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Invasive Fusarium infections in bone marrow transplant recipients
Abstract:
From November 1982 to September 1983, three cases of invasive infection due to Fusarium species were documented in bone marrow transplant recipients. Fusarium was cultured from discrete skin nodules (one patient), maxillary sinus (one patient), or from the blood and surgically excised nasal septum (one patient). All three isolates were resistant to 5-fluorocytosine, whereas only one isolate was resistant to amphotericin B. Although all three patients died, two of the patients had clearing of their Fusarium infection. From this experience and from a review of the literature, it is concluded that despite the dismal prognosis for immunocompromised patients with Fusarium, beneficial therapies would include systemic amphotericin B, local surgical resection, and possibly leukocyte transfusions.
Insights
Invasive Fusarium infections pose a severe risk to bone marrow transplant recipients. Early treatment with amphotericin B, surgery, and transfusions may improve outcomes despite high mortality.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal infections are a significant concern in immunocompromised patients, particularly bone marrow transplant (BMT) recipients.
- Fusarium species, typically soil-dwelling fungi, can cause severe, disseminated infections in susceptible individuals.
Observation:
- Three cases of invasive Fusarium infections occurred in BMT recipients between November 1982 and September 1983.
- Infections presented as skin nodules, maxillary sinusitis, or disseminated disease involving blood and nasal septum.
- Fungal isolates demonstrated resistance to 5-fluorocytosine and, in one case, amphotericin B.
Findings:
- All three patients with invasive Fusarium infection ultimately died.
- Despite the fatal outcomes, two patients experienced clearance of their Fusarium infection with treatment.
- Treatment strategies involved systemic amphotericin B, surgical resection, and leukocyte transfusions.
Implications:
- Invasive Fusarium infections in immunocompromised patients carry a grave prognosis.
- Prompt diagnosis and aggressive management, including antifungal therapy and surgical intervention, are crucial.
- Leukocyte transfusions may offer a potential adjunctive therapy in managing these difficult infections.