Emergence of Trichosporon mycotoxinivorans (Apiotrichum mycotoxinivorans) invasive infections in Latin America

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Abstract

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.

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Towards an integrated phylogenetic classification of the Tremellomycetes

X.-Z. Liu, Q.-M. Wang, M Göker … (2015)

Families and genera assigned to Tremellomycetes have been mainly circumscribed by morphology and for the yeasts also by biochemical and physiological characteristics. This phenotype-based classification is largely in conflict with molecular phylogenetic analyses. Here a phylogenetic classification framework for the Tremellomycetes is proposed based on the results of phylogenetic analyses from a seven-genes dataset covering the majority of tremellomycetous yeasts and closely related filamentous taxa. Circumscriptions of the taxonomic units at the order, family and genus levels recognised were quantitatively assessed using the phylogenetic rank boundary optimisation (PRBO) and modified general mixed Yule coalescent (GMYC) tests. In addition, a comprehensive phylogenetic analysis on an expanded LSU rRNA (D1/D2 domains) gene sequence dataset covering as many as available teleomorphic and filamentous taxa within Tremellomycetes was performed to investigate the relationships between yeasts and filamentous taxa and to examine the stability of undersampled clades. Based on the results inferred from molecular data and morphological and physiochemical features, we propose an updated classification for the Tremellomycetes. We accept five orders, 17 families and 54 genera, including seven new families and 18 new genera. In addition, seven families and 17 genera are emended and one new species name and 185 new combinations are proposed. We propose to use the term pro tempore or pro tem. in abbreviation to indicate the species names that are temporarily maintained.

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Current knowledge of Trichosporon spp. and Trichosporonosis.

Arnaldo Colombo, Ana Padovan, Guilherme M. Chaves (2011)

Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive trichosporonosis. Disseminated trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.

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Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection—Scotland, 2012–2013

R Rajendran, L. Sherry, C.J. Nile … (2016)

Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalized patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n = 217) in Scotland (2012–2013) was performed to assess the risk factors associated with patient mortality, in particular the impact of biofilm formation. Candida bloodstream isolates (n = 280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro with standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms with fixed concentrations of different classes of antifungal. Available mortality data for 134 patients showed that the 30-day candidaemia case mortality rate was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox regression survival analysis for 42 patients showed a significantly higher mortality rate for Candida albicans infection than for Candida glabrata infection. Biofilm-forming ability was significantly associated with C. albicans mortality (34 patients). Finally, in vitro antifungal sensitivity testing showed that low biofilm formers and high biofilm formers were differentially affected by azoles and echinocandins, but not by polyenes. This study provides further evidence that the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy in vitro. Collectively, these findings show that greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity.

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Author and article information

Journal

Journal ID (nlm-ta): Mem Inst Oswaldo Cruz

Journal ID (iso-abbrev): Mem. Inst. Oswaldo Cruz

Journal ID (publisher-id): mioc

Title: Memórias do Instituto Oswaldo Cruz

Publisher: Instituto Oswaldo Cruz, Ministério da Saúde

ISSN (Print): 0074-0276

ISSN (Electronic): 1678-8060

Publication date (Print and electronic): October 2017

Publication date (Print): October 2017

Volume: 112

Issue: 10

Pages: 719-722

Affiliations

[1 ]Universidade de São Paulo, Instituto de Medicina Tropical, Divisão de Laboratório Central (LIM03) e Laboratório de Micologia Médica (LIM53), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

[2]Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil

[2 ]Universidade Federal de São Paulo, Escola Paulista de Medicina, Laboratório Especial de Micologia, São Paulo, SP, Brasil

[3 ]Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgar Santos, Laboratório de Microbiologia, Salvador, BA, Brasil

[4 ]Universidade de São Paulo, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

[5 ]Universidade Federal da Bahia, Departamento de Medicina, Complexo Hospitalar Universitário Professor Edgar Santos, Salvador, BA, Brasil

[6 ]Universidade Federal de Alfenas, Departamento de Microbiologia e Imunologia, Alfenas, MG, Brasil

Author notes

[+ ] Corresponding-author: jnaj99@ 123456gmail.com

AUTHORS’ CONTRIBUTION

JNAJ, ALC and ACBP designed, wrote and reviewed the full manuscript; MGMB, LVRFSF and OMB provided the clinical data and helped to design the study; ECF and ACBP performed the microbiological analysis.

Article

Publisher ID: 0074-02760170011

DOI: 10.1590/0074-02760170011

PMC ID: 5607521

PubMed ID: 28954000

SO-VID: 27d5a41e-d90f-4c7a-911a-b9e3664f0c3b

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 12 January 2017

Date accepted : 3 April 2017

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Figures: 1, Tables: 0, Equations: 0, References: 19, Pages: 4

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Emergence of Trichosporon mycotoxinivorans (Apiotrichum mycotoxinivorans) invasive infections in Latin America

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Most cited references 17

Towards an integrated phylogenetic classification of the Tremellomycetes

Current knowledge of Trichosporon spp. and Trichosporonosis.

Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection—Scotland, 2012–2013

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