Abstract

Species of Trichosporon and related genera are widely used in biotechnology and, hence, many species have their genome sequenced. Importantly, yeasts of the genus Trichosporon have been increasingly identified as a cause of life-threatening invasive trichosporonosis (IT) in humans and are associated with an exceptionally high mortality rate. Trichosporon spp. are intrinsically resistant to frontline antifungal agents, which accounts for numerous reports of therapeutic failure when echinocandins are used to treat IT. Moreover, these fungi have low sensitivity to polyenes and azoles and, therefore, are potentially regarded as multidrug-resistant pathogens. However, despite the clinical importance of Trichosporon spp., our understanding of their antifungal resistance mechanisms is quite limited. Furthermore, antifungal susceptibility testing is not standardized, and there is a lack of interpretive epidemiological cut-off values for minimal inhibitory concentrations to distinguish non-wild type Trichosporon isolates. The route of infection remains obscure and detailed clinical and environmental studies are required to determine whether the Trichosporon infections are endogenous or exogenous in nature. Although our knowledge on effective IT treatments is rather limited and future randomized clinical trials are required to identify the best antifungal agent, the current paradigm advocates the use of voriconazole, removal of central venous catheters and recovery from neutropenia.

摘要

Trichosporon物种和相关属被广泛用于生物技术，因此，许多物种的基因组已被测序。重要的是，越来越多的丝孢子菌属酵母被确定为人类危及生命的侵袭性毛孢子菌病 (IT) 的原因，并且与异常高的死亡率有关。毛孢子菌属 对一线抗真菌药物具有内在抗性，这导致了许多使用棘白菌素治疗 IT 时治疗失败的报告。此外，这些真菌对多烯和唑类的敏感性较低，因此可能被视为多重耐药病原体。然而，尽管Trichosporon的临床重要性spp.，我们对它们的抗真菌抗性机制的了解非常有限。此外，抗真菌药敏试验没有标准化，并且缺乏用于区分非野生型丝孢菌素分离株的最小抑制浓度的解释性流行病学临界值。感染途径仍不清楚，需要详细的临床和环境研究来确定Trichosporon感染是内源性还是外源性。虽然我们对有效 IT 治疗的了解相当有限，并且需要未来的随机临床试验来确定最好的抗真菌剂，但目前的范式主张使用伏立康唑、移除中心静脉导管和从中性粒细胞减少症中恢复。