Trichosporon Fungemia in a Tertiary Pediatric Hospital: A Case Series.

BACKGROUND

Trichosporon asahii is an opportunistic fungal pathogen increasingly recognized in immunocompromised patients, including children. Although rare, T. asahii fungemia carries significant morbidity and mortality, particularly in those with hematologic malignancies or prolonged immunosuppression.

OBJECTIVES

This case series aimed to describe the clinical characteristics, risk factors, microbiological profiles, and treatment outcomes of pediatric patients diagnosed with T. asahii fungemia over a 13-year period at a tertiary care children's hospital.

METHODS

A retrospective review was conducted of all cases of T. asahii fungemia diagnosed between 2010 and 2023 in patients under 18 years of age. Data collected included patient demographics, underlying conditions, immunosuppressive status, presence of central venous catheters (CVCs), neutrophil counts, antifungal susceptibility profiles, treatments administered, and clinical outcomes.

RESULTS

Most cases occurred in immunocompromised patients, mainly those with neutropenia and a CVC. Half of the patients died. T. asahii isolates were generally susceptible to voriconazole and other azoles but showed partial resistance to amphotericin B. Clinical improvement was mainly associated with early antifungal treatment (particularly voriconazole) and supportive measures, including immunosuppression reduction, neutrophil recovery, and CVC removal.

CONCLUSIONS

Voriconazole appears to be a reasonable empiric treatment option for pediatric T. asahii fungemia, a condition associated with a very poor prognosis. Successful management may also require early recognition of risk factors and interventions aimed at reversing immunosuppression and eliminating potential sources of infection such as CVCs.