Management of fusariosis in transplant patients

Area of Science:

• Mycology
• Transplant Infectious Diseases
• Clinical Microbiology

Background:

• Invasive fusariosis is a rare but life-threatening mold infection in hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT) recipients.
• Diagnosis is often delayed, leading to high fungal burden, dissemination with fungemia, and limited effective antifungal options, contributing to high mortality rates.
• Host immune status significantly impacts outcomes, highlighting the need for improved diagnostic and therapeutic strategies.

Purpose of the Study:

• To review the epidemiology, clinical presentation, diagnostic approaches, and management of fusariosis in transplant recipients.
• To discuss diagnostic challenges, including culture and biomarker limitations, and therapeutic outcomes with current antifungal agents.
• To explore emerging diagnostic tools and novel antifungal agents for fusariosis.

Main Methods:

• Systematic literature search of PubMed (1990-2025) for studies on fusariosis in transplant recipients.
• Analysis of data on species distribution, geographical variations, and trimodal timing post-HCT.
• Review of diagnostic methods, including culture, biomarkers, and molecular platforms, and assessment of treatment outcomes.

Main Results:

• Fusariosis presents significant diagnostic challenges due to non-specific symptoms and delayed identification.
• Current antifungal treatments, including amphotericin B and voriconazole, have variable efficacy.
• Emerging agents like fosmanogepix and advanced molecular diagnostics show promise for future management.

Conclusions:

• Fusariosis remains a critical threat to transplant recipients due to diagnostic delays and limited treatment options.
• Integrating rapid molecular diagnostics and next-generation antifungals is essential for better outcomes.
• Immune-directed strategies alongside improved diagnostics and therapeutics are key to enhancing survival rates.