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Fusarium infections in immunocompromised patients: case reports and literature review
M Rabodonirina1, M A Piens, M F Monier
1Département de Parasitologie et de Mycologie, Université Claude-Bernard Lyon I, France.
Abstract:
Five cases are reported of Fusarium infection in patients with aplasia following chemotherapy of leukemia. The clinical signs, diagnosis and course of the infection during treatment are outlined and discussed in conjunction with the characteristics of other cases already reported in the literature. Sixty-three cases of Fusarium infection have been reported in immunocompromised patients, 44 cases since 1985. These included patients with hematological malignancies (58 cases), especially acute leukemia (43 cases). The main sites of infection were the skin (46 cases), blood (28 cases) and lungs (13 cases). The infection was mostly diagnosed by means of skin biopsy but also by means of positive blood cultures. Forty-three strains were identified, 19 of which were Fusarium solani. Amphotericin B treatment was given in 55 cases, often combined with other antifungal agents, leukocyte transfusions or granulocyte-macrophage-colony stimulating factor. The outcome was fatal in 36 of the 63 cases reported, often due to resistance of the strain to antifungal agents, particularly amphotericin B (20 of 33 strains tested). The most important risk factor seems to be profound and prolonged aplasia. Deep mycoses due to Fusarium species thus pose an important problem and are occurring in increasing numbers in immunocompromised patients. Treatment of these infections is difficult and the prognosis is poor.
Insights
Fusarium infections are a serious threat to immunocompromised patients, particularly those with leukemia and prolonged aplasia. Treatment is challenging, with high fatality rates due to antifungal resistance.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Fusarium species are increasingly recognized as opportunistic pathogens.
- Immunocompromised patients, especially those with hematological malignancies, are at high risk.
Observation:
- This report details five cases of Fusarium infection in leukemia patients with aplasia.
- A literature review identified 63 cases, predominantly in patients with hematological malignancies (58 cases).
- Common infection sites include skin (46 cases), blood (28 cases), and lungs (13 cases).
Findings:
- Diagnosis often relies on skin biopsy or positive blood cultures.
- Fusarium solani was the most frequently identified species (19 of 43 strains).
- Treatment with Amphotericin B, often in combination, had a high fatality rate (36 of 63 cases), frequently linked to antifungal resistance.
Implications:
- Profound and prolonged aplasia is a significant risk factor.
- Deep Fusarium mycoses present a growing clinical challenge in immunocompromised populations.
- Effective treatment strategies are urgently needed due to the poor prognosis and difficulty in managing these infections.