Characteristics of fungaemia caused by Trichosporon species in South-Eastern Europe
Clinical Snapshot
PICO Framework
| P — Population | Patients with Trichosporon fungaemia in South-Eastern Europe (Turkey, Greece, Croatia) |
| I — Intervention | Various diagnostic approaches (phenotypic methods, MALDI-TOF MS, DNA sequencing) and antifungal treatments |
| C — Comparator | Not applicable (descriptive systematic review) |
| O — Outcomes | Epidemiology, diagnostic accuracy, antifungal susceptibility patterns, clinical outcomes, and mortality |
Bottom Line
This systematic review of 59 Trichosporon fungaemia cases from South-Eastern Europe reveals T. asahii as the predominant species (86.4%) causing severe infections in immunocompromised patients, particularly those with haematologic disorders. The study highlights diagnostic challenges, with phenotypic methods still widely used despite availability of more accurate MALDI-TOF MS and molecular techniques. Notably, 16 breakthrough infections occurred despite antifungal prophylaxis or empirical therapy, emphasising the clinical significance of this pathogen. Voriconazole emerged as the preferred treatment option. While the review provides valuable epidemiological insights, the limited search methodology and small case numbers restrict the strength of recommendations. Australian clinicians should maintain awareness of Trichosporon species in immunocompromised patients with unexplained fungaemia, utilise advanced diagnostic methods when available, and consider voriconazole as first-line therapy. Enhanced surveillance and molecular diagnostics are essential for optimal patient outcomes in this challenging clinical scenario.
Key Findings
P Value: Not applicable (descriptive review)
Effect Size: T. asahii predominance (86.4% of cases)
Primary Outcome: Epidemiological characteristics of Trichosporon fungaemia
Nnt Or Sensitivity: 16 breakthrough fungaemia cases identified despite antifungal therapy
Confidence Interval: Not reported
Clinical Application
Diagnostic recommendations feasible in Australian laboratories with MALDI-TOF MS and molecular capabilities Relevant to Australian practice given similar patient populations and diagnostic infrastructure. Voriconazole recommendations align with TGA-approved indications for invasive fungal infections Immunocompromised patients, particularly those with haematologic malignancies in tertiary care settings
Abstract
The incidence of fungaemia caused by rare yeasts, particularly Trichosporon species, is rising globally, posing diagnostic and therapeutic challenges-especially in immunocompromised patients. This systematic review aims to analyse the epidemiology, diagnostic approaches, antifungal susceptibility, and clinical outcomes of Trichosporon fungaemia (TF) in South-Eastern Europe, including Turkey. A comprehensive search was conducted in PubMed and Scopus in August 2025. A total of 59 cases from 12 studies were identified, with Trichosporon asahii being the most prevalent species (86.4%). Cases originated from Turkey (79.7%), Greece (18.6%), and Croatia (1.7%). Diagnostic techniques varied, with phenotypic methods still widely used. MALDI-TOF MS and DNA sequencing were mainly applied as confirmatory methods. Haematologic disorders were the most frequently reported underlying conditions among the patients. Sixteen breakthrough fungaemia cases-occurring despite empirical or prophylactic antifungal therapy-were identified. Although rare, TF represents a severe infection with significant mortality in South-Eastern Europe. Early and accurate species identification-facilitated by advanced diagnostic tools-is crucial for effective management. In addition to diagnostic difficulties, treatment is also challenging. Voriconazole appears to be the preferred antifungal agent, even in breakthrough fungaemia cases. Enhanced awareness, routine use of molecular diagnostics, and ongoing epidemiological monitoring are essential to improve patient outcomes.
References
- 1.Varlamis, S., Pessach, I., Kyriazidi, M. A., Gavriilaki, E., Mavridou, M., Mitka, S., Chatzidimitriou, M., & Vyzantiadis, T. A. (2026). Characteristics of fungaemia caused by Trichosporon species in South-Eastern Europe. Acta Microbiologica et Immunologica Hungarica. https://doi.org/10.1556/030.2026.02852
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