A rare case of Trichosporon inkin bloodstream infection in an immunocompetent patient: Diagnostic challenges and antigenic cross-reactivity

Yongqin Wu
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Abstract

Trichosporon inkin is a rare opportunistic pathogen typically associated with superficial infections but can also cause invasive infections, particularly in immunocompromised hosts. Here, we report a rare case of T. inkin bloodstream infection in an immunocompetent male with a history of cerebral hemorrhage surgery. The patient presented with fever, limb twitching, and brain lesions. Blood cultures revealed fungal growth, which was initially misidentified as Trichosporon ovoides by mass spectrometry but was later confirmed as T. inkin through ITS and IGS1 sequencing. The isolate exhibited low MICs for azoles and amphotericin B but high MICs for echinocandins. Notably, the patient's serum tested positive for cryptococcal antigen and Aspergillus galactomannan, despite the absence of clinical signs of cryptococcosis or aspergillosis. The T. inkin isolate expresses cryptococcal antigen but not galactomannan cross-reactive antigens when cultured in standard media. However, it expresses galactomannan cross-reactive antigens when cultured in human whole blood. This case highlights diagnostic challenges, including antigenic cross-reactivity and misidentification, and emphasizes the role of host–pathogen interactions in antigen expression. Our findings underscore the need for improved diagnostics and cautious interpretation of fungal antigen tests. This report expands the understanding of T. inkin infections and provides insights into their clinical management.

Abstract Image

一例罕见的免疫功能正常患者血中感染三磷酸丝蛋白:诊断挑战和抗原交叉反应性
三磷体墨染是一种罕见的机会性病原体,通常与浅表感染有关,但也可引起侵袭性感染,特别是在免疫功能低下的宿主中。在此,我们报告一例罕见的T. inkin血流感染的免疫功能正常的男性脑出血手术史。患者表现为发热、肢体抽搐和脑损伤。血液培养显示真菌生长,最初通过质谱分析被误认为是Trichosporon ovoides,但后来通过ITS和IGS1测序证实是T. inkin。该分离物对唑类和两性霉素B的mic较低,但对棘白菌素的mic较高。值得注意的是,尽管没有隐球菌病或曲霉病的临床症状,但患者的血清隐球菌抗原和半乳甘露聚糖曲霉检测呈阳性。T. inkin分离物在标准培养基中培养时表达隐球菌抗原,但不表达半乳甘露聚糖交叉反应抗原。然而,在人全血培养时,它表达半乳甘露聚糖交叉反应抗原。该病例突出了诊断挑战,包括抗原交叉反应性和错误识别,并强调了宿主-病原体相互作用在抗原表达中的作用。我们的发现强调需要改进诊断和谨慎解释真菌抗原测试。本报告扩展了对T. inkin感染的理解,并为其临床管理提供了见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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