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. 2022 Sep 30;77(10):2850-2858.
doi: 10.1093/jac/dkac235.

Invasive Trichoderma spp. infections: clinical presentation and outcome of cases from the literature and the FungiScope® registry

Ertan Sal  1   2   3 , Jannik Stemler  1   2   3 , Jon Salmanton-García  1   2   3 , Iker Falces-Romero  4   5 , László Kredics  6 , Elisabeth Meyer  7 , Benjamin Würstl  7 , Cornelia Lass-Flörl  8 , Zdenek Racil  9   10 , Nikolay Klimko  11 , Simone Cesaro  12 , Anupma Jyoti Kindo  13 , Hilmar Wisplinghoff  14 , Philipp Koehler  1   2 , Oliver A Cornely  1   2   3   15 , Danila Seidel  1   2   3
Affiliations

Invasive Trichoderma spp. infections: clinical presentation and outcome of cases from the literature and the FungiScope® registry

Ertan Sal et al. J Antimicrob Chemother. .

Abstract

Background: Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients.

Objectives: To analyse clinical presentation, predisposing factors, treatment and outcome of Trichoderma infections.

Methods: A systematic literature review was conducted for published cases of invasive Trichoderma infection in PubMed until December 2021 and by reviewing the included studies' references. Cases from the FungiScope® registry were added to a combined analysis.

Results: We identified 50 invasive infections due to Trichoderma species, including 11 in the FungiScope® registry. The main underlying conditions were haematological malignancies in 19 and continuous ambulatory peritoneal dialysis (CAPD) in 10 cases. The most prevalent infection sites were lung (42%) and peritoneum (22%). Systemic antifungal therapy was administered in 42 cases (84%), mostly amphotericin B (n = 27, lipid-based formulation 13/27) and voriconazole in 15 cases (30%). Surgical interventions were performed in 13 cases (26%). Overall mortality was 48% (n = 24) and highest for allogeneic HSCT and solid organ transplantation (SOT) recipients [80% (4/5) and 77% (7/9), respectively]. In patients treated with amphotericin B, voriconazole and caspofungin, mortality was 55% (15/27), 46% (7/15) and 28% (2/7), respectively. Three out of four patients treated with a combination therapy of voriconazole and caspofungin survived.

Conclusions: Despite treatment with antifungal therapies and surgery, invasive Trichoderma infections are life-threatening complications in immunocompromised patients, especially after HSCT and SOT. In addition, Trichoderma spp. mainly affect the lungs in patients with haematological malignancies and the peritoneum in CAPD patients.

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Figures

Figure 1.
Figure 1.
Enrolment and study flow chart.
Figure 2.
Figure 2.
Geographical distribution of invasive Trichoderma infections. Cases were reported from France (n = 10), Spain (n = 7), Italy and the USA (n = 4, each), Austria, Germany, Greece, Hungary, Japan and Turkey (n = 2, each) and Argentina, Belgium, Brazil, Chile, China, the Czech Republic, India, Korea, Lithuania, the Netherlands, Russia, Slovenia and the UK (n = 1, each). This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
See this image and copyright information in PMC

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