Trichosporon infection in chronic kidney disease patients from a tertiary care hospital - a case series or an outbreak? An unanswered question but a well-managed problem

Abstract

While the majority of Trichosporon spp. isolated in clinical laboratories are typically associated with episodes of colonization or superficial infections, this fungal species has gained recognition as an opportunistic pathogen, leading to invasive infections worldwide. In this article, we present a case series of Trichosporon spp. identified through conventional methods, complemented by MALDI-TOF analysis from a reference institute for a single sample. The reported cases occurred within a confined time frame, and the construction of an epidemic curve suggested a common source with intermittent exposure. Despite the absence of identified breaches in infection prevention and control (IPC) in units with common exposure, this case series underscores the significance of considering Trichosporonosis in the differential diagnoses for post-transplant and chronic kidney disease patients, particularly those undergoing hemodialysis or utilizing Foley's catheter. Notably, research gaps were identified, emphasizing the need for further exploration of factors such as the role of magnesium and prolonged antibiotic usage in the development of invasive Trichosporon infections and newer treatment modalities against biofilm producing yeast like fungi.

Keywords: Trichosporon; chronic kidney disease; haemodialysis; magnesium; voriconazole.

Table 1. Patient risk factors

Figure 1. Dry wrinkled colonies of Trichosporon on MacConkey agar incubated at 37°C after 24 hours of incubation

Figure 2. Report of MALDI-TOF

Figure 3. Advanced epidemic curve: distribution of laboratory confirmation of cases over time