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Journal of Clinical Microbiology, October 2009, p. 3091-3097, Vol. 47, No. 10
0095-1137/09/$08.00+0     doi:10.1128/JCM.00460-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Trichosporon mycotoxinivorans, a Novel Respiratory Pathogen in Patients with Cystic Fibrosis{triangledown}

Patrick W. Hickey,1,2* Deanna A. Sutton,3 Annette W. Fothergill,3 Michael G. Rinaldi,3 Brian L. Wickes,4 Howard J. Schmidt,5,6 and Thomas J. Walsh7

Division of Pediatric Infectious Disease,1 Division of Pediatric Pulmonology, Walter Reed Army Medical Center, Washington, DC,5 Departments of Pediatrics and Preventive Medicine & Biometrics, Uniformed Services University, Bethesda, Maryland,2 Fungus Testing Laboratory, Department of Pathology, University of Texas Health Science Center, San Antonio, Texas,3 Department of Microbiology, University of Texas Health Science Center, San Antonio, Texas,4 Division of Pediatric Pulmonology, Virginia Commonwealth University, Richmond, Virginia,6 National Cancer Institute, Pediatric Oncology Branch, Immunocompromised Host Section, Bethesda, Maryland7

Received 4 March 2009/ Returned for modification 22 June 2009/ Accepted 31 July 2009

This report describes the molecular epidemiology, in vitro susceptibility, colonial and microscopic morphologies, and biochemical features of Trichosporon mycotoxinivorans, a newly recognized pathogen that appears to have a propensity for patients with cystic fibrosis. The index patient died with histologically documented Trichosporon pneumonia complicating cystic fibrosis. This is also the first report of disease caused by a Trichosporon species in a nontransplant patient with cystic fibrosis. As T. mycotoxinivorans has not previously been recognized as a respiratory pathogen, the significance of its recovery from sputum samples was not initially appreciated. Genetic analysis of archived clinical samples found three additional cases of T. mycotoxinivorans infection which had previously been identified as other members of the genus. An additional isolate of T. mycotoxinivorans was identified from a clinical sample on initial testing. Three of these four cases were also patients with cystic fibrosis. All isolates had MICs at 48 h of amphotericin B of ≥1 µg/ml and of echinocandins of ≥16 µg/ml, but they displayed various susceptibilities to the triazoles. In summary, Trichosporon mycotoxinivorans is a newly recognized human pathogen that is associated with cystic fibrosis.

* Corresponding author. Mailing address: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4712. Phone: (301) 295-9779. Fax: (301) 295-1971. E-mail: phickey{at}usuhs.mil

{triangledown} Published ahead of print on 5 August 2009.

Journal of Clinical Microbiology, October 2009, p. 3091-3097, Vol. 47, No. 10
0095-1137/09/$08.00+0     doi:10.1128/JCM.00460-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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