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Fusariosis in patients with hematological malignancies: Two case reports
Jord W Raymakers1, Daan A R Castelijn2, Caroline E Rutten2
1Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Abstract:
Immunosuppressed patients with hematological malignancies are at risk for invasive fungal infections (IFI), including infections with Fusarium species (spp.), which are increasingly reported. Particularly at risk are patients with acute myeloid leukemia (AML) treated with high-dose cytarabine as remission-induction therapy. Whether cytarabine increases the risk of IFI in comparison to other chemotherapy remains not fully determined. Additionally, no clear correlation between the in vitro established minimal inhibitory concentrations (MICs) of antifungal agents and clinical outcome has been established for fusariosis. To increase awareness and knowledge of invasive fusariosis, we report two cases of Fusarium spp. infections in neutropenic patients following treatment with cytarabine for AML. Despite high MICs for azoles both patients were treated with an azole in combination with liposomal amphotericin B. The combination therapy was successful in one patient, however the other patient did not survive the disseminated Fusarium infection.
Insights
Hematological malignancy patients receiving cytarabine chemotherapy face a significant risk of invasive fungal infections (IFI), particularly from Fusarium species. Combination antifungal therapy showed variable success in treating these serious infections.
Area of Science:
- Hematology
- Mycology
- Infectious Diseases
Background:
- Patients with hematological malignancies, especially acute myeloid leukemia (AML) undergoing high-dose cytarabine therapy, are susceptible to invasive fungal infections (IFI).
- Fusarium species are an emerging cause of IFI in immunocompromised individuals, with limited understanding of risk factors and treatment efficacy.
- The correlation between in vitro antifungal susceptibility (MICs) and clinical outcomes for fusariosis remains unclear.
Purpose of the Study:
- To enhance awareness and knowledge of invasive fusariosis in the context of AML treatment.
- To report clinical cases of Fusarium infections in neutropenic patients treated with cytarabine.
- To evaluate the effectiveness of combination antifungal therapy in invasive fusariosis.
Main Methods:
- Retrospective case report of two neutropenic patients with AML treated with cytarabine.
- Documented Fusarium species infections.
- Antifungal susceptibility testing (MICs) and clinical treatment outcomes were recorded.
Main Results:
- Both patients developed invasive Fusarium infections following cytarabine-based chemotherapy for AML.
- In vitro testing revealed high minimal inhibitory concentrations (MICs) for azoles against the Fusarium isolates.
- Combination therapy with an azole and liposomal amphotericin B resulted in successful treatment for one patient, while the other patient succumbed to disseminated infection.
Conclusions:
- Invasive fusariosis is a serious complication in AML patients treated with cytarabine.
- High azole MICs may indicate potential treatment challenges, but combination therapy can be effective in select cases.
- Further research is needed to clarify the role of cytarabine in IFI risk and establish clear treatment guidelines for invasive fusariosis.
