Fagundes Júnior Antônio Aurélio de Paiva, Carvalho Ricardo Tavares de, Focaccia Rinaldo, Fernandez Juliana Gabriela, Araújo Hélia Beatriz Nunes de, Strabelli Tânia Mara Varejão, Kopel Liliane, Lage Silvia G
Instituto do Coração, HC, FM, USP, São Paulo, SP.
Rev Bras Ter Intensiva. 2008 Mar;20(1):106-9.
Infection with the non-Candida yeast species Trichosporon have been recognized with increasing frequency over the last two decades. Invasive disease due to trichosporonosis has been reported from neutropenic patients with cancer and the mortality is high. Recently, others groups of patients have become susceptible to this rare fungi. We report the emerging of infection with pathogenic Trichosporon asahii in severely ill heart failure patients in a tertiary cardiological intensive care unit (CICU). We describe our data, and report a fatal case of disseminated trichosporonosis in a patient with heart failure. We also review literature pertaining to T. asahii infections.
An 85 year-old woman with a history of hypertension, heart failure (ejection fraction (EJ): 30%) and pulmonary embolism was admitted to a medical cardiological ICU after cardiac arrest (ventricular fibrillation) resuscitated during a routine consultation. There were no neurological sequelae and the echocardiogram revels no changes, neither the cardiac biomarkers. Ventricular fibrillation was considered secondary to heart failure. The patient had extubation failure and difficult weaning needing long term mechanical ventilation even after tracheostomy. Her hospital course was complicated by acute renal failure and recurrent respiratory, urinary and systemic bacterial infections, which responded to broad-spectrum antibiotics. After a temporary improvement she developed urinary infection and subsequent septic shock. Cultures of urine and blood specimens grew T. asahii. Treatment with liposome amphotericin B (5 mg/kg/day) was started. Despite receiving vancomycin and imipenem, the clinical condition of the patient deteriorates. Blood taken for culture on the seventh day of amphotericin B therapy were negative but urine specimen still grew T. asahii. On the eighteenth day of antifungal therapy, the patient died with multiorgan failure.
The increasing of severely ill patients, and the use of broad spectrum antibiotics, has predisposed the emerging of invasive infections by rare and new opportunistic fungal pathogens. Severe infection related to T. asahii, until recently restricted to neutropenic patients with cancer, has been frequently identified in heart failure patients with advanced age. The mortality is high. These data highlights the importance of considering this group of patients as a risk group for T. asahii infection.
在过去二十年中，非念珠菌属酵母样真菌毛孢子菌的感染日益常见。癌症中性粒细胞减少患者中已报告了由毛孢子菌病引起的侵袭性疾病，且死亡率很高。最近，其他患者群体也易感染这种罕见真菌。我们报告了在一家三级心脏病重症监护病房（CICU）中，重症心力衰竭患者感染致病性阿萨希毛孢子菌的情况。我们描述了我们的数据，并报告了一例心力衰竭患者播散性毛孢子菌病的致死病例。我们还回顾了与阿萨希毛孢子菌感染相关的文献。
一名85岁女性，有高血压、心力衰竭（射血分数（EJ）：30%）和肺栓塞病史，在一次常规会诊期间心脏骤停（室颤）复苏后入住心内科重症监护病房。无神经后遗症，超声心动图及心脏生物标志物均无变化。室颤被认为是心力衰竭的继发表现。患者拔管失败且脱机困难，即使气管切开后仍需长期机械通气。其住院过程因急性肾衰竭以及反复的呼吸道、泌尿系统和全身性细菌感染而复杂化，这些感染对广谱抗生素有反应。经过短暂改善后，她发生了尿路感染及随后的感染性休克。尿液和血液标本培养出阿萨希毛孢子菌。开始用脂质体两性霉素B（5mg/kg/天）治疗。尽管使用了万古霉素和亚胺培南，患者的临床状况仍恶化。两性霉素B治疗第7天采集的血培养阴性，但尿液标本仍培养出阿萨希毛孢子菌。抗真菌治疗第18天，患者死于多器官功能衰竭。
重症患者的增加以及广谱抗生素的使用，使得罕见和新的机会性真菌病原体引发侵袭性感染的情况增多。与阿萨希毛孢子菌相关的严重感染，直到最近还局限于癌症中性粒细胞减少患者，现在在高龄心力衰竭患者中也经常被发现。死亡率很高。这些数据凸显了将这组患者视为阿萨希毛孢子菌感染风险群体的重要性。
