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Trichosporon Infections Workup

  • Author: Ryan C Maves, MD, FACP, FIDSA; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Jan 16, 2015
 

Laboratory Studies

The diagnosis of trichosporonosis is usually confirmed by a positive blood culture result obtained in the evaluation of a febrile (typically neutropenic) patient.

Important laboratory tests include blood culture sets, blood chemistries and hepatic transaminases, alkaline phosphatase, bilirubin, lactic acid dehydrogenase (LDH), and urinalysis with urine culture.

Urine cultures may be the first to grow Trichosporon in the setting of disseminated disease,[6] and it should not be presumed to be a contaminant or colonizer in the high-risk host (ie, in the setting of neutropenic fever).[1]

Trichosporon and C neoformans are closely related organisms and share a number of surface antigens. As such, the latex agglutination test results for serum cryptococcal antigen is often positive in the setting of disseminated trichosporonosis[7] (except trichosporonosis due to B capitatus[11] ). This widely used, rapid, and inexpensive test may provide an early clue about a Trichosporon infection. Because of changes in cell wall conformation, these test results may become negative during antifungal therapy, but newly negative test results do not imply a response to therapy.[1]

Investigational methods of rapid molecular diagnostics, such as DNA-based microarrays,[34] polymerase chain reaction (PCR), and pyrosequencing,[35] are in development but are not yet widely available for clinical use.[36, 37]

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Imaging Studies

Radiologic evaluation should include a chest radiograph and CT scans of the abdomen and pelvis. A CT scan of the chest is also frequently useful in the evaluation of the pulmonary infiltrate in the patient population at risk for Trichosporon infection, but confirmation of the diagnosis should rely on a tissue sample or on another useful clinical sample. Depending on the clinical picture, a CT scan or MRI of the brain may be indicated.

Endocarditis is rarely reported[16, 33] but is associated with high mortality rate (82% in a single series). Patients with prosthetic heart valves or persistently positive blood culture results should undergo echocardiography.

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Procedures

Bronchoscopy

When pulmonary infiltrates are present, bronchoscopy is a useful means of obtaining samples if the patient can tolerate the procedure. Positive culture results from a bronchial lavage support the diagnosis.[26]

Biopsy

Open-lung biopsy may be required for definitive diagnosis because of the large number of viral, bacterial, protozoal, and fungal pathogens that can cause disease in patients with pulmonary infiltrates.

Lesions of the GI tract may be accessible for biopsy and may yield a diagnosis before blood cultures return positive findings.

Skin lesions occur in roughly 10% of patients with disseminated trichosporonosis. Biopsy of suspicious lesions in immunocompromised patients with fever may facilitate early diagnosis.

Liver lesions or other visceral lesions may also require biopsy for diagnosis and optimal management.

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Histologic Findings

Grossly, infected tissues may contain micronodules (0.5-1.0 cm), occasionally surrounded by red rims. The GI tract may demonstrate ulceration and erosion associated with hemorrhage and hemorrhagic infarction.[7]

Microscopic examination of a nodule may reveal a necrotic center with fungal elements either in a starburst pattern or more loosely organized. Fungal elements may be observed invading the vasculature. Visualization of blastoconidia, arthroconidia, hyphae, and pseudohyphae in a histologic section supports the diagnosis of invasive Trichosporon infection.[7, 13] The cellular inflammation surrounding the fungal elements may vary, occasionally associated with hemorrhage. Granulomatous inflammation with multinucleated giant cells has been reported.[38]

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Contributor Information and Disclosures
Author

Ryan C Maves, MD, FACP, FIDSA Attending Physician, Infectious Diseases and Critical Care Medicine, Naval Medical Center San Diego; Associate Professor of Medicine, Uniformed Services University of the Health Sciences

Ryan C Maves, MD, FACP, FIDSA is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, HIV Medicine Association, Infectious Diseases Society of America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey M Zaks, MD Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American Association for Physician Leadership, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Braden R Hale, MD, MPH, Director, Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California.

Braden R Hale, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Armed Forces Infectious Diseases Society, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Tyler E Warkentien, MD, MPH, Attending Physician, Department of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD

Tyler E Warkentien is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

DISCLAIMER

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The author of this work is an employee of the U.S. Government. This work was prepared as part of his official duties. Title 17 U.S.C. § 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government’. Title 17 U.S.C. § 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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