Case report: Complicated urinary tract infection with trichosporon asahii

Abstract

Trichosphoron spp. are members of Basidiomycetous group organism (Basidiomycota, Hymenomycetes, Trichosporonales) thats widely distributed in nature. In humans although they are accepted as a member of gastrointestinal flora, they can be cultured infrequently as an infection agent in immunosupressive and patient with invasive intervention. The most common isolated type from invasive infections are Trichosphoron ashaii. Invasive trihosphoronosis is documanted mostly in patients with malignancies and medical conditions associated with immunosupressions and included usually as case reports in literature. In our case 64 year old male patient admitted in emergency with loss of consciousness and tight sided contraction. Five year ago he has history of cerebrovascular accident attack with ischemic episode and left sided hemiparesis. Patient has started to given anticoagulant therapy enoxaparin 0.6 cc 2x1 sc daily. Patient was followed for two months in intensive care unit. He has given the treatment protocol for lower respiratory tract infections with betalactam antibiotics combined with quinolone several times. During follow-up yeast was isolated from consecutive urine cultures (60.000-80.000 cfu/ml). It was identified as Trichosporon asahii using VITEK 2. Since the resistance limit values not yet confirmed for Trichosporon spp. the tratment is changed to lipozomal amphotericin B iv (3mg/kg) and flukanazol iv (400 mg/day). During follow-up treatment 64th day of hospitalization patient died because of cardiac reasons. Infections with Trichosporon asahii the mortality is high in the immunocompromised host. Therefore Trichosporon infections has to be diagnosed correctly as early as possible in clinical and preclinical perspective.