Epidemiology And Outcome Of Trichosporonosis All Over The World:A Review Of 602 Cases

BackgroundIn recent years,there are more and more opportunistic fungal infections,among which trichosporonosis is concerned increasingly by clinicians.Trichosporonosis is a fungal infectious disease infected by trichosporon.At present,there are more than 50 kinds of trichosporon,16 of which are clinically pathogenic.Trichosporon is a basidiomycete yeast.It is not only widely distributed in the natural environment,but also colonized in human respiratory tract,digestive tract and skin.Under certain conditions,it can cause superficial or even invasive fungal infection.The superficial infection of trichosporon is not specific,so it is easy to be misdiagnosed and missed.Previous studies have shown that immunocompromised patients with hematological malignancies or organ transplantation or advanced HIV or diabetes,are susceptible to invasive trichosporon infection.In the treatment of invasive trichosporon infection,it is difficult to treat because of its resistance to most antifungal drugs,and the mortality is high.In 2014,European guidelines for the treatment of rare invasive yeast infections were making.Voriconazole(B-Ⅲ)was recommended as the first choice for the treatment of trichosporonosis,followed by fluconazole(C-Ⅲ).However,the recommended levels were lower(Ⅲ:Based on clinical experience,case reports or expert consensus,etc.,and there was no randomized controlled trial of large clinical samples).Therefore,this study aims to analyze the epidemiology,infection,treatment and outcome of trichosporonosis in recent 69 years,so that it could make clinicians,experts and scholars have a deep and systematic understanding of trichosporonosis,and provide important reasoning for clinical diagnosis,treatment and outcome.Therefore,this study aims to analyze the epidemiology,infection,treatment and outcome of trichosporonosis in recent 69 years,so that it could make clinicians,experts and scholars have a deep and systematic understanding of trichosporonosis,and provide important reasoning for clinical diagnosis,treatment and outcome.ObjectiveThrough the analysis of all the cases in the original case reports and case series in English and Chinese literature from December 1951 to June 2019,we may guide the clinicians to fully understand the epidemiology,in vitro drug sensitivity,therapeutic drugs and outcome of trichosporonsis,and provide important clinical basis and ideas for clinicians to diagnose and treat trichosporonsis。MethodsWe performed a systematic search in the PubMed database using the following key words:"trichosporon","trichosporonsis","trichosporosis","white piedra","piedra".At the same time,we performed a systematic search CNKI,VIP and Wanfang Chinese databases using the following key words:"trichosporidiosis","trichosporidiosis".We performed three independent searchs totally,and let the second person(Li Haitao)review the search results in order to avoid omissions.Results1.602 patients with trichosporonosis were included by this study.2.In addition to Antarctica and Oceania,the other five continents have the distribution of trichosporonosis patients,mainly in Asia and North America,and the number of patients was increasing year by year.It was reported in all ages,with the most patients aged 41-65,and male patients were always the main affected population.3.The main inducing factors are antibiotic use and chemotherapy;the most common basic disease was blood system disease;The main types of infection were bacteremia,disseminated infection and urinary system infection;and the most frequently infected organs were blood system,urinary system and skin;The most common samples were blood,urine and skin tissue;Morphological and ecological methods were the most common identification methods;The most common trichosporon species was Trichosporon asahii(39.7%),then Trichosporon inkin(9.8%),Trichosporon cutaneum(4.8%),Trichosporon laibachii(0.2%),Trichosporon montevideense(0.2%),Trichosporon terrestre(0.2%)4.Among the 602 patients with trichosporonosis,123 were reported susceptibility test in vitro and the results showed that most of the patients with T.beigelii infection were most sensitive to Amphotericin B,and most of the patients with T.asahii and T.inkin infection were most sensitive to Voriconazole.5.Among the 602 patients 523 patients(86.9%)showed documentation antifungal therapy,but 79 patients(13.1%)did not.The most common antifungal drug was Amphotericin B/Amphotericin B liposome(13.6%),followed by Fluconazole(10.1%),Amphotericin B combined with Triazoles(9.3%),Voriconazole(8.8%).6.Of 523 patients with definite therapy,490 patients were reported outcome,and 286 patients were reported positive outcome(improved or cured),but 204 patients were reported negative outcome(deteriorated or died).7.The clinical effect of four commonly antifungal therapies for invasive trichosporonosis was analyzed:the effective rate of Amphotericin B alone was 30.9%,and Fluconazole alone was 79.3%,and Voriconazole alone was 72.5%,and Amphotericin B combined with Azoles was 42.9%.Comparing the effect between four different antifungal therapies,we found that there were significant differences in the clinical outcome between Amphotericin B and Fluconazole,between Amphotericin B and Voriconazole,between Fluconazole and Amphotericin B combined with Azoles,between Voriconazole and Amphotericin B combined with Azoles(P<0.0083).While there was no significant difference between Amphotericin B and Amphotericin B combined with Azoles,between Fluconazole and Voriconazole(P>0.0083).8.The clinical effect of two commonly antifungal therapies for superficial trichosporonosis was analyzed:the effective rate of oral antifungal drugs combined with topical drugs was 100.0%,and topical drugs alone was 96.8%.Comparing the effect between these two different antifungal therapies,we found that there was no significant difference between them(P>0.05).Conclusion1.The number of case reports of trichosporonosis was increasing year by year;patients with trichosporonosis were mainly distributed in Asia and North America;It was reported in all ages,with the most patients aged 41-65;the most common basic disease was blood system disease;the main types of infection were bacteremia;the most common trichosporon species was T.asahii;susceptibility test in vitro showed that most of the patients with T.asahii infection were most sensitive to Voriconazole.2.All-cause mortality of trichosporonosis was 39.6%.According to different types of infection,the mortalities of disseminated trichosporon infection and trichosporon bacteremia were 64.3%and 56.3%,respectively.3.Fluconazole and Voriconazole had the best effect on the treatment of invasive trichosporonosis,and there was significant difference comparing with Amphotericin B(P<0.0083).The effect of oral antifungal drugs combined with topical drugs and topical antifungal drugs alone on superficial trichosporonosis was similar(P>0.05),and it was very good.