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Disseminated fusariosis and hematologic malignancies, a still devastating association. Report of three new cases

Juan Carlos García-Ruiz1, Iñigo Olazábal1, Rosa María Adán Pedroso2

  • 1Servicio de Hematología y Hemoterapia, BioCruces Health Research Institute, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain.

Revista Iberoamericana De Micologia
|May 5, 2015
PubMed
Abstract

Insights

Disseminated fusariosis (DF) is a rare but deadly fungal infection in immunocompromised patients. Early diagnosis and aggressive treatment with liposomal amphotericin B and voriconazole are crucial for survival.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Fusarium species cause disseminated infections in immunocompromised individuals, particularly those with hematologic malignancies.
  • Disseminated fusariosis (DF) is the second most common invasive filamentous fungal infection in transplant recipients and cancer patients.
  • Despite a stable incidence, DF has a high mortality rate and lacks standardized treatment protocols.

Observation:

  • Three cases of DF caused by Fusarium oxysporum, Fusarium solani, and Fusarium dimerum in patients with advanced hematologic malignancies were analyzed.
  • Species identification was performed using TEF1 gene sequencing.
  • In vitro antifungal susceptibility testing revealed low susceptibility to most agents, with notable exceptions for F. dimerum and F. oxysporum.

Findings:

  • Fusarium isolates demonstrated limited susceptibility to common antifungals.
  • One Fusarium solani strain showed high minimum inhibitory concentrations (MICs) for amphotericin B (AmB) and voriconazole, yet responded well to treatment.
  • Successful DF management involved antifungal therapy, surgical debridement of infection foci, catheter removal, and recovery from neutropenia.

Implications:

  • Early diagnosis and prompt, aggressive treatment are vital for improving outcomes in disseminated fusariosis.
  • Combined therapy with liposomal amphotericin B (L-AmB) and voriconazole is recommended for DF.
  • Preventing infection in colonized patients and maintaining high diagnostic suspicion are key strategies.
Keywords:
Disseminated fusariosisFusariosis diseminadaFusarium dimerumFusarium keratoplasticumFusarium oxysporumFusarium solaniHematologic malignanciesNeoplasias hematológicas

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