Disseminated Trichosporon asahii Infection in an Immunocompetent Polytrauma Patient; A Case Report

Trichosporon asahii is a yeast-like opportunistic pathogen known to cause many infections. It is known to cause infections in immunocompromised patients with hematologic malignancies and those who develop neutropenia secondary to cytotoxic drugs. We report a case of a 35-year-old man with no previously known comorbid who presented at our ED with polytrauma and full-thickness burns covering 20% of the total body surface area (TBSA). Despite being previously healthy, we explored several factors that made our patient susceptible to T asahii infection, including full-thickness burns, polytrauma, indwelling catheters, and massive blood transfusions. The definitive route of infection remains unclear, however case reports like ours can shed light on modifiable risk factors in patients. Keywords: Polytrauma, Fungemia, Burn, Trichosporon asahii, Indwelling catheters 1. A. L. Colombo, A. C. B. Padovan, and G. M. Chaves, “Current Knowledge of Trichosporon spp. and Trichosporonosis,” Clin. Microbiol. Rev., vol. 24, no. 4, pp. 682–700, Oct. 2011, doi: 10.1128/CMR.00003-11. 2. O. Cho, M. Matsukura, and T. Sugita, “Molecular evidence that the opportunistic fungal pathogen Trichosporon asahii is part of the normal fungal microbiota of the human gut based on rRNA genotyping,” Int. J. Infect. Dis., vol. 39, pp. 87–88, Oct. 2015, doi: 10.1016/j.ijid.2015.09.009. 3. D. Ch, “Trichosporon Asahii fungaemia in an immunocompetent polytrauma patient who received multiple antibiotics,” 2020. 4. J. N. De Almeida Júnior and C. Hennequin, “Invasive Trichosporon Infection: a Systematic Review on a Re-emerging Fungal Pathogen,” Front. Microbiol., vol. 7, Oct. 2016, doi: 10.3389/fmicb.2016.01629. 5. D. G. Wolf et al., “Multidrug-Resistant Trichosporon asahii Infection of Nongranulocytopenic Patients in Three Intensive Care Units,” J. Clin. Microbiol., vol. 39, no. 12, pp. 4420–4425, Dec. 2001, doi: 10.1128/JCM.39.12.4420-4425.2001. 6. Z. Rubic, A. Novak, Z. Tomic, I. Goic-Barisic, M. Radic, and M. Tonkic, “Prompt diagnosis and effective treatment of Trichosporon asahii catheterrelated infection in non-immunocompromised neurosurgical patient,” Mycopathologia, vol. 179, no. 1–2, pp. 125–128, Feb. 2015, doi: 10.1007/s11046-014-9814-9. 7. H. Dt. Torrance et al., “Association Between Gene Expression Biomarkers of Immunosuppression and Blood Transfusion in Severely Injured Polytrauma Patients,” Ann. Surg., vol. 261, no. 4, pp. 751–759, Apr. 2015, doi: 10.1097/SLA.0000000000000653. 8. R. Halbgebauer et al., “Hemorrhagic shock drives glycocalyx, barrier and organ dysfunction early after polytrauma,” J. Crit. Care, vol. 44, pp. 229– 237, Apr. 2018, doi: 10.1016/j.jcrc.2017.11.025. 9. M. A. Pfaller and D. J. Diekema, “Rare and Emerging Opportunistic Fungal Pathogens: Concern for Resistance beyond Candida albicans and Aspergillus fumigatus,” J. Clin. Microbiol., vol. 42, no. 10, pp. 4419–4431, Oct. 2004, doi: 10.1128/JCM.42.10.4419-4431.2004. 10. H. G. Lee et al., “Blood Stream Infections in Patients in the Burn Intensive Care Unit,” Infect. Chemother., vol. 45, no. 2, p. 194, 2013, doi: 10.3947/ic.2013.45.2.194. 11. M. J. Cawley, G. R. Braxton, L. R. Haith, K. J. Reilly, R. E. Guilday, and M. L. Patton, “Trichosporon beigelii infection: experience in a regional burn center,” Burns, vol. 26, no. 5, pp. 483–486, Aug. 2000, doi: 10.1016/S0305- 4179(99)00181-3. 12. R. A. Hajjeh and H. M. Blumberg, “Bloodstream Infection due to Trichosporon beigelii in a Burn Patient: Case Report and Review of Therapy,” Clin. Infect. Dis., vol. 20, no. 4, pp. 913–916, Apr. 1995, doi: 10.1093/clinids/20.4.913. 13. C. Duarte-Oliveira, F. Rodrigues, S. M. Gonçalves, G. H. Goldman, A. Carvalho, and C. Cunha, “The Cell Biology of the Trichosporon-Host Interaction,” Front. Cell. Infect. Microbiol., vol. 7, Apr. 2017, doi: 10.3389/fcimb.2017.00118. 14. G. Di Bonaventura, A. Pompilio, C. Picciani, M. Iezzi, D. D’Antonio, and R. Piccolomini, “Biofilm Formation by the Emerging Fungal Pathogen Trichosporon asahii : Development, Architecture, and Antifungal Resistance,” Antimicrob. Agents Chemother., vol. 50, no. 10, pp. 3269–3276, Oct. 2006, doi: 10.1128/AAC.00556-06. 15. M. Washington, J. C. Barnhill, M. A. Duff, and J. Griffin, “Recovery of Bacteria and Fungi From a Leg Wound,” J. Spec. Oper. Med., vol. 15, no. 4, p. 113, 2015, doi: 10.55460/DW1G-SZNG. 16. F. Yang et al., “Disseminated Trichosporon asahii infection presenting as eosinophilia in an immunocompetent patient: A case report,” Indian J. Med. Microbiol., vol. 39, no. 4, pp. 552–555, Oct. 2021, doi: 10.1016/j.ijmmb.2021.05.021.