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A case report of a cystic fibrosis patient with repeated isolation of Trichosporon mycotoxinivorans identified by a novel short-extraction method


Background:
Trichosporon mycotoxinivorans is a recently described yeast-like fungal organism and its association as a pathogen for patients with cystic fibrosis (CF) was reported previously. We show the clinical course of a CF patient over 9 years as well as the applications of modern molecular and proteomic identification techniques of this rare fungus.

Case presentation:
We present the case of a 32-year-old male CF patient with sputum cultures continuously positive with the anamorphic yeast T. mycotoxinivorans during 9 years. Furthermore, susceptibility testing of T. mycotoxinivorans to different antifungals were performed. In addition, a rapid identification method of this novel fungal pathogen with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was applied using a simple extraction protocol.

Conclusions:
Our case presentation confirms T. mycotoxinivorans as a potential emerging pathogen in patients with CF. However, our CF patient showed mild symptoms over a very long time period of 9 years. A short MALDI-TOF MS procedure allows reliable and rapid identification of T. mycotoxinivorans and therefore should facilitate further study on the clinical relevance and epidemiology of this unusual fungal organism.

Keywords:
Trichosporon mycotoxinivorans, Cystic fibrosis (CF), Internal transcribed spacer (ITS), Emerging pathogen, MALDI-TOF MS


Autoři: Daniel Goldenberger† 1*;  Vladimira Hinić† 1;  Spasenija Savic Prince 2;  Michael Tamm 3;  Anna-Maria Balestra 3,4;  Doris Hohler 1;  Reno Frei 1
Působiště autorů: Division of Clinical Microbiology, University Hospital Basel, Petersgraben , CH-40 1 Basel, Switzerland. 1;  Division of Pathology, University Hospital Basel, Schönbeinstrasse 0, CH-40 1 Basel, Switzerland. 2;  Division of Pneumology, University Hospital Basel, Petersgraben , CH- 031 Basel, Switzerland. 3;  Present address: Division of Pneumology, St. Claraspital Basel, Basel, Switzerland. 4
Vyšlo v časopise: BMC Infectious diseases 2016, 16:601
Kategorie: Case report
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12879-016-1910-7

© 2016 The Author(s).

Open access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1910-7

Souhrn

Background:
Trichosporon mycotoxinivorans is a recently described yeast-like fungal organism and its association as a pathogen for patients with cystic fibrosis (CF) was reported previously. We show the clinical course of a CF patient over 9 years as well as the applications of modern molecular and proteomic identification techniques of this rare fungus.

Case presentation:
We present the case of a 32-year-old male CF patient with sputum cultures continuously positive with the anamorphic yeast T. mycotoxinivorans during 9 years. Furthermore, susceptibility testing of T. mycotoxinivorans to different antifungals were performed. In addition, a rapid identification method of this novel fungal pathogen with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was applied using a simple extraction protocol.

Conclusions:
Our case presentation confirms T. mycotoxinivorans as a potential emerging pathogen in patients with CF. However, our CF patient showed mild symptoms over a very long time period of 9 years. A short MALDI-TOF MS procedure allows reliable and rapid identification of T. mycotoxinivorans and therefore should facilitate further study on the clinical relevance and epidemiology of this unusual fungal organism.

Keywords:
Trichosporon mycotoxinivorans, Cystic fibrosis (CF), Internal transcribed spacer (ITS), Emerging pathogen, MALDI-TOF MS


Zdroje

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2. Molnar O, Schatzmayr G, Fuchs E, Prillinger H. Trichosporon mycotoxinivorans sp. nov., a new yeast species useful in biological detoxification of various mycotoxins. Syst Appl Microbiol. 2004;27:661–71.

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4. Hirschi S, Letscher-Bru V, Pottecher J, Lannes B, Jeung MY, Degot T, et al. Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum coinfection after lung and liver transplantation in a cystic fibrosis patient. J Clini Microbiol. 2012;50:4168–70.

5. Kroner C, Kappler M, Grimmelt AC, Laniado G, Wurstl B, Griese M. The basidiomycetous yeast Trichosporon may cause severe lung exacerbation in cystic fibrosis patients-clinical analysis of Trichosporon positive patients in a Munich cohort. BMC Pulm Med. 2013;13:61.

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10. Padhye AA, Verghese S, Ravichandran P, Balamurugan G, Hall L, Padmaja P, et al. Trichosporon loubieri infection in a patient with adult polycystic kidney disease. J Clin Microbiol. 2003;41:479–82.

11. Motaung TE, Albertyn J, Kock JL, Lee CF, Suh SO, Blackwell M, Pohl CH. Trichosporon vanderwaltii sp. nov., an asexual basidiomycetous yeast isolated from soil and beetles. Antonie Van Leeuwenhoek. 2013;103:313–9.

12. Van Herendael BH, Bruynseels P, Bensaid M, Boekhout T, De Baere T, Surmont I, et al. Validation of a modified algorithm for the identification of yeast isolates using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Eur J Clin Microbiol Infect Dis. 2012;31:841–8.

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