Session Type: ePosters
Session Title: ePosters
Authors(s): A. Goenka (1), I. Harding (2), S. Fudge (2)
Authors Affiliations(s): (1) University of Bristol, United Kingdom, (2) Bristol Royal Infirmary, United Kingdom
Background:
Trichopsoron spp. are a heterogenous group of environmental yeasts found mainly in the soil that colonise the skin, respiratory and gastrointestinal tract. The name was derived by Hermann Beigel in 1865 from the Greek words for hair (trichos) and hair (sporon) after observing its association with benign hair infections. Trichosporon spp. uncommonly causes invasive infections including funagemia, endocarditis and peritonitis.
Case:A 21-month-old boy presented to his local hospital with a short history of irritability, abnormal posturing and drowsiness. He was known to have congenital heart disease involving transposition of the great arteries and a ventricular septal defect (VSD). Following insertion of a Blalock–Taussig shunt in first weeks of life, he underwent Rastelli procedural repair at 11 months of age involving patch VSD closure and an aortic homograft conduit to relieve pulmonary outflow obstruction. Echocardiogram revealed a large mobile lesion in the right ventricular outflow tract and a vegetation partially occluding the homograft conduit suggestive of prosthetic valve endocarditis . Further imaging revealed pulmonary emboli and a mycotic lesion in the right kidney.
Blood cultures were positive and Gram staining demonstrated yeasts, prompting treatment with intravenous liposomal amphotericin B (3mg/kg). Trichosporon inkin was subsequently identified in blood and tissue cultures by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF).
Discussion:
The child underwent surgery to refashion the right ventricle outflow conduit. The original graft and surrounding tissue was excised and vegetations from the pulmonary artery were removed. It was not technically possible to remove all of the infected material from the VSD patch. A craniotomy was performed and the occipital haematoma was evacuated. An external ventricular device (EVD) was placed temporarily and subsequently the aneurysm was coiled, before insertion of a ventriculoperitoneal shunt.
Treatment for fungal endocarditis was rationalised to oral fluconazole (12mg/kg daily) and oral metronidazole for a following three months. He continues to receive long-term antifungal suppression with oral fluconazole.
Our case highlights that the diagnostic and therapeutic challenges presented by PVE caused by T. inkinthat can be overcome by early identification of the organism facilitated by MALDI-TOF, prompt surgery and prolonged antifungal therapy driven by in vitro susceptibility testing.
Keyword(s): Endocarditis, trichosporon, fungalSession Type: ePosters
Session Title: ePosters
Authors(s): A. Goenka (1), I. Harding (2), S. Fudge (2)
Authors Affiliations(s): (1) University of Bristol, United Kingdom, (2) Bristol Royal Infirmary, United Kingdom
Background:
Trichopsoron spp. are a heterogenous group of environmental yeasts found mainly in the soil that colonise the skin, respiratory and gastrointestinal tract. The name was derived by Hermann Beigel in 1865 from the Greek words for hair (trichos) and hair (sporon) after observing its association with benign hair infections. Trichosporon spp. uncommonly causes invasive infections including funagemia, endocarditis and peritonitis.
Case:A 21-month-old boy presented to his local hospital with a short history of irritability, abnormal posturing and drowsiness. He was known to have congenital heart disease involving transposition of the great arteries and a ventricular septal defect (VSD). Following insertion of a Blalock–Taussig shunt in first weeks of life, he underwent Rastelli procedural repair at 11 months of age involving patch VSD closure and an aortic homograft conduit to relieve pulmonary outflow obstruction. Echocardiogram revealed a large mobile lesion in the right ventricular outflow tract and a vegetation partially occluding the homograft conduit suggestive of prosthetic valve endocarditis . Further imaging revealed pulmonary emboli and a mycotic lesion in the right kidney.
Blood cultures were positive and Gram staining demonstrated yeasts, prompting treatment with intravenous liposomal amphotericin B (3mg/kg). Trichosporon inkin was subsequently identified in blood and tissue cultures by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF).
Discussion:
The child underwent surgery to refashion the right ventricle outflow conduit. The original graft and surrounding tissue was excised and vegetations from the pulmonary artery were removed. It was not technically possible to remove all of the infected material from the VSD patch. A craniotomy was performed and the occipital haematoma was evacuated. An external ventricular device (EVD) was placed temporarily and subsequently the aneurysm was coiled, before insertion of a ventriculoperitoneal shunt.
Treatment for fungal endocarditis was rationalised to oral fluconazole (12mg/kg daily) and oral metronidazole for a following three months. He continues to receive long-term antifungal suppression with oral fluconazole.
Our case highlights that the diagnostic and therapeutic challenges presented by PVE caused by T. inkinthat can be overcome by early identification of the organism facilitated by MALDI-TOF, prompt surgery and prolonged antifungal therapy driven by in vitro susceptibility testing.
Keyword(s): Endocarditis, trichosporon, fungal