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Journal of Clinical Microbiology, April 2005, p. 1818-1828, Vol. 43, No. 4
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.4.1818-1828.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Invasive Infections Caused by Trichosporon Species and Geotrichum capitatum in Patients with Hematological Malignancies: a Retrospective Multicenter Study from Italy and Review of the Literature

Corrado Girmenia,^1* Livio Pagano,² Bruno Martino,³ Domenico D'Antonio,⁴ Rosa Fanci,⁵ Giorgina Specchia,⁶ Lorella Melillo,⁷ Massimo Buelli,⁸ Giampaolo Pizzarelli,⁹ Mario Venditti,¹⁰ Pietro Martino,¹ the GIMEMA Infection Program,

Dipartimento di Biotecnologie Cellulari ed Ematologia,¹ Dipartimento di Medicina Clinica, University "La Sapienza," ,¹⁰ Istituto di Ematologia, Universita Cattolica del S. Cuore,² Pfizer Italia S.r.l., Rome,⁹ Ospedali Riuniti, Reggio Calabria,³ Unità di Microbiologia, Divisione di Ematologia, Ospedale Civile Spirito Santo, Pescara,⁴ Cattedra di Ematologia, Azienda Ospedaliera Careggi, University of Florence, Florence,⁵ Sezione di Ematologia, Dipartimento di Medicina Interna e Medicina Pubblica, University of Bari, Bari,⁶ IRCCS Ospedale "Casa Sollievo della Sofferenza", San Giovanni Rotondo,⁷ Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy⁸

Received 4 August 2004/ Returned for modification 12 October 2004/ Accepted 16 December 2004

Trichosporonosis is an uncommon but frequently fatal mycosis in immunocompromised patients. A multicenter retrospective study was conducted to characterize cases of proven or probable invasive trichosporonosis diagnosed over the past 20 years in Italian patients with hematological diseases. Of the 52 cases identified, 17 were classified as Trichosporon sp. infections and 35 were attributed to Geotrichum capitatum. Acute myeloid leukemia accounted for 65.4% of the cases. The incidence rates of Trichosporon sp. and G. capitatum infections in acute leukemia patients were 0.4 and 0.5%, respectively. Overall, 76.9% of cases had positive blood cultures. Pulmonary involvement was documented in 26.9% of cases. Death was reported for 57.1% of G. capitatum infections and for 64.7% of Trichosporon sp. infections. A literature review on trichosporonosis in patients with any underlying disease or condition reveals G. capitatum as a predominantly European pathogen, particularly in certain Mediterranean areas, while Trichosporon sp. infections are seen with similar frequencies on all continents. The majority of published Trichosporon sp. and G. capitatum infections occurred in patients with hematological diseases (62.8 and 91.7%, respectively). Well over half of these were suffering from acute leukemia (68 and 84% of patients with Trichosporon sp. and G. capitatum infections, respectively). Crude mortality rates were 77% for Trichosporon spp. and 55.7% for G. capitatum. The optimal therapy for trichosporonosis has yet to be identified; however, in vitro experiences are providing encouraging evidence of the potential role of the new triazoles, in particular, voriconazole.

Participating members of the GIMEMA Infection Program are listed in Acknowledgments.

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