SUCCESSFULLY TREATED FUNGEMIA DUE TO TRICHOSPORON BEIGELII IN NEONATES

J. Evdoridou, P. Panagopoulou, E. Bibashi, D. Sofianou, G. Kremenopoulos, E. Roilides

Aristotle University; Hippokration Hospital of Thessaloniki, Greece

Trichosporon beigelii is a blastomycete isolated from soil, water and vegetation. It causes both superficial and invasive (localised or disseminated) infections, mainly in immunodeficient hosts, associated with high mortality. Five cases have been described in children and 9 in neonates. We describe the first neonatal case of T. beigelii fungemia in Greece. A 26-wk 890-gr female delivered vaginally was admitted to NICU where she suffered from severe RDS during the first days and was managed with assisted ventilation, surfactant and ampicillin plus gentamycin. After the 4th day she manifested seizures, respiratory deterioration, gastrointestinal signs and shock. A blood culture (BC) drawn during this episode and before she started imipenem empirically was positive for Klebsiella pneumoniae and T. beigelii. Four days later, another BC was positive only for T. beigelii. The tip of a venous catheter and surveillance cultures of the patient's pharynx and perineum also yielded T.beigelii. Minimal inhibitory concentrations (NCCLS method) were 2 ug/ml for amphotericin B, 64 for flucytosine, 8 for fluconazole and 4 for itraconazole. The fungemia was successfully treated with deoxycholate amphotericin B (total dose 28mg/Kg) without adverse effects. To our knowledge, this is the first case of neonatal trichosporonosis in Greece and the 10th case in the English literature (MEDLINE). In addition to our patient, only two of the previously reported 9 cases survived (one with urinary tract infection and one with fungemia). In 3/10 neonates the diagnosis was made post mortem. The remaining 7 cases were premature neonates (23-26wks of gestation). All survivors were treated with amphotericin B. T. beigelii is a rare cause of neonatal fungemia that may have favourable outcome with prompt antifungal therapy.