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Review Articles

Multidrug-resistant Trichosporon species: underestimated fungal pathogens posing imminent threats in clinical settings

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Pages 679-698 | Received 21 Dec 2020, Accepted 19 Apr 2021, Published online: 11 Jun 2021
 

Abstract

Species of Trichosporon and related genera are widely used in biotechnology and, hence, many species have their genome sequenced. Importantly, yeasts of the genus Trichosporon have been increasingly identified as a cause of life-threatening invasive trichosporonosis (IT) in humans and are associated with an exceptionally high mortality rate. Trichosporon spp. are intrinsically resistant to frontline antifungal agents, which accounts for numerous reports of therapeutic failure when echinocandins are used to treat IT. Moreover, these fungi have low sensitivity to polyenes and azoles and, therefore, are potentially regarded as multidrug-resistant pathogens. However, despite the clinical importance of Trichosporon spp., our understanding of their antifungal resistance mechanisms is quite limited. Furthermore, antifungal susceptibility testing is not standardized, and there is a lack of interpretive epidemiological cut-off values for minimal inhibitory concentrations to distinguish non-wild type Trichosporon isolates. The route of infection remains obscure and detailed clinical and environmental studies are required to determine whether the Trichosporon infections are endogenous or exogenous in nature. Although our knowledge on effective IT treatments is rather limited and future randomized clinical trials are required to identify the best antifungal agent, the current paradigm advocates the use of voriconazole, removal of central venous catheters and recovery from neutropenia.

Additional information

Funding

JNAJ has received a research grant from Fundação de Amparo à Pesquisa do Estado de São Paulo (n. 2018/19347-4). ALC has received research grants from the Conselho Nacional de Desenvolvimento Científico e Tecnologico (CNPq 484020-2013-7 and CNPq 307510/ 2015-8), and from Astellas and Pfizer.

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