Breakthrough trichosporonosis in patients with hematologic malignancies receiving micafungin.

Abstract

BACKGROUND:

Micafungin is a newly approved antifungal agent in the echinocandin class that is active against Candida species and Aspergillus species. However, this agent has limited activity against a number of fungi, including Trichosporon species. We describe 4 patients who developed disseminated trichosporonosis during the use of micafungin. No cases of trichosporonosis had been seen in the 2 years prior to January 2003, when micafungin became available in our hospital.

METHODS:

We reviewed microbiological records of patients at Kameda General Hospital (Kamogawa City, Chiba, Japan) from 1 January 2002 to 31 July 2005, and identified 4 patients whose blood culture results were positive for Trichosporon species.

RESULTS:

Since January 2003, four patients--3 with acute myelocytic leukemia and 1 with myelodysplastic syndrome--developed disseminated trichosporonosis while receiving treatment with micafungin with or without amphotericin B. The initial 2 isolates were identified as Trichosporon beigelii, and the later 2 isolates were identified as Trichosporon asahii. All 4 patients received micafungin, and 2 also received amphotericin B concomitantly. Minimal inhibitory concentrations of micafungin were >16 microg/mL for the 2 isolates available for susceptibility testing. One patient with hematologic recovery (neutrophils >500 cells/mm3) showed elimination of the fungus after receiving treatment with voriconazole. However, the 3 other patients without hematologic or immunological recovery died of disseminated infection.

CONCLUSIONS:

The rarity of trichosporonosis in our hospital and its emergence after the introduction of micafungin therapy support the idea that micafungin may exert a significant, selective pressure toward resistant fungi, such as Trichosporon species. Therefore, care should be taken regarding the possibility of trichosporonosis in patients receiving micafungin with or without amphotericin B.

• Authors: Kosei Matsue, Hidetaka Uryu, Mihoko Koseki, Noboru Asada, Masami Takeuchi
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 42 Issue 6 Pg. 753-7 (Mar 15 2006) ISSN: 1537-6591 [Electronic] United States
• PMID: 16477548 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antifungal Agents
• Echinocandins
• Lipopeptides
• Lipoproteins
• Peptides, Cyclic
• Amphotericin B
• Micafungin

Topics

• Amphotericin B (therapeutic use)
• Antifungal Agents (therapeutic use)
• Drug Resistance, Fungal
• Drug Therapy, Combination
• Echinocandins
• Hematologic Neoplasms (complications)
• Humans
• Japan
• Lipopeptides
• Lipoproteins (therapeutic use)
• Male
• Micafungin
• Microbial Sensitivity Tests
• Middle Aged
• Mycoses (complications, drug therapy, microbiology)
• Peptides, Cyclic (therapeutic use)
• Selection, Genetic
• Trichosporon (isolation & purification)