Infection by Trichosporon Inkin in Lung Transplant: Rare Infection, or Not So Rare?

The incidence of invasive fungal infections has increased in recent years among transplant patients, with Trichosporon inkin being a rare but relevant etiological agent. This study examines the experience of our multidisciplinary lung transplant unit in the diagnosis and treatment of 6 cases of T. inkin infection in transplant patients from 2016 to 2023. The cumulative incidence was 1.25% (6/480), with 2 temporal clusters: 5 cases between 2016 and 2017, and 1 case in 2023. The patients had a mean age of 59 ± 5.5 years, and all had undergone bilateral lung transplantation. The median time from transplantation to diagnosis was 53 days. Three patients (50%) presented with local dissemination, while the other three (50%) showed hematogenous spread, resulting in a 66.6% (2/3) mortality rate in the latter group. Treatment included the use of azoles, with voriconazole administered either as monotherapy or in combination with other antifungals such as amphotericin B, fluconazole or micafungin. The overall mortality was 33.3% (2/6). These findings highlight the importance of early diagnosis of T. inkin infection in lung transplant patients, as hematogenous dissemination is associated with a significantly worse prognosis. Azole therapy, combined with surgical interventions for localized infections, was effective in the majority of patients. Additional preventive measures were implemented following the initial 5 cases, including environmental cultures, carrier screening, and reverse isolation protocols.