Kumar Anil, Udayakumaran Suhas, Babu Rachana, Rajamma Bindhu M, Prakash Anupam, Panikar Dilip, Karim Shamsul, Chowdhary Anuradha
Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Mycoses. 2015 Feb;58(2):99-103. doi: 10.1111/myc.12282. Epub 2015 Jan 15.
Central nervous system trichosporonosis is a rare clinical entity and so far only six cases including three each of brain abscess and meningitis has been on record. We report a rare case of chronic meningo-ventriculitis and intraventricular fungal ball due to Trichosporon asahii in an 18-year-old immunocompetent male from Burundi, east Africa. Neuroendoscopy showed multiple nodules and a fungal ball within the ventricle, which on culture grew T. asahii. He was initially empirically treated with liposomal amphotericin B. However, the antifungal susceptibility testing of T. asahii isolate revealed high minimum inhibitory concentration for amphotericin B (2 μg ml⁻¹), flucytosine (16 μg ml⁻¹) and caspofungin (2 μg ml⁻¹) but exhibited potent activity for voriconazole, posaconazole, itraconazole and fluconazole. The patient rapidly succumbed to cardiac arrest before antifungal therapy could be changed. Although disseminated trichosporonosis has been increasingly reported the diagnosis represents a challenge especially in rare clinical settings such as intraventricular fungal ball in the present case, which has not been described previously.
中枢神经系统毛孢子菌病是一种罕见的临床病症，迄今为止仅有6例记录在案，其中脑脓肿和脑膜炎各3例。我们报告了一例罕见病例，一名来自东非布隆迪的18岁免疫功能正常男性因阿萨希毛孢子菌感染导致慢性脑膜脑室炎和脑室内真菌球。神经内镜检查显示脑室内有多个结节和一个真菌球，培养后鉴定为阿萨希毛孢子菌。患者最初接受脂质体两性霉素B经验性治疗。然而，对阿萨希毛孢子菌分离株的抗真菌药敏试验显示，两性霉素B（2μg/ml⁻¹）、氟胞嘧啶（16μg/ml⁻¹）和卡泊芬净（2μg/ml⁻¹）的最低抑菌浓度较高，但对伏立康唑、泊沙康唑、伊曲康唑和氟康唑表现出强效活性。在更改抗真菌治疗之前，患者迅速死于心脏骤停。尽管播散性毛孢子菌病的报道越来越多，但诊断仍然具有挑战性，尤其是在本病例这种罕见的临床情况下，如脑室内真菌球，此前尚未见相关描述。
