# Trichosporonaceae as (Re-)Emerging Pathogens: A Warning to the Medical Community

## TL;DR

Trichosporonaceae fungi, especially Trichosporon asahii, are causing severe infections in vulnerable patients, leading to high mortality rates and the need for better diagnosis and treatment.

## Contribution

This study provides clinical and epidemiological insights into Trichosporonaceae infections in Brazil, emphasizing their rising threat and antifungal resistance patterns.

## Key findings

- Trichosporon asahii was the most common species causing infections, primarily in hospitalized ICU patients.
- High mortality (51.6%) and prolonged hospital stays (34.8 days) were observed in Trichosporonaceae-infected patients.
- Fluconazole was the most commonly used antifungal therapy despite limited treatment rates (35%).

## Abstract

Background: The Trichosporonaceae family includes genera such as Trichosporon, Apiotrichum, and Cutaneotrichosporon, which are components of the human microbiota but may cause infections under conditions such as immunosuppression, prolonged hospitalization, invasive procedures, and broad-spectrum antimicrobial use. Objectives: This study aimed to describe the clinical and epidemiological characteristics of hospitalized and outpatient individuals with positive cultures for Trichosporonaceae species in Juiz de Fora, Minas Gerais, Brazil, and to correlate these findings with antifungal susceptibility profiles. Methods: Clinical isolates collected between 2020 and 2023 were identified using the Vitek 2® system, and antifungal susceptibility was assessed by disk diffusion. Clinical and epidemiological data were obtained from electronic health records. Results: Among 40 isolates, Trichosporon asahii predominated (92.5%). Most cases involved hospitalized individuals (83.8%), mainly from intensive care units (81.8%). Respiratory infections and acute renal failure were the most common reasons for admission. The mean hospital stay was 34.8 days, and overall mortality reached 51.6%. Most individuals were male (77.5%) and older than 61 years (57.5%). Urine was the most frequent specimen (52.5%), and invasive infections predominated (87.5%). Corticosteroid use and invasive devices were common, and prior antibiotic use occurred in most cases. Only 35.0% of patients received antifungal therapy, predominantly fluconazole. Conclusions: Trichosporonaceae infections, particularly those caused by T. asahii, are associated with critically ill patients and high mortality, highlighting the need for early diagnosis, appropriate therapy, and continuous surveillance.