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Clinical patterns of Fusarium infections in immunocompromised patients
P Martino1, R Gastaldi, R Raccah
1Department of Human Biopathology, University La Sapienza, Rome, Italy.
Abstract:
Fusarium is an ubiquitous fungus commonly found in soil and on plants. Human infection usually occurs as a result of inoculation of the organism through the body surface, thus causing skin infection, onychomycosis, keratitis, endophthalmitis and arthritis. Dissemination may occur in subjects with underlying immunodeficiency. Among immunocompromised hosts, Fusarium sp. is an emerging pathogen in neutropenic patients. To our knowledge, since 1973, when the first disseminated fusariosis in a child with acute leukemia was reported, about 80 new cases have been reported, mainly occurring in patients with haematologic malignancies. Specific portals of entry are not well understood, nevertheless the respiratory tract, colonised gastrointestinal tract, onychomycosis, disrupted skin barrier and central venous catheter have been reported as entry sites of deep seated Fusarium infections. Fever, positive blood cultures, severe myalgias, disseminated ecthyma gangrenosum-like skin lesions, ocular symptoms and multiple-organ-system involvement are distinctive features in most cases of disseminated fusariosis. The prognosis is very poor with death generally following despite antifungal therapy, unless an increase in the white blood cell count occurs. All available antifungal drugs show a low activity against the various species of Fusarium. Nevertheless, amphotericin B seems to have the highest in vitro activity and, even if it does not appear to be effective in persistently neutropenic patients, it should be currently considered to be the treatment of choice.
Insights
Fusarium fungus causes infections, especially in immunocompromised patients. Disseminated fusariosis has a poor prognosis, with amphotericin B being the current treatment of choice despite limited efficacy.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Fusarium is a ubiquitous fungus found in soil and plants.
- Human infections typically result from inoculation, causing localized issues like skin infections and arthritis.
- Dissemination can occur in immunocompromised individuals, particularly neutropenic patients, making Fusarium an emerging pathogen.
Purpose of the Study:
- To review the epidemiology, clinical features, and treatment of disseminated fusariosis.
- To highlight Fusarium as an emerging pathogen in immunocompromised hosts, especially those with hematologic malignancies.
Main Methods:
- Literature review of reported cases since 1973.
- Analysis of clinical presentations, portals of entry, and treatment outcomes.
Main Results:
- Approximately 80 cases of disseminated fusariosis reported since 1973, predominantly in patients with hematologic malignancies.
- Common entry sites include the respiratory tract, gastrointestinal tract, and disrupted skin barriers.
- Distinctive features include fever, positive blood cultures, myalgias, ecthyma gangrenosum-like lesions, and multi-organ involvement.
Conclusions:
- Disseminated fusariosis carries a very poor prognosis, often leading to death despite antifungal therapy.
- Limited antifungal drug activity against Fusarium species is noted.
- Amphotericin B demonstrates the highest in vitro activity and is considered the treatment of choice, though its efficacy is limited in persistently neutropenic patients.