Trichosporon species are saprophytic fungi widespread in soil environments and can also be part of the human skin and gut microbiota. They were first thought to produce skin diseases such as the white piedra but are currently known to be the second most frequent agents of yeast infections in man. These fungi are part of the saprobic flora of the soil and may be considered as saprophytes in the human body. Initially recognized as a single species, Trichosporon has since been re-categorized into several species; with Trichosporon asahii being the most prevalent in disseminated infections. Some species are linked to hypersensitivity pneumonitis in Japan. Thus, there has been more frequent recognition of Trichosporon as the source of systemic disease, especially in immunocompromised individuals, such as patients with haematological malignancies.  

It should be noted that Trichosporon infections are infrequent even in immunocompromised patients. Corticosteroids, solid tumors, HIV/AIDS, Intravascular devices like catheters are some of the key risk factors. The focus applies primarily to hematologic malignances, which are proven to be the most potent risk factor in such cases. Spatial distribution indicates that B. capitatus tends to infect patients in the European countries of Spain and Italy, whereas T. asahii is more connected with patients in Japan. 

Overall, mortality evaluated at the time when the acute disseminated trichosporonosis was diagnosed was reported to be between 50 to 80%, but in the studies reporting cases in the last ten years, 40 to 50% was observed. The infection is more common in males than in females, with the ratio being 2:1, and individuals of an adult age are usually infected, with a median age of 44 years. However, it has been observed in neonates and pediatric patients and has been reported to cause hospital outbreaks rarely. 

Trichosporon species were proved to have some putative virulence factors such as enzymes like proteinases, lipases and phospholipases; and a cell wall constituent which may suppress phagocytosis. They also form biofilms which helps in the adherence of medical devices and making it less responsive to antifungal agents. Although severe infections can occur from many factors, they most often take place when the patient is neutropenic and if they undergo chemotherapeutic treatment that causes mucosal damage. Patients who undergo peritoneal dialysis suffer from Trichosporon peritonitis and can disseminate it to other areas of the body, especially patients who recently faced neutropenia and have some problems with the removal of this infection. 

Trichosporon infections commonly affect the immunosuppressed persons like the patients with hematologic malignancies, HIV/AIDS, or those undergoing chemotherapy. The risk factors associated with the development of infection include the administration of corticosteroids, the existence of solid tumors and use of indwelling medical devices including catheters and prosthetic heart valves. It can be found in the human skin, within the gastrointestinal and respiratory tracts, and it can also adhere to medical instruments and form biofilms, cause infection. 

Immune Status: Patients with Hematologic malignancy, HIV/AIDS, or those that are on immunosuppressive therapies are considered as having a poor prognosis. 

Presence of Neutropenia: It has been observed that those patients having neutropenia persisting beyond the said time have higher chance of mortality. 

Severity of Infection: Systemic infections are less favorable in terms of outlook as compared to localized infections. 

Timeliness of Treatment: Promoting early diagnosis and interventions is critical for improving patient prognosis. 

Age Group 

• Adults: More often struck primarily important these high-risk groups in community particularly those with compromised immune systems. 
• Pediatrics: Occasional but possible as in new borns and other children with weakened immune systems or in cases of hospital-acquired outbreaks in NICU. 

Chronic or Recurrent Infections: May be in patients with persistent risk factors or those who have poor clearance mechanisms of the virus. 

Skin: Localized lesions as nodules or plaques: cutaneous infection; white piedra presenting with white or grayish nodules on the hair shaft. 

Respiratory: Cough, dyspnea, and possibly pneumonia/possible pulmonary abscess signs. 

Gastrointestinal: Pain localized on the abdomen, especially patients who have peritoneal dialysis catheters. 

• HIV/AIDS 
• End stage renal disease 
• Solid tumors 
• Hematologic malignancies 

Acute Invasive Disease: It can present as disseminated infection with the onset of the disease being rapid and the symptoms severe particularly in immunocompromised patients. 

Localized Infections: May be present for example in the lungs or skin but are commonly a sign of further spread of the disease if not detected early. 

Antifungal Therapy: 

First-Line Agents: 

• Azoles: Either voriconazole or posaconazole is administered as they are effective against Trichosporon species. 
• Echinocandins: Several antifungals may be used including caspofungin or micafungin, but treatment may require longer times owing to possible resistance. 
• Alternative Agents: Amphotericin B might be employed in severe or resistant cases, but it is relatively less employed because of its toxicity. 
• Management of Underlying Conditions: Treat and stabilize diseases that affect the immune system like cancer, HIV/AIDS or use of corticosteroids. If there is an indication of the patient having a catheter for example, treatment for the infection may require removal or replacement of the catheter. 
• Surgical Intervention: If the infection is localized or has invaded the tissues then surgical excision of the infected tissues could be necessary. 

Supportive Care: 

• Symptom Management: Management of the general manifestations like fever and pain and close observation for possible complications. 

Infectious Disease

Infection Control: 

Hygiene Practices: Wash the hands frequently with water and soap or use alcohol-based hand rub as a precaution to lower chances of transmitting the infection. 

Sterilization: Adhering to proper sterilization requirements as well as medical equipment and indwelling devices to reduce colonization or infection. 

Device Management: There are instances where the infection is related to implanted devices such as catheters or prosthetic heart valves; in which case the management is to remove or replace the device. 

Environmental Controls: Cleaning and sanitation practices, particularly in health facilities and areas where patients with compromised immunity are treated. 

Nutritional Support: Maintaining proper feeding to enhance immune system in the body and increase healing and the ability to avoid infections. 

Infectious Disease

Amphotericin B: This is a polyene class of antifungal which has a relatively general spectrum of action against various fungal infections. It is routinely employed by the intravenous route; however, it has also been used intra-thecally, intra-articularly, or as an irrigation. Because of the observed toxic effects, the dose should be determined by the medical application and higher concentrations must be used for Trichosporon treatment. Amphotericin B lipid formulations are usually preferred since they cause less toxicity. 

Amphotericin B Liposomal: This lipid formulation of Amphotericin B enables achievement of higher drug concentrations without compromising on nephrotoxicity. It is obtained from Streptomyces nodosus and acts by chelating the receptor ergosterol in the fungal cell membrane and altering the permeability of the membrane to ions leading to cell death. At low doses, it interferes with the development of fungi by promoting potassium leakage while at high doses, it creates channels and causes oxidative stress. 

Voriconazole: It is an antifungal that belongs to the triazole class; it works by interacting with the enzyme 14 alpha-lanosterol demethylase which is important in ergosterol synthesis in fungi. It is active against species of Trichosporon and is employed for aspergillosis, invasive candidal infection, and febrile neutropenia. It has been shown to be effective as a single agent in certain conditions. 

Posaconazole: Another one is a triazole antifungal which through blocking of the enzyme that is involved in ergosterol synthesis called lanosterol 14-alpha-demethylase affects cell membrane. Approved for oral suspension, it is given for prophylaxis of invasive Aspergillus and Candida infections in patients with severe forms of immunosuppression. 

Fluconazole: It is a triazole derivative with good absorption by oral route or use in Candida infections and the endemic mycoses including Trichosporon ones. Since Trichosporonosis needs a long course of therapy, the dosage should be maximized based on the severity of the disease. 

Caspofungin: It is a glucan synthesis inhibitor in cases of persistent invasive aspergillosis and candidiasis. It functions by inhibiting the formation of beta-(1,3) -D-glucan, a critical structural protein found within the fungal cell wall. 

Micafungin: It belongs to a group of called echinocandin which disrupts fungal cell wall synthesis via 1,3-beta-D-glucan that is not present in mammals. It is also used for the prevention of candidal infections in patients who are likely to undergo hematopoietic stem cell transplantation and for treating esophageal candidiasis. 

Infectious Disease

Surgical Debridement: The additional treatment that might be needed at times of localized infection especially when there is severe tissue involvement is surgical removal of infected tissues. This has a role of clearing fungal load and enhance the efficiency for the antifungal drugs. 

Drainage: Surgical or percutaneous drainage may be necessary in cases of abscesses or deep-seated infection, to address purulent collections and decrease fungal load. 

Infectious Disease

Diagnostic Phase: Primeval screening of an infection the patient must undergo a clinical examination and/or microbial culture microscopy, histopathological examination, or imaging testing to define the spread of Trichosporon spp. 

Initial Treatment Phase: Managing the fungus commonly requires the prescription of drugs belonging to the azoles mainly fluconazole or itraconazole whereas in serious situations, echinocandin/amphotericin b can be used. Some of the more invasive procedures may involve operation when it is required to debride the wound, or to have it drained. 

Ongoing Management Phase: To evaluate the case, the duration of antifungal treatment should be continued depending on the culture result and clinical response. Take the primary diseases with drugs, address some of which may be indicative of other diseases and eliminate side effects as well. The follow-ups are crucial for they enable the treatment to be effective and enables early identification of complication. 

Resolution and Follow-Up Phase: It is also useful for repeated check for infection clearance and for enrolment follow-up in case of redo surgeries. Educate the patients on measures to avoid in order not to be a victim of the same infection again, while being very vigilant on any sign of reinfection.