, and McBride ME: were required for minimum fungicidal activity. White piedra (Trichosporosis). Arch Derm Treatment with 5-fluorocytosine, 100 mg/kg or­ 107:439-442, 1973 ally, in divided doses was begun. Patient became 2. Hatschke D, and Goetz H: On the determina­ afebrile, and the fungus was not cultured from tion of trichosporon cutaneum (de Beurm, subsequent blood specimens. The serum levels of Gougerot et Vaucher) OTA in the respiratory 5-fluorocytosine after 100 mg/kg oral dose were and digestive tract of miners with silicosis. 82.5 Aig/ml at two hours, and 102.3 /xg/ml at Mykosen 14(9):425-427, 1971 eight hours. Therapy could not be continued beyond two weeks because of persistent marrow 3. Watson KC, and Kallichurum S: Brain abscess depression resulting from her immunosuppressive due to trichosporon cutaneum. / Microbiol therapy. 3:191-192, 1970 4. Kaye |H, Bernstein S, and Tsuji HK: Surgical Comment treatment of Candida endocarditis. jAMA 203:612-626, 1968 A diagnosis of post-cardiotomy endocar­ ditis due to 7. cutaneum was made in the first 5. Bundebelde AG, Maucera AA, and johnson BE: 5-Fluorocytosine in the treatment of my­ patient and treatment given. Fungal endo­ cotic infections. Ann Intern Med 77:43-51, carditis usually requires prolonged antibi­ 1972 otic therapy and surgical excision for 6. Steer PL, Marks Ml, and Clyde PD: 5-Fluo- eventual cure, but in exceptional circum­ rocytosine; an oral antifungal compound: a stances, susceptible fungi can be eradicated report on clinical and laboratory experience. with medical therapy alone." This fungus Ann Intern Med 76:15-22, 1972 30 .