The basidiomycetous yeast Trichosporon may cause severe lung exacerbation in cystic fibrosis patients - clinical analysis of Trichosporon positive patients in a Munich cohort

Background: The relevance of Trichosporon species for cystic
fibrosis (CF) patients has not yet been extensively investigated.
Methods: The clinical course of CF patients with Trichosporon spp.
in their respiratory secretions was analysed between 2003 and 2010
in the Munich CF center. All respiratory samples of 360 CF patients
(0 - 52.4 years; mean FEV1 2010 81.4% pred) were investigated.
Results: In 8 patients (2.2%, 3 male, mean age 21.8 years)
Trichosporon was detected at least once. One patient carried T.
asahii. One patient carried T. mycotoxinivorans and one patient T.
inkin as determined by DNA sequencing. As potential risk factors
for Trichosporon colonization steroid treatment, allergic
bronchopulmonary aspergillosis (ABPA) and CF associated diabetes
were identified in 6, 5, and 2 patients respectively. For one
patient, the observation period was not long enough to determine
the clinical course. One patient had only a single positive
specimen and exhibited a stable clinical course determined by
change in forced expiratory volume in one second (FEV1),
body-mass-index (BMI), C-reactive protein (CRP) and immunoglobulin
G (IgG). Of 6 patients with repeatedly positive specimen (mean
detection period 4.5 years), 4 patients had a greater decline in
FEV1 than expected, 2 of these a decline in BMI and 1 an increase
in IgG above the reference range. 2 patients received antimycotic
treatment: one patient with a tormenting dry cough subjectively
improved under Amphotericin B inhalation; one patient with a severe
exacerbation due to T. inkin was treated with i.v. Amphotericin B,
oral Voriconazole and Posaconazole which stabilized the clinical
condition. Conclusions: This study demonstrates the potential
association of Trichosporon spp. with severe exacerbations in CF
patients.