Journal of Clinical & Medical Case Reports
Case Report
Candida Duobushaemulonii and Trichosporon Asahii in Hematopoietic Stem Cell Transplant Patient: A Rare Bug in Febrile Neutropenic Patient
Goutham KJ¹, Rubaina A¹, Delvin K¹, Nishit², Yesheswini N², Aswathy AN³, and Sachin SJ⁴*
1Department of Clinical pharmacology, HCG Cancer Hospital, Bangalore
2Junior consultant , Department of Hematology & stem cell transplant, HCG Cancer Hospital, Bangalore
3Department of nursing, Hematology & stem transplant, HCG Cancer Hospital, Bangalore
4Group Head, Hematology & stem cell transplant, HCG Cancer Hospital, Bangalore
2Junior consultant , Department of Hematology & stem cell transplant, HCG Cancer Hospital, Bangalore
3Department of nursing, Hematology & stem transplant, HCG Cancer Hospital, Bangalore
4Group Head, Hematology & stem cell transplant, HCG Cancer Hospital, Bangalore
*Address for Correspondence:Sachin Suresh Jadhav, Group Head Haematology & SCT HCG
Cancer hospital Bangalore E-mail Id: drsachinjadhav@gmail.com
Submission:13 April, 2024
Accepted: 16 May, 2024
Published:20 May, 2024
Copyright:© 2024 Goutham KJ, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords:Candida duobushaemulonii; Trichosporon asahii; Aplastic
anemia; Bone marrow; Stem cell transplant; Echinocandins; Azole
antibiotics
Abstract
Aplastic anemia is defined by profound reduction in number of
bone marrow- Hematopoietic stem cell or Hematopoietic progenitor
cell. Fungal infection is the second cause of infections caused in
hematopoietic stem cell transplant patients, with viral infection being
first and bacterial accounts third. Candida duobushaemulonii is an
emerging pathogen, given its resistance to multiple antifungal (to
azoles and amphotericin B) it poses a substantial problem of causing
invasive infection in immunocompromised setting. The Candida
duobushaemulonii requires molecular based method for accurate
identification and the conventional/ traditional biochemical method
is currently inadequate. Trichosporon asahii is one of the most common
species of trichosporon genus, which is a rare fatal emerging fungal
infection whose occurrence has increased in immunocompromised
patients with blood disease. A 58-year-old patient was diagnosed to
have very severe aplastic anemia and febrile neutropenia post stem
cell transplant.On basis of Sputum analysis the patient was diagnosed
to have aspergillus pneumonia with High resolution computed
tomography showing moderate pleural effusion and blood and
urine culture revealed presence of fungal infections for which he was
then started on antibiotics and antifungal. Blood Culture revealed
that Candida duobushaemulonii was resistant to fluconazole and
voriconazole and had a good sensitivity to echinocandins hence
the patient was started on inj Anidulafungin 100 mg OD for 12 days.
After 3 days the patient became hypoxic, required 2 litres of oxygen
through face mask to maintain saturation, the urine and blood culture
were sent in which urine culture reports showed Trichosporon asahii
which was then treated with inj Anidulafungin 100 mg after which the
patient was stable and afebrile. Echinocandins are more susceptible
to Candida duobushaemulonii whereas azoles and amphotericin
B are resistant. EarlyAnalysis of the risk factor to develop Candida
duobushaemulonii and Trichosporon asahii priorto stem cell transplant
is required and possibly will help in identifying this rare fungal infection
by using molecular method rather than by using a traditional method
and it also helps in choosing a better prophylactic antifungal.