Yoss B S, Sautter R L, Brenker H J
Department of Pediatrics, Harrisburg Hospital, Pennsylvania, USA.
Am J Perinatol. 1997 Feb;14(2):113-7. doi: 10.1055/s-2007-994109.
Trichosporon beigelii is an uncommon cause of sepsis in low-birth-weight infants. We present two cases of neonatal trichosporonosis and two cases of neonatal trichosporon colonization to familiarize neonatologists with this entity and to discuss management considerations. A 23-week-gestation male developed clinical evidence of sepsis on day 10 and was found to have "yeast" growing in a blood culture on day 12. Despite receiving amphotericin B, he expired within 2 days, at which time the organism was identified as T. beigelii. A 23-week gestation female developed fungal septicemia in the second week of life, while being treated for persistent bacterial sepsis. Candida albicans grew from blood culture, while T. beigelii grew from suprapubic urine, tracheal aspirate, and umbilical catheter tip cultures. She died 2 days later despite therapy with amphotericin B, at which time the fungal isolates were correctly identified. Two other infants were found to have colonization of central vascular catheters, without evidence of invasive disease. Trichosporon infections in neonates have been almost uniformly fatal. Most strains of T. beigelii are relatively resistant to amphotericin B and may be confused with Candida sp. on initial culture examinations. Therefore, delays in appropriate treatment may occur. We discuss treatment options, including alternative antifungal drugs, as well as possibilities for combination therapy.
白吉利丝孢酵母是低体重儿败血症的罕见病因。我们报告两例新生儿丝孢酵母病和两例新生儿丝孢酵母定植病例，以使新生儿科医生熟悉这一疾病，并讨论治疗方面的注意事项。一名孕23周的男性在出生后第10天出现败血症的临床证据，第12天血培养发现有“酵母”生长。尽管接受了两性霉素B治疗，他仍在2天内死亡，此时该病原体被鉴定为白吉利丝孢酵母。一名孕23周的女性在出生后第二周发生真菌败血症，当时正在治疗持续性细菌性败血症。血培养分离出白色念珠菌，耻骨上尿液、气管吸出物和脐静脉导管尖端培养分离出白吉利丝孢酵母。尽管接受了两性霉素B治疗，她仍在2天后死亡，此时真菌分离株得到正确鉴定。另外两名婴儿被发现中心血管导管有定植，但无侵袭性疾病的证据。新生儿丝孢酵母感染几乎均为致命性。大多数白吉利丝孢酵母菌株对两性霉素B相对耐药，在初次培养检查时可能与念珠菌混淆。因此，可能会出现适当治疗延迟的情况。我们讨论了治疗方案，包括替代抗真菌药物以及联合治疗的可能性。
