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- W2040757114 abstract "Background: Disseminated infection by Trichosporon species (DT) is an uncommon but frequently fatal mycosis in neutropenic patients, including recipients of hematopoietic stem cell transplantation (HSCT). However, little is known about the clinical characteristics and treatment outcome of DT due to its rarity. Methods: A questionnaire was sent to 468 hospitals in Japan to survey DT, which was defined as infectious symptoms associated with positive blood culture for Trichosporon species. In selected patients, genetic subtypes and antifungal susceptibility of the isolates were analyzed. Results: Between 2000 and 2007, 67 patients (median age, 57 years: range, 16–78) with a variety of hematological diseases developed DT. The diagnosis included acute myeloid leukemia (n = 39), acute lymphoblastic leukemia (8), chronic myeloid leukemia (6), and lymphoma (6), and 28 patients (42%) were recipients of HSCT. At the onset of DT, 55 patients (82%) had an absolute neutrophil count below 500 /mm3, and 58 patients (87%) had been receiving antifungal agents, including micafungin (MCFG) in 39 patients. In 35 patients (52%), Trichosporon species were detected in various organs including lung (n = 18), kidney (12), heart (6), and skin (6). A beta-D-glucan test was positive in 43 of the 62 evaluated patients (median, 96 pg/ml; range, 22–3961). Whereas 2 isolates of T. asahi appeared to be resistant to all antifungal agents including azoles, 22 isolates showed good susceptibility to voriconazole, but not to MCFG. Although 56 of the 67 patients (84%) received various antifungal agents for DT, the mortality rate within 30 days was 67% (median survival time, 13 days). Overall survival was significantly better in patients who received azoles rather than amphotericin products without azole (p = 0.0002). In a multivariate analysis, treatment without azoles for DT and recipients of HSCT were associated with a higher probability of day-30 mortality after the development of DT. Conclusions: Our study suggests that most cases of DT occurred as a breakthrough infection, especially in patients who had received MCFG. Although mortality after the development of DT was high, it is possible that prompt initiation of treatment with azoles may improve survival." @default.
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- W2040757114 date "2009-02-01" @default.
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- W2040757114 title "Clinical Characteristics and Treatment Outcome of Disseminated Trichosporonosis: Survey of 67 Patients with Hematological Disease" @default.
- W2040757114 doi "https://doi.org/10.1016/j.bbmt.2008.12.285" @default.
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