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LETTER TO EDITOR  
Year : 2015  |  Volume : 58  |  Issue : 3  |  Page : 413-414
Trichosporon asahii as a cause of urinary tract infection: A rare human pathogen


1 Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India

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Date of Web Publication14-Aug-2015
 

How to cite this article:
Ranjan R, Chowdhary P, Pandey A, Adarsh R. Trichosporon asahii as a cause of urinary tract infection: A rare human pathogen. Indian J Pathol Microbiol 2015;58:413-4

How to cite this URL:
Ranjan R, Chowdhary P, Pandey A, Adarsh R. Trichosporon asahii as a cause of urinary tract infection: A rare human pathogen. Indian J Pathol Microbiol [serial online] 2015 [cited 2020 Jun 6];58:413-4. Available from: http://www.ijpmonline.org/text.asp?2015/58/3/413/162941


Editor,

Trichosporon species are basidiomycetes fungi that inhabit the soil and may also be present in air, water, organic substrate, and in other external environments. [1],[2] They colonize the skin, gastrointestinal tract, and respiratory tract of humans, and also been detected in feces, sputum, blood, and central venous catheters. [3],[4] They cause white piedra and onychomycosis in immunocompetent hosts. [5] They are reported as a cause of disseminated invasive yeast infection in the immunocompromised host. [3] Invasive urinary tract infection caused by Trichosporon asahii is rare.

A 55-year-old male was admitted in our hospital following a road traffic accident. His Glasgow Coma Score was poor at the time of admission with computerized tomographic scan of brain showing extensive subarachnoid hemorrhage with marked cerebral edema. Patient was put on ventilator and treatment was started. Patient had a history of diabetes mellitus. His investigations showed hemoglobin 13.1 g%. His total leukocyte count was 17,600/mL with 85% neutrophils and 13% lymphocytes. Random blood sugar was 267 mg/dL.

His blood and urine samples came in our laboratory for culture and sensitivity. Blood was sterile on culture. Urine was cultured on cystine lactose electrolyte deficient (CLED) agar plate. On Gram-staining, urine showed few pus cells and budding yeast cells. Tiny creamy white wrinkled colony was seen on CLED agar plate after overnight incubation at 37°C. Gram stain of colony showed intertwined hyphae and rectangular arthroconidia [Figure 1]a. Germ tube test was performed which was negative. Two more consecutive urine samples of the patient were obtained and analyzed. Colony from CLED agar was subcultured on Sabouraud's dextrose agar (SDA) and incubated at 25°C and 37°C. After 24 h of incubation, both tubes of SDA showed white to the creamy smooth colony. It became yellow waxy wrinkled and raised with central cerebriform folds after 7 days of incubation [Figure 2]. In CHROM agar, light green colony was seen after overnight incubation. In Cornmeal Tween 80 agar, this yeast-like fungus showed hyphae that fragmented in arthroconidia and blastoconidia [Figure 1]b. The yeast-like fungus was identified as Trichosporon species on the basis of its colony morphology, Gram-staining, positive urease test, failure to ferment carbohydrates, and formation of pellicle in Sabouraud's dextrose broth. It was further identified as T. asahii by VITEK ® 2 system (bioMeriux Inc.,100 Rodolphe Street, Durham, NC, USA).
Figure 1: (a) Gram stain of colony showed intertwined hyphae and rectangular arthroconidia, (b) Cornmeal Tween 80 agar showing hyphae that fragment in arthroconidia and blastoconidia


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Figure 2: (a) After 24 h of incubation, both tubes of Sabouraud's dextrose agar showed white to creamy smooth colony, (b) it became yellow waxy wrinkled and raised with central cerebriform folds after 7 days of incubation


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On the basis of our preliminary report, antifungal therapy with fluconazole was started. However, unfortunately as the patient had severe brain injury he did not survive.

Isolation of same yeast in three consecutive samples in significant count established T. asahii as an etiological agent of urinary tract infection.

In this case, the patient was diabetic that is, immunocompromised. Hence, he was prone to opportunistic infection. Furthermore, the patient was on the urinary catheter; it is possible that the fungus colonized the urinary catheter from the skin flora during catheterization and subsequently progressed toward invasive Trichosporonosis.

We concluded that early detection and identification of Trichosporon is necessary to provide specific and appropriate treatment. For this, a high level of suspicion is necessary because of the silent diagnostic feature of the etiological agent.

 
   References Top

1.
Pini G, Faggi E, Donato R, Fanci R. Isolation of Trichosporon in a hematology ward. Mycoses 2005;48:45-9.  Back to cited text no. 1
    
2.
Biswas SK, Wang L, Yokoyama K, Nishimura K. Molecular phylogenetics of the genus trichosporon inferred from mitochondrial cytochrome B gene sequences. J Clin Microbiol 2005;43:5171-8.  Back to cited text no. 2
    
3.
Wolf DG, Falk R, Hacham M, Theelen B, Boekhout T, Scorzetti G, et al. Multidrug-resistant Trichosporon asahii infection of nongranulocytopenic patients in three intensive care units. J Clin Microbiol 2001;39:4420-5.  Back to cited text no. 3
    
4.
Shang ST, Yang YS, Peng MY. Nosocomial Trichosporon asahii fungemia in a patient with secondary hemochromatosis: A rare case report. J Microbiol Immunol Infect 2010;43:77-80.  Back to cited text no. 4
    
5.
Chowdhary A, Ahmad S, Khan ZU, Doval DC, Randhawa HS. Trichosporon asahii as an emerging etiologic agent of disseminated trichosporonosis: A case report and an update. Indian J Med Microbiol 2004;22:16-22.  Back to cited text no. 5
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Correspondence Address:
Dr. Priti Chowdhary
Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.162941

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