Fusariosis in Mexico: cases and gaps to be addressed

This mini-review synthesizes four decades of Mexican fusariosis literature, organizing cases into four clinical categories: ocular, superficial/cutaneous, invasive/disseminated, and central nervous system (CNS) disease. It identified significant gaps in national surveillance, molecular diagnostics, antifungal susceptibility testing, access to effective therapies, specialized mycology infrastructure, and highlights the urgent need for a coordinated clinical mycology network in Mexico. Fusariosis, caused by Fusarium species, presents a broad clinical spectrum, from keratitis and onychomycosis in immunocompetent individuals to disseminated disease in those with hematologic conditions. In Mexico, most reported cases stem from clinical case reviews rather than systematic national surveillance. Exceptions include a 10-year retrospective study published in 2023, and a Fusarium solani meningitis outbreak in Durango and Matamoros during 2022-2023, which together represent the largest global clusters of healthcare-associated fungal meningitis including an antifungal-resistant isolate in Matamoros that required investigational treatments such as Fosmanogepix. Keratitis by Fusarium spp. is the most documented manifestation, with 380 cases reported, most of them in clinical centers for diagnosis in Ciudad de Mexico, where F. solani predominated and ocular trauma was the primary risk factor. Additionally, 49 cases of invasive fusariosis have been reported across six states, mainly linked to burn injuries and hematological malignancies. Collectively, this review provides a national framework for understanding fusariosis and informs future research and public health strategies to address this emerging threat.