BACKGROUND: Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients. OBJECTIVES: To analyse clinical presentation, predisposing factors, treatment and outcome of Trichoderma infections. METHODS: A systematic literature review was conducted for published cases of invasive Trichoderma infection in PubMed until December 2021 and by reviewing the included studies' references. Cases from the FungiScope® registry were added to a combined analysis. RESULTS: We identified 50 invasive infections due to Trichoderma species, including 11 in the FungiScope® registry. The main underlying conditions were haematological malignancies in 19 and continuous ambulatory peritoneal dialysis (CAPD) in 10 cases. The most prevalent infection sites were lung (42%) and peritoneum (22%). Systemic antifungal therapy was administered in 42 cases (84%), mostly amphotericin B (n = 27, lipid-based formulation 13/27) and voriconazole in 15 cases (30%). Surgical interventions were performed in 13 cases (26%). Overall mortality was 48% (n = 24) and highest for allogeneic HSCT and solid organ transplantation (SOT) recipients [80% (4/5) and 77% (7/9), respectively]. In patients treated with amphotericin B, voriconazole and caspofungin, mortality was 55% (15/27), 46% (7/15) and 28% (2/7), respectively. Three out of four patients treated with a combination therapy of voriconazole and caspofungin survived. CONCLUSIONS: Despite treatment with antifungal therapies and surgery, invasive Trichoderma infections are life-threatening complications in immunocompromised patients, especially after HSCT and SOT. In addition, Trichoderma spp. mainly affect the lungs in patients with haematological malignancies and the peritoneum in CAPD patients.

Centro de Investigación Biomédica en Red de Enfermedades Infecciosas Instituto de Salud Carlos 3 Madrid Spain

Clinical Microbiology and Parasitology Department University Hospital La Paz Madrid Spain

Department of Clinical Mycology Allergology and Immunology North Western State Medical University St Petersburg Russia

Department of Microbiology Faculty of Science and Informatics University of Szeged Szeged Hungary

Department of Microbiology Sri Ramachandra Medical College and Research Institute Sri Ramachandra University Porur Chennai India

Department of Physiology Faculty of Medicine Masaryk University Brno Czech Republic

German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Institute for Medical Microbiology Immunology and Hygiene University Hospital of Cologne Cologne Germany

Institute of Haematology and Blood Transfusion Prague Czech Republic

Institute of Hygiene and Medical Microbiology Excellence Center for Medical Mycology Medical University of Innsbruck Innsbruck Austria

Pediatric Haematology Oncology Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

Stabsstelle Krankenhaushygiene und Infektionsprävention München Klinik München Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Clinical Trials Centre Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Cologne Germany

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