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Barragán-Reyes A, Jácome LEL, Perales-Martínez D, Nava-Ruiz A, Hernández MDLG, Cornejo-Juárez P, Rincón-Zuno J, Camacho A, Cendejas RF, Guzmán JMF, Rivera-Martínez NE, Ontañón-Zurita D, Reséndiz-Sánchez J, Juárez-Hernández E, Aguilar-Zapata D. Fusariosis in Mexico: A 10-year retrospective series. Med Mycol 2023; 61:myad112. [PMID: 37944000 DOI: 10.1093/mmy/myad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.
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Affiliation(s)
| | - Luis Esaú López Jácome
- Instiuto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division,Mexico City, Mexico
| | - Diana Perales-Martínez
- Hospital Ángeles San Luis, San Luis Potosí, México / Hospital Regional de Alta Especialidad del Bajío, Leon. Infectious diseases and hospital epidemiology division, Mexico
| | - Alejandra Nava-Ruiz
- Hospital de Especialidades Pediáricas, Pediatric infectious diseases, Tuxtla Gutiérrez, Chiapas, Mexico
| | - María de Lourdes García Hernández
- Instiuto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division,Mexico City, Mexico
| | | | - Joaquín Rincón-Zuno
- Instituto materno Infantil del Estado de México, Infectious diseases department, Toluca, Mexico
| | - Adrián Camacho
- Hospital Universitario Dr. José Eleuterio González, Hospital epidemiology and infectious diseases division, Monterrey, Mexico
| | - Rafael Franco Cendejas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Clinical microbiology laboratory. Infectious diseases division. Mexico City, Mexico
| | - José M Feliciano Guzmán
- Hospital de Especialidades Pediáricas, Pediatric infectious diseases, Tuxtla Gutiérrez, Chiapas, Mexico
| | - Norma E Rivera-Martínez
- Hospital regional de alta especialidad de Oaxaca, Infectious diseases division, Oaxaca, Mexico
| | - Diego Ontañón-Zurita
- Instituto Nacional de Cancerología, Infectious diseases division, Mexico City, Mexico
| | | | - Eva Juárez-Hernández
- Hospital Médica Sur, Infectious diseases. Translational Research Unit, Mexico City, Mexico
| | - Daniel Aguilar-Zapata
- Hospital Médica Sur, Infectious diseases. Translational Research Unit, Mexico City, Mexico
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Al-Farsi F, Balkhair A, Al-Siyabi T, Qureshi A. Fusarium solani Necrotizing Fasciitis Complicating Treatment for Acute Lymphoblastic Leukemia: A Case Report. Cureus 2022; 14:e25847. [PMID: 35832765 PMCID: PMC9273167 DOI: 10.7759/cureus.25847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
Fungal infections due to Fusarium species are serious albeit rare and mostly occur in severely immunocompromised patients. The prognosis of such infections, especially of disseminated manifestations, is poor as a result of multi-antifungal resistance, particularly to azoles. We report a case of a rapidly progressive necrotizing fasciitis of the foot secondary to Fusarium solani in a young female patient with acute lymphoblastic leukemia on consolidation therapy. Surgical debridement was undertaken and liposomal amphotericin was given as definitive therapy for a total of six weeks followed by secondary prophylaxis that resulted in remarked clinical and radiological improvement. High clinical suspicion, prompt surgical intervention, rapid diagnosis, and timely initiation of appropriate antifungal therapy are crucial for a favorable outcome in this relatively uncommon life-threatening infection.
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Bupha-Intr O, Butters C, Reynolds G, Kennedy K, Meyer W, Patil S, Bryant P, Morrissey CO. Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:177-219. [PMID: 34937139 DOI: 10.1111/imj.15592] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
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Affiliation(s)
- Olivia Bupha-Intr
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand
| | - Coen Butters
- Department of General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Sushrut Patil
- Malignant Haematology and Stem Cell Transplantation Service, Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Penelope Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine O Morrissey
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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How different is invasive fusariosis in pediatric patients than in adults? A systematic review. Curr Opin Infect Dis 2021; 34:619-626. [PMID: 34751181 DOI: 10.1097/qco.0000000000000776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients. METHODS We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021. RECENT FINDINGS One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous system involvement (8%, 9/106). Fusarium solani, followed by Fusarium oxysporum, were the most commonly reported species. In disseminated fusariosis, relapsed or refractory baseline disease (P < 0.001, OR=10.555, CI 95% 3.552-31.365) was associated with poor outcome, whereas voriconazole-based therapy was associated with better prognosis (P = 0.04, OR = 0.273, CI 95% 0.076-0.978). SUMMARY Hematologic malignancies and solid tumors requiring intensive immunosuppression are the main conditions related to IF in children where other organs than skin, blood, and lungs were frequently involved. Voriconazole therapy appears to be also effective in children with IF, despite the wide pharmacokinetic variability of this triazole in pediatric patients.
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Hoenigl M, Salmanton-García J, Walsh TJ, Nucci M, Neoh CF, Jenks JD, Lackner M, Sprute R, Al-Hatmi AMS, Bassetti M, Carlesse F, Freiberger T, Koehler P, Lehrnbecher T, Kumar A, Prattes J, Richardson M, Revankar S, Slavin MA, Stemler J, Spiess B, Taj-Aldeen SJ, Warris A, Woo PCY, Young JAH, Albus K, Arenz D, Arsic-Arsenijevic V, Bouchara JP, Chinniah TR, Chowdhary A, de Hoog GS, Dimopoulos G, Duarte RF, Hamal P, Meis JF, Mfinanga S, Queiroz-Telles F, Patterson TF, Rahav G, Rogers TR, Rotstein C, Wahyuningsih R, Seidel D, Cornely OA. Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology. THE LANCET. INFECTIOUS DISEASES 2021; 21:e246-e257. [PMID: 33606997 DOI: 10.1016/s1473-3099(20)30784-2] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 01/12/2023]
Abstract
With increasing numbers of patients needing intensive care or who are immunosuppressed, infections caused by moulds other than Aspergillus spp or Mucorales are increasing. Although antifungal prophylaxis has shown effectiveness in preventing many invasive fungal infections, selective pressure has caused an increase of breakthrough infections caused by Fusarium, Lomentospora, and Scedosporium species, as well as by dematiaceous moulds, Rasamsonia, Schizophyllum, Scopulariopsis, Paecilomyces, Penicillium, Talaromyces and Purpureocillium species. Guidance on the complex multidisciplinary management of infections caused by these pathogens has the potential to improve prognosis. Management routes depend on the availability of diagnostic and therapeutic options. The present recommendations are part of the One World-One Guideline initiative to incorporate regional differences in the epidemiology and management of rare mould infections. Experts from 24 countries contributed their knowledge and analysed published evidence on the diagnosis and treatment of rare mould infections. This consensus document intends to provide practical guidance in clinical decision making by engaging physicians and scientists involved in various aspects of clinical management. Moreover, we identify areas of uncertainty and constraints in optimising this management.
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Affiliation(s)
- Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA; Clinical and Translational Fungal Research Working Group, University of California San Diego, San Diego, CA, USA; European Confederation of Medical Mycology Council, Basel, Switzerland.
| | - Jon Salmanton-García
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Thomas J Walsh
- Department of Medicine, Department of Pediatrics, and Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA; New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Marcio Nucci
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chin Fen Neoh
- Faculty of Pharmacy, and Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences, Community of Research, Universiti Teknologi MARA, Selangor, Malaysia
| | - Jeffrey D Jenks
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA; Clinical and Translational Fungal Research Working Group, University of California San Diego, San Diego, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Michaela Lackner
- Institute of Hygiene and Medical Microbiology, Department of Hygiene, Medical Microbiology and Publics Health, Medical University Innsbruck, Innsbruck, Austria
| | - Rosanne Sprute
- Faculty of Medicine, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - Abdullah M S Al-Hatmi
- Department of Microbiology, Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
| | - Matteo Bassetti
- Division of Infections Diseases, Department of Health Sciences, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Fabianne Carlesse
- Department of Pediatrics, and Pediatric Oncology Institute IOP-GRAACC-UNIFESP, Federal Univeristy of São Paulo, São Paulo, Brazil
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Philipp Koehler
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Frankfurt, Germany
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Malcolm Richardson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sanjay Revankar
- Division of Infectious Diseases, Wayne State University, Detroit, MI, USA
| | - Monica A Slavin
- University of Melbourne, Melbourne, VIC, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jannik Stemler
- Faculty of Medicine, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - Birgit Spiess
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Saad J Taj-Aldeen
- Department of Laboratory Medicne and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Patrick C Y Woo
- Department of Microbiology, University of Hong Kong, Hong Kong, China
| | | | - Kerstin Albus
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Dorothee Arenz
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Valentina Arsic-Arsenijevic
- National Reference Laboratory for Medical Mycology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; European Confederation of Medical Mycology Council, Basel, Switzerland
| | - Jean-Philippe Bouchara
- Host-Pathogen Interaction Study Group, and Laboratory of Parasitology and Mycology, Angers University Hospital, Angers University, Angers, France
| | | | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - G Sybren de Hoog
- Center of Expertise in Mycology, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - George Dimopoulos
- Critical Care Department, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Rafael F Duarte
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Petr Hamal
- Department of Microbiology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic; European Confederation of Medical Mycology Council, Basel, Switzerland
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Center of Expertise in Mycology, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands; European Confederation of Medical Mycology Council, Basel, Switzerland
| | - Sayoki Mfinanga
- National Institute for Medical Research, Tanzania; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Flavio Queiroz-Telles
- Department of Public Health, Clinics Hospital, Federal University of Parana, Curitiba, Brazil
| | - Thomas F Patterson
- UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Galia Rahav
- Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital Campus, Dublin, Ireland
| | - Coleman Rotstein
- Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Danila Seidel
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology Council, Basel, Switzerland
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Ning JJ, Li XM, Li SQ. Disseminated Fusarium bloodstream infection in a child with acute myeloid leukemia: A case report. World J Clin Cases 2021; 9:6049-6055. [PMID: 34368326 PMCID: PMC8316941 DOI: 10.12998/wjcc.v9.i21.6049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/06/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Disseminated Fusarium is rare in healthy children. Children with hematological tumors may have secondary fungal infections, including Fusarium infections, which are due to tumor bone marrow infiltration or prolonged bone marrow suppression after chemotherapy. Because of the lack of typical clinical manifestations and effective antifungal drugs, early diagnosis and treatment of the disease are difficult, and the prognosis is poor.
CASE SUMMARY The patient in this case was a 13-year-old female child with rash and fever as the first symptoms. She had the characteristics of the four stages of skin that are typical of Fusarium infection. She was diagnosed with disseminated Fusarium infection through skin biopsy and blood culture and diagnosed with Fusarium solani infection based on the morphological characteristics of the blood culture. After treatment with liposome amphotericin B combined with voriconazole, the child recovered.
CONCLUSION This case highlights that for children with secondary agranulocytosis after receiving chemotherapy for hematological malignancies, once typical abnormal skin damage is found, the possibility of Fusarium infection should be considered, and voriconazole alone or in combination with polyenes may be the most effective anti-Fusarium drugs. Amphotericin B, the traditional drug of disseminated Fusarium disease, has a high mortality rate, and it is not recommended to use it alone. Adequate neutrophil counts are essential for the treatment of disseminated Fusarium bloodstream infection.
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Affiliation(s)
- Jun-Jie Ning
- Department of PICU, First People's Hospital of Zigong City, Zigong 643000, Sichuan Province, China
| | - Xue-Mei Li
- Department of PICU, First People's Hospital of Zigong City, Zigong 643000, Sichuan Province, China
| | - Sheng-Qiu Li
- Department of PICU, First People's Hospital of Zigong City, Zigong 643000, Sichuan Province, China
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Samrah S, Sweidan A, Aleshawi A, Ayesh M. Fusarium-Induced Cellulitis in an Immunocompetent Patient With Sickle Cell Disease: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620934303. [PMID: 32539466 PMCID: PMC7298209 DOI: 10.1177/2324709620934303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fungal infections due to Fusarium species are mostly
present in immunocompromised and patients with poorly controlled
diabetes mellitus. We report a case of lower extremity skin infection
caused by Fusarium species in a 61-year-old woman
diagnosed with sickle cell disease. Single skin ulceration caused by
Fusarium species can result from fungal
inoculation into damaged tissue, so any condition that damages the
skin can be considered as a risk factor for inoculation. Long-standing
sickle cell disease may develop vaso-occlusion in the skin that can
produce lower extremity ulcers and myofascial syndromes. The mechanism
is not completely characterized, but compromised blood flow,
endothelial dysfunction, thrombosis, inflammation, and delayed healing
are thought to contribute to locally compromised tissue that may
eventually lead to opportunistic infection such as in our case. Other
factors contribute to the pathophysiology of lower extremity ulcers
such as diabetes mellitus, with the resulting peripheral vascular
ischemia causing poor circulation to the lower extremity, and
peripheral neuropathy, which can make patients with diabetes unaware
of minor trauma leading to the development of skin infections.
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Affiliation(s)
- Shaher Samrah
- Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob Sweidan
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Mahmoud Ayesh
- Jordan University of Science and Technology, Irbid, Jordan
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8
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Agyei JO, Qiu J, Fabiano AJ. Fusarium species intramedullary spinal cord fungus ball: case report. J Neurosurg Spine 2019; 31:440-446. [PMID: 31075770 DOI: 10.3171/2019.2.spine181286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/20/2019] [Indexed: 11/06/2022]
Abstract
The Fusarium species are one of the most common opportunistic fungal infections occurring in immunocompromised patients and are associated with high morbidity and mortality. Common sites of infection include blood, skin, nasal passages, lungs, bone, and other visceral organs. There is a paucity of literature on Fusarium infections in the brain, and the true nature and extent of central nervous system involvement is not well described. To the authors' knowledge, there have been no reported cases of Fusarium infection of the spine. The authors report the case of a man with acute myeloblastic leukemia and resultant pancytopenia who presented with fungal sinusitis, upper- and lower-extremity weakness, and cardiopulmonary arrest. Imaging studies revealed a spinal cervical intramedullary ring-enhancing lesion. Because of the progressive nature of his symptoms, neurosurgical intervention involving a C2-3 laminectomy and drainage of the lesion was performed. Intraoperative cultures and histopathology results were positive for Fusarium species and, along with intraoperative findings, were consistent with a fungus ball. The patient was placed on a regimen of intravenous and intrathecal antifungal therapy. Unfortunately, his clinical condition declined postoperatively, and he ultimately died of disseminated infection.
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Affiliation(s)
- Justice O Agyei
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, New York
| | - Jingxin Qiu
- 3Pathology, Roswell Park Comprehensive Cancer Center, Buffalo; and
| | - Andrew J Fabiano
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, New York
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9
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Smith RJ, Klieger SB, Sulieman SE, Berger E, Treat JR, Fisher BT. Retrospective review of immunocompromised children undergoing skin biopsy for suspected invasive infection: Analysis of factors predictive of invasive mold. Pediatr Dermatol 2018; 35:104-111. [PMID: 29231258 DOI: 10.1111/pde.13351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Cutaneous lesions are often the first marker of invasive mold infection, which can cause substantial morbidity in immunocompromised children. The purpose of this study was to describe the evaluation and outcomes of immunocompromised children who presented with findings requiring skin biopsy because of concern about invasive infection. In children who were biopsied, we sought to determine the factors predictive of invasive mold infection. METHODS A retrospective review was conducted at the Children's Hospital of Philadelphia. Patients included in the study were immunocompromised individuals younger than 26 years old who underwent skin biopsy by the inpatient dermatology consultation team between January 1, 2003, and March 15, 2015, because of development of new cutaneous lesions that were suspected of being invasive infection. RESULTS One hundred five encounters met the inclusion criteria. Fifty (47.6%) biopsied individuals had an infectious pathogen identified on histopathology or culture. Mold was the most common (36%) pathogen, followed by bacteria (32%) and yeast (26%). The presence of a single lesion (P = .001) and prior occlusion at the site of the lesion (P < .001) were associated with mold on biopsy. The combination of a single lesion, history of occlusion, and tissue necrosis on examination was highly predictive for invasive mold infection (86.3% [95% confidence interval 55.1-97.0%]). Of the 18 individuals with confirmed invasive mold infection, 13 (72%) underwent surgical resection, of whom 12 (92%) survived the 30-day follow-up period. CONCLUSION Skin biopsy enabled the detection of a pathogen that informed directed therapeutic interventions in nearly half of participants. Institutions caring for immunocompromised children should ensure adequate staffing of clinical personnel approved to perform skin biopsies.
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Affiliation(s)
- Robert J Smith
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah B Klieger
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Salwa E Sulieman
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Emily Berger
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Ronald O. Perelman Department of Dermatology, New York University, New York, NY, USA
| | - James R Treat
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian T Fisher
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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10
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Muraosa Y, Oguchi M, Yahiro M, Watanabe A, Yaguchi T, Kamei K. Epidemiological Study of Fusarium Species Causing Invasive and Superficial Fusariosis in Japan. Med Mycol J 2017; 58:E5-E13. [PMID: 28250364 DOI: 10.3314/mmj.16-00024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In Japan, Fusarium species are known etiological agents of human fungal infection; however, there has been no report of a large-scale epidemiological study on the etiological agents of fusariosis. A total of 73 Fusarium isolates from patients with invasive fusariosis (IF, n= 36) or superficial fusariosis (SF, n= 37), which were obtained at hospitals located in 28 prefectures in Japan between 1998 and 2015, were used for this study. Fusarium isolates were identified using Fusarium- and Fusarium solani species complex (FSSC) -specific real-time PCR and partial DNA sequences of the elongation factor-1 alpha (EF-1α) gene and the nuclear ribosomal internal transcribed spacer (ITS) region. FSSC was predominately isolated from both patients with IF and SF (IF, 77.8% and SF, 67.6%). Distribution of the phylogenetic species of FSSC isolates from patients with IF and SF exhibited different spectra; specifically, F. keratoplasticum (FSSC 2) (25.0%) was the most frequent isolate from patients with IF, whereas F. falciforme (FSSC 3+4) (32.4%) was the most frequent isolate from patients with SF. Fusarium sp. (FSSC 5) was the second most frequent isolate from both patients with IF and SF (IF, 22.2% and SF, 24.3%). Notably, F. petroliphilum (FSSC 1) was isolated only from patients with IF. Each species was isolated from a broad geographic area, and an epidemic was not observed. This is the first epidemiological study of Fusarium species causing IF and SF in Japan.
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11
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Rahn S, Schuck A, Kondakci M, Haas R, Neuhausen N, Pfeffer K, Henrich B. A novel comprehensive set of fungal Real time PCR assays (fuPCR) for the detection of fungi in immunocompromised haematological patients—A pilot study. Int J Med Microbiol 2016; 306:611-623. [DOI: 10.1016/j.ijmm.2016.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/12/2016] [Indexed: 01/04/2023] Open
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12
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13
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Al-Maqtoofi M, Thornton CR. Detection of human pathogenic Fusarium species in hospital and communal sink biofilms by using a highly specific monoclonal antibody. Environ Microbiol 2016; 18:3620-3634. [PMID: 26914362 DOI: 10.1111/1462-2920.13233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
The fungus Fusarium is well known as a plant pathogen, but has recently emerged as an opportunistic pathogen of humans. Habitats providing direct human exposure to infectious propagules are largely unknown, but there is growing evidence that plumbing systems are sources of human pathogenic strains in the Fusarium solani species complex (FSSC) and Fusarium oxysporum species complex (FOSC), the most common groups infecting humans. Here, a newly developed Fusarium-specific monoclonal antibody (mAb ED7) was used to track FSSC and FOSC strains in sink drain biofilms by detecting its target antigen, an extracellular 200 kDa carbohydrate, in saline swabs. The antigen was detectable in 52% of swab samples collected from sinks across a University campus and a tertiary care hospital. The mAb was 100% accurate in detecting FSSC, FOSC, and F. dimerum species complex (FDSC) strains that were present, as mixed fungal communities, in 83% of sink drain biofilms. Specificity of the ELISA was confirmed by sequencing of the internally transcribed spacer 1 (ITS1)-5.8S-ITS2 rRNA-encoding regions of culturable yeasts and molds that were recovered using mycological culture, while translation elongation factor (TEF)-1α analysis of Fusarium isolates included FSSC 1-a, FOSC 33, and FDSC ET-gr, the most common clinical pathotypes in each group.
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Affiliation(s)
- Marwan Al-Maqtoofi
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.,University of Basrah, College of Science, Biology Department, Basrah, Iraq
| | - Christopher R Thornton
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
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14
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Hooten JN, Cheng R, Selim MA, Hall RP, Cardones AR. Opportunistic cutaneous fungal infections in the inpatient setting. Int J Dermatol 2015; 55:e223-6. [DOI: 10.1111/ijd.13059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/01/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Joanna N. Hooten
- Department of Dermatology; Duke University Medical Center; Durham, NC USA
| | - Rui Cheng
- Duke University School of Medicine; Durham, NC USA
| | - M. Angelica Selim
- Departments of Dermatology and Pathology; Duke University Medical Center; Durham, NC USA
| | - Russell P. Hall
- Department of Dermatology; Duke University Medical Center; Durham, NC USA
| | - Adela R. Cardones
- Department of Dermatology; Duke University Medical Center; Durham, NC USA
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15
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Dabas Y, Bakhshi S, Xess I. Fatal Cases of Bloodstream Infection by Fusarium solani and Review of Published Literature. Mycopathologia 2015; 181:291-6. [PMID: 26541869 DOI: 10.1007/s11046-015-9960-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/27/2015] [Indexed: 12/25/2022]
Abstract
Fusarium species are ubiquitously present in environment and are well known as human pathogens with high mortality rate in immunocompromised patients. We report here two cases where immunocompromised patients developed fatal bloodstream infections by this organism. Isolates were further identified by ITS1 region sequencing which confirmed them as Fusarium solani. Antifungal susceptibility testing was done following CLSI M38-A2 guidelines to amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, and micafungin. Both patients had a fatal outcome and expired of septic shock. Therefore, identification up to species level is of utmost importance as that helps in directing the management of the patient thereby leading to a favourable outcome.
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Affiliation(s)
- Yubhisha Dabas
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRA-IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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16
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Crabol Y, Lortholary O. Invasive mold infections in solid organ transplant recipients. SCIENTIFICA 2014; 2014:821969. [PMID: 25525551 PMCID: PMC4261198 DOI: 10.1155/2014/821969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/03/2014] [Indexed: 05/13/2023]
Abstract
Invasive mold infections represent an increasing source of morbidity and mortality in solid organ transplant recipients. Whereas there is a large literature regarding invasive molds infections in hematopoietic stem cell transplants, data in solid organ transplants are scarcer. In this comprehensive review, we focused on invasive mold infection in the specific population of solid organ transplant. We highlighted epidemiology and specific risk factors for these infections and we assessed the main clinical and imaging findings by fungi and by type of solid organ transplant. Finally, we attempted to summarize the diagnostic strategy for detection of these fungi and tried to give an overview of the current prophylaxis treatments and outcomes of these infections in solid organ transplant recipients.
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Affiliation(s)
- Yoann Crabol
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, 75015 Paris, France
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17
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Peterson A, Pham MH, Lee B, Commins D, Cadden J, Giannotta SL, Zada G. Intracranial fusarium fungal abscess in an immunocompetent patient: case report and review of the literature. J Neurol Surg Rep 2014; 75:e241-5. [PMID: 25485222 PMCID: PMC4242827 DOI: 10.1055/s-0034-1387182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/25/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction Fusarium spp is an omnipresent fungal species that may lead to fatal infections in immunocompromised populations. Spontaneous intracranial infection by Fusarium spp in immunocompetent individuals is exceedingly rare. Case Report An immunocompetent 33-year-old Hispanic woman presented with persistent headaches and was found to have a contrast-enhancing mass in the left petrous apex and prepontine cistern. She underwent a subsequent craniotomy for biopsy and partial resection that revealed a Fusarium abscess. She had a left transient partial oculomotor palsy following the operation that resolved over the next few weeks. She was treated with long-term intravenous antifungal therapy and remained at her neurologic baseline 18 months following the intervention. Discussion To our knowledge, this is the first reported case of Fusarium spp brain abscess in an immunocompetent patient. Treatment options include surgical intervention and various antifungal medications. Conclusion This case demonstrates the rare potential of intracranial Fusarium infection in the immunocompetent host, as well as its successful treatment with surgical aspiration and antifungal therapy.
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Affiliation(s)
- Asa Peterson
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Martin H Pham
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Brian Lee
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Deborah Commins
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Joseph Cadden
- Department of Infectious Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Steven L Giannotta
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Tortorano AM, Richardson M, Roilides E, van Diepeningen A, Caira M, Munoz P, Johnson E, Meletiadis J, Pana ZD, Lackner M, Verweij P, Freiberger T, Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Guinea J, Guarro J, de Hoog S, Hope W, Kathuria S, Lortholary O, Meis JF, Ullmann AJ, Petrikkos G, Lass-Flörl C. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect 2014; 20 Suppl 3:27-46. [PMID: 24548001 DOI: 10.1111/1469-0691.12465] [Citation(s) in RCA: 341] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 01/03/2023]
Abstract
Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation.
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Affiliation(s)
- A M Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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19
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del Alcazar E, Jaka A, Camino N, Gancho G, Tuneu A. Fever and skin lesions in an immunocompromised patient. Clin Exp Dermatol 2014; 40:219-21. [DOI: 10.1111/ced.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E. del Alcazar
- Department of Dermatology; Hospital Universitario Donostia; Donostia-San Sebastián Spain
| | - A. Jaka
- Department of Dermatology; Hospital Universitario Donostia; Donostia-San Sebastián Spain
| | - N. Camino
- Department of Haematology; Hospital Universitario Donostia; Donostia-San Sebastián Spain
| | - G. Gancho
- Department of Pathology; Hospital Universitario Donostia; Donostia-San Sebastián Spain
| | - A. Tuneu
- Department of Dermatology; Hospital Universitario Donostia; Donostia-San Sebastián Spain
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20
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Abstract
Dermatologic infections are among the most commonly experienced complications of cancer and anti-cancer therapy. Alterations in host immune function secondary to the underlying malignant process and/or its treatment have been linked to an increase in the risk of infections. The skin and its appendages (i.e., hair and nails) represent the first line of defense against infectious microorganism; its dysfunction as a physical barrier and an immunologic organ in cancer patients leads to an increased susceptibility to infectious organisms. Moreover, a cancer patient's vulnerable state facilitates dissemination of infections to other sites, secondarily involving the skin. This chapter delineates dermatologic infections that are unique to cancer patients as a result of their underlying malignancies and associated comorbidities as well as those resulting from antineoplastic therapies.
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Affiliation(s)
- Mona Gandhi
- Division of Dermatology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Administration Building, Room 519, Chicago, IL, 60612, USA,
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21
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Abstract
Fusariosis, an emerging opportunistic mycosis caused by Fusarium species, carries a high mortality rate in immunocompromised patients. The dismal prognosis of patients with fusariosis is aggravated by the limited therapeutic options. Here we give an overview of the epidemiology, pathogenesis, clinical manifestations, antifungal susceptibility and management of fusariosis.
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Affiliation(s)
- H A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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22
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[Fusariosis diagnosed in the laboratory of an UH in Tunisia: epidemiological, clinical and mycological study]. J Mycol Med 2013; 23:130-5. [PMID: 23725904 DOI: 10.1016/j.mycmed.2013.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/12/2013] [Accepted: 04/09/2013] [Indexed: 11/20/2022]
Abstract
The genus Fusarium, initially known for its important agro-economic impact, is more and more often implicated in human pathology. In fact, multiples allergic, toxic and infectious manifestations are more reported in immunocompetent and immunocompromised hosts. The objective of our study was to analyse the epidemiological, mycological and clinical features of fusariosis reported in our CHU. Eighty-seven cases of Fusarium infections were collected: 34 cases of onychomycosis (39%), 26 cases of intertrigos (30%), 25 cases of keratomycosis (29%), one case of atypical invasive fusariosis due to Fusarium oxysporum species complex (FOSC) and one case of localized gingivolabial fusariosis due to Fusarium solani species complex (FSSC) in a patient with leukemia in phase of deep bone marrow aplasia, whose outcome was favorable after exiting of aplasia period and a treatment by amphotericine B. The case of pseudotumoral cutaneous fusariosis to F. oxysporum complicated with osteolysis and septic arthritis occurred in a pregnant woman without any immune deficit. The evolution was fatal in spite of prescription of multiple systemic antifungals. Concerning keratomycosis, Fusarium was the first agent responsible for these infections (43%). The corneal traumatism was found in 37.5% of cases and FSSC was the most isolated (72%). For superficial dermatomycosis, Fusarium was the third agent of onychomycosis in molds (25%). The most isolated species were FSSC (68%) and FOSC (20%). The intertrigo frequency was 0.07% and they were mostly caused by FSSC (84%) and FOSC (16%). Fusarium is an important cause of mold infections in our region. So, the species identification is useful because some species are resistant to the most common systemic antifungal agents.
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Abstract
Systemic mycoses are a heterogeneous group of infections caused by different species of fungi that mainly affect individuals with primary or secondary alterations of immunity. In recent years, there has been an increase in the incidence of infections related to migration, AIDS, and other causes of immunosuppression, such as solid organ and bone marrow transplantation; oncological, hematological, and autoimmune diseases; and the use of new drugs. In this paper, we outline the microbiological and epidemiological characteristics of 3 fungi: Aspergillus spp, Fusarium spp, and Penicillium spp. We describe the clinical manifestations of disease with emphasis on those that should alert the dermatologist to make an early diagnosis. We detail the various tools for early diagnosis, prevention, and the epidemiology of different antifungals available for treatment and their mechanism of action and therapeutic efficacy.
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Affiliation(s)
- Ricardo Galimberti
- Department of Dermatology, Hospital Italiano de Buenos Aires, Juan D. Peron 4190 (CP1181ACH), Buenos Aires, Argentina.
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24
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Cocchi S, Codeluppi M, Venturelli C, Bedini A, Grottola A, Gennari W, Cavrini F, Di Benedetto F, De Ruvo N, Rumpianesi F, Gerunda GE, Guaraldi G. Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole. Diagn Microbiol Infect Dis 2012; 71:438-41. [PMID: 22083080 DOI: 10.1016/j.diagmicrobio.2011.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/26/2011] [Accepted: 08/26/2011] [Indexed: 11/26/2022]
Abstract
Fusarium is an opportunistic fungal pathogen which is emerging as a significant cause of morbidity and mortality in immunocompromised hosts. We present a rare case of F. verticillioides fungemia that occurred in a patient who underwent a second orthotopic liver transplantation for chronic rejection and completely responded to treatment with voriconazole.
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Affiliation(s)
- Stefania Cocchi
- Clinic of Infectious Diseases, Department of Medicine and Medical Specialities, Microbiology and Virology Laboratories, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
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25
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Abstract
Many emerging pathogens present in the skin and are of interest to dermatologists. Recent epidemics of measles, avian flu, and SARS demonstrated how an organism can rapidly spread worldwide because of airline travel. Travelers are often contagious before they are aware that they have the disease, contributing to the spread. This article reviews bacterial, mycobacterial, fungal, and viral pathogens important to dermatologists.
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Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821, USA.
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Marangon AV, Svidzinski TIE, Salci TP, Meurer R, da Cruz Fernandes M, Hernandes L. Metabolic extract ofFusarium oxysporuminduces histopathologic alterations and apoptosis in the skin of Wistar rats. Int J Dermatol 2009; 48:697-703. [DOI: 10.1111/j.1365-4632.2009.04013.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Interactions between triazoles and amphotericin B in treatment of disseminated murine infection by Fusarium oxysporum. Antimicrob Agents Chemother 2009; 53:1705-8. [PMID: 19188382 DOI: 10.1128/aac.01606-08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have evaluated and compared the efficacies of high doses of amphotericin B (AMB; 3 mg/kg of body weight/day), voriconazole (60 mg/kg), and posaconazole (PSC; 100 mg/kg) alone and combined in a murine model of disseminated infection by Fusarium oxysporum. The combination of AMB with PSC showed the best results, prolonging the survival of mice and reducing their organ fungal loads. This combination might constitute a therapeutic option for those infections where monotherapies fail.
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28
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Worth LJ, Slavin MA. Bloodstream infections in haematology: risks and new challenges for prevention. Blood Rev 2008; 23:113-22. [PMID: 19046796 DOI: 10.1016/j.blre.2008.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bloodstream infections are an important cause of morbidity and mortality in the haematology population, and may contribute to delayed administration of chemotherapy, increased length of hospitalisation, and increased healthcare expenditure. For gram-positive, gram-negative, anaerobic and fungal infections, specific risk factors are recognised. Unique host and environmental factors contributing to pathogenesis are acknowledged in this population. Trends in spectrum and antimicrobial susceptibility of pathogens are examined, and potential contributing factors are discussed. These include the widespread use of empiric antimicrobial therapy, increasingly intensive chemotherapeutic regimens, frequent use of central venous catheters, and local infection control practices. In addition, the risks and benefits of prophylaxis, and spectrum of endemic flora are identified as relevant factors within individual centres. Finally, challenges are presented regarding prevention, early detection, surveillance and prophylaxis. To reduce the rate and impact of bloodstream infections multifaceted and customised strategies are required within individual haematology units.
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Affiliation(s)
- Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia.
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29
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Elston DM. The dermatopathology of new and emerging infectious diseases. ACTA ACUST UNITED AC 2007; 23:165-76. [PMID: 18159901 DOI: 10.1016/j.yadr.2007.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821, USA.
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30
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Abstract
Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered.
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31
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Foell JL, Fischer M, Seibold M, Borneff-Lipp M, Wawer A, Horneff G, Burdach S. Lethal double infection with Acremonium strictum and Aspergillus fumigatus during induction chemotherapy in a child with ALL. Pediatr Blood Cancer 2007; 49:858-61. [PMID: 16429409 DOI: 10.1002/pbc.20756] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fungal infections are a major cause of morbidity and mortality in patients during chemotherapeutic treatments and malignant hematologic disease. We present a case of a double fungal infection with disseminated Acremonium strictum (A. strictum) and pulmonary Aspergillus fumigatus (A. fumigatus) and its rapid clinical course. A 17-year-old boy with prolonged neutropenia developed a disseminated fungal infection during induction chemotherapy of his acute lymphoblastic leukemia. The infection was rapidly lethal despite neutrophil recovery and early antifungal combination therapy with amphotericin B and caspofungin. Since there are only a few reports about invasive Acremonium infections, we present this case with regard to differences in the clinic pathologic features of Aspergillosis and other opportunistic fungal infections due to Fusarium or Acremonium species.
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Affiliation(s)
- J L Foell
- Department of Pediatric Hematology/Oncology, Martin-Luther University Halle-Wittenberg, Halle, Germany.
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32
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Torres-Rodríguez JM, Sellart-Altisent M. Celulitis y onicomicosis proximal de ambos ortejos mayores producida por Fusarium solani. Rev Iberoam Micol 2006; 23:241-4. [PMID: 17388651 DOI: 10.1016/s1130-1406(06)70053-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report a case of proximal fold cellulitis in both big toes, associated with a bilateral proximal onychomycosis and an intertrigo of the fourth space due to Fusarium solani. The infection occurred in an immunocompetent man with diabetes mellitus type II. Apparently, the infection was acquired in a tropical country and once the patient was in Spain the infection progressed causing nail detachment (onychomadesis). Seven months later a relapse that affected the left toenail occurred. The patient was treated topically with chemical toenail avulsion contained 40% urea associated with bifonazole followed by ciclopirox-olamine nail lacquer for 12 months. Complete cure without relapse was observed after 10 years of follow-up. In vitro antifungal susceptibility study demonstrated that two of the recovered isolates were both resistant to itraconazole and voriconazole.
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Affiliation(s)
- Josep M Torres-Rodríguez
- URMIM (Unidad de Investigación de Enfermedades Infecciosas y Micología), IMIM, Facultad de Medicina, Universitat Autònoma de Barcelona, c/ Dr. Aiguader, 80, 08003 Barcelona, Spain.
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Ruiz de Casas A, Herrera A, Suárez AI, Camacho FM. [Skin infection with Fusarium in an immunocompetent patient]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:278-80. [PMID: 16801025 DOI: 10.1016/s0001-7310(06)73400-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fusarium spp. are fungi found throughout the world and can cause a great variety of skin infections, mainly in immunodepressed individuals. We present a case of skin infection with Fusarium sp. which manifested as painful superficial ulcers on the legs of an immunocompetent female patient, who had applied <<medicinal mud>> as a <<natural remedy>> for leg pain. The condition was cured with oral itraconazole and local treatments.
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Affiliation(s)
- Andrés Ruiz de Casas
- Departamento de Dermatología M.Q., Hospital Universitario Virgen Macarena, Sevilla, España.
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Abstract
The hyalohyphomycetes (especially Fusarium spp) have emerged as significant pathogens in severely immunocompromised patients. Human infections by Fusarium spp can be superficial or limited to single organs in otherwise healthy patients. Such infections are rare and tend to respond well to therapy. By contrast, disseminated fusarial hyalohyphomycosis affects the immunocompromised host and frequently is fatal. Successful outcome is determined by the degree of immunosuppression and the extent of the infection. These infections may be suspected clinically on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy.
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Affiliation(s)
- Marcio Nucci
- Hematology Service, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
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Raad II, Hachem RY, Herbrecht R, Graybill JR, Hare R, Corcoran G, Kontoyiannis DP. Posaconazole as Salvage Treatment for Invasive Fusariosis in Patients with Underlying Hematologic Malignancy and Other Conditions. Clin Infect Dis 2006; 42:1398-403. [PMID: 16619151 DOI: 10.1086/503425] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 01/11/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Conventional amphotericin B-based antifungal therapy for invasive fusariosis in patients with a hematologic malignancy results in a > or = 70% failure rate. Posaconazole is a broad-spectrum antifungal agent with in vitro and in vivo activity against Fusarium species. METHODS In this retrospective analysis of patients from 3 open-label clinical trials, we evaluated posaconazole for the treatment of invasive fusariosis. Twenty-one patients with proven or probable invasive fusariosis who had disease refractory to or who were intolerant of standard antifungal therapy received oral posaconazole suspension (800 mg per day in divided doses) as salvage therapy. RESULTS Successful outcome occurred in 10 (48%) of all 21 patients. Among patients with leukemia who received posaconazole therapy for >3 days, the overall success rate was 50%; for patients who recovered from myelosuppression, the success rate was 67%, compared with 20% for those with persistent neutropenia. CONCLUSION These results suggest that posaconazole is useful for the treatment of invasive fusariosis.
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Affiliation(s)
- Issam I Raad
- The M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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36
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Ullmann AJ, Cornely OA, Burchardt A, Hachem R, Kontoyiannis DP, Töpelt K, Courtney R, Wexler D, Krishna G, Martinho M, Corcoran G, Raad I. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother 2006; 50:658-66. [PMID: 16436724 PMCID: PMC1366875 DOI: 10.1128/aac.50.2.658-666.2006] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetic profiles, safety, and efficacies of different dosing schedules of posaconazole oral suspension in patients with possible, probable, and proven refractory invasive fungal infection (rIFI) or febrile neutropenia (FN) were evaluated in a multicenter, open-label, parallel-group study. Sixty-six patients with FN and 32 patients with rIFI were randomly assigned to one of three posaconazole regimens: 200 mg four times a day (q.i.d.) for nine doses, followed by 400 mg twice a day (b.i.d.); 400 mg q.i.d. for nine doses, followed by 600 mg b.i.d.; or 800 mg b.i.d. for five doses, followed by 800 mg once a day (q.d.). Therapy was continued for up to 6 months in patients with rIFI or until neutrophil recovery occurred in patients with FN. The 400-mg-b.i.d. dose provided the highest overall mean exposure, with 135% (P = 0.0004) and 182% (P < 0.0001) greater exposure than the 600-mg-b.i.d. and 800-mg-q.d. doses, respectively. However, exposure in allogeneic bone marrow transplant (BMT) recipients (n = 12) was 52% lower than in non-BMT patients. Treatment-related adverse events (occurring in 24% of patients) were mostly gastrointestinal in nature. Twenty-four percent of patients had adverse events leading to premature discontinuation (none were treatment related). In efficacy-evaluable patients, successful clinical response was observed in 43% with rIFI (56% of patients receiving 400 mg b.i.d., 17% receiving 600 mg b.i.d., and 50% receiving 800 mg q.d.) and 77% with FN (74% receiving 400 mg b.i.d., 78% receiving 600 mg b.i.d., and 81% receiving 800 mg q.d.). Posaconazole is well tolerated and absorbed. Divided doses of 800 mg (400 mg b.i.d.) provide the greatest posaconazole exposure.
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Affiliation(s)
- A J Ullmann
- Third Medical Department, Johannes Gutenberg-University, Mainz, Germany.
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Xu J, Moore JE, Millar BC, Alexander HD, McClurg R, Morris TCMC, Rooney PJ. Improved laboratory diagnosis of bacterial and fungal infections in patients with hematological malignancies using PCR and ribosomal RNA sequence analysis. Leuk Lymphoma 2004; 45:1637-41. [PMID: 15370218 DOI: 10.1080/10428190410001667695] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
During October 1999 to November 2000, 98 blood culture specimens from the same number of febrile episodes originating from 49 patients with hematological malignancies were examined for the presence of eubacteria and fungi based on 16S rRNA gene and the 5.8, 18 and 28S rRNA combined with in vitro PCR amplification and sequencing, in addition to conventional blood culture laboratory techniques. Nineteen of the samples were associated with positive blood cultures. Eubacterial (16S rRNA) PCR detected bacterial DNA in 26 febrile episodes, i.e. in an additional 7 febrile episodes than blood-culture alone. The species identified by partial 16S rRNA gene sequencing were as follows Staphylococcus spp (n = 6), Staphylococcus epidermidis (n = 5), Acinetobacter spp (n = 5), Escherichia coli (n = 2), Enterobacter agglomerans (n = 2), Campylobacter spp (n = 1), Citrobacter spp (n = 1), Corynebacterium spp (n = 1), Enterobacter faecium (n = 1), Ralstonia spp (n = 1), Acidovorax spp. (n = 1) and Stenotrophomonas maltophilia (n = 1). Gram-positive bacteria were found in 12/27 (44.6%) and gram-negative bacteria were found in 15/27 (55.6%). After optimization of a PCR-based fungal detection method, none of the febrile episodes were shown to be attributable to fungi. The results of this study suggest that fungi are not common causal agents of febrile episodes in patients with a hematological malignancy at this centre and that molecular techniques can augment cultural methods in the diagnosis of causal agents of bacteremia in patients, so that appropriate antibiotic regimens may be commenced in patients with culture-negative episodes of infection.
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Affiliation(s)
- Jiru Xu
- Northern Ireland Public Health Laboratory, Departnment of Bacteriology, Belfast City Hospital, Belfast, BT9 7AD, Northern Ireland, UK
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Nir-Paz R, Strahilevitz J, Shapiro M, Keller N, Goldschmied-Reouven A, Yarden O, Block C, Polacheck I. Clinical and epidemiological aspects of infections caused by fusarium species: a collaborative study from Israel. J Clin Microbiol 2004; 42:3456-61. [PMID: 15297483 PMCID: PMC497645 DOI: 10.1128/jcm.42.8.3456-3461.2004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fusarium infections are an important problem worldwide, commonly affecting immunocompromised individuals. We conducted a retrospective study in two Israeli tertiary medical centers of factors predisposing to infection by Fusarium spp. and their influence on the epidemiology and clinical outcome of this infection. Fusarium spp. were isolated from 89 patients with a median age of 57 years. Sixty-eight patients were considered immunocompetent. Seven patients had disseminated disease, 34 had locally invasive disease, and 48 had superficial infection. Most infections were limited and occurred mainly in lower limbs. Factors associated with in-hospital mortality were chronic renal failure, hematological malignancy, immunosuppression, disseminated infection, and positive blood culture. Multivariate analysis showed that chronic renal failure, hematological malignancy, burns, and disseminated infection were independently associated with mortality. A surge in the frequency of infections was noticed during the summer for patients from rural areas, involving mainly the eyes and lungs. At one of the hospitals (in a mountainous area), there was an increase in the isolation rate over time.
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Affiliation(s)
- Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, The Hebrew University-Hadassah Medical Center, P.O. Box 12000, Ein Kerem, Jerusalem 91120, Israel
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39
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Abstract
More yeasts and molds are now recognized to cause more human disease than ever before. This development is not due to a change in the virulence of these fungi, but rather to changes in the human host. These changes include immunosuppression secondary to the pandemic of HIV, the use of life-saving advances in chemotherapy and organ transplantation, and the use of corticosteroids and other immunosuppressive agents to treat a variety of diseases. Fungi that were once considered common saprophytes are now recognized as potential pathogens in these patients. This situation necessitates better communication than ever between the clinician, pathologist, and clinical mycologist to ensure the prompt and accurate determination of the cause of fungal diseases.
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Affiliation(s)
- Gary W Procop
- Section of Clinical Microbiology, The Cleveland Clinic Foundation, L40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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40
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Guimerá-Martín-Neda F, García-Bustínduy M, Noda-Cabrera A, Sánchez-González R, Montelongo RG. Cutaneous infection by Fusarium: successful treatment with oral voriconazole. Br J Dermatol 2004; 150:777-8. [PMID: 15099384 DOI: 10.1111/j.0007-0963.2004.05878.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Fusarium species frequently implicated in human infections include F. solani, F. oxysporum and F. moniliforme. Among immunocompetent patients, tissue breakdown (as caused by trauma, severe burns or foreign body) is the risk factor for fusariosis. Infections include keratitis, onychomycosis and occasionally peritonitis and cellulitis. Treatment is usually successful and requires removal of the foreign body as well as antifungal therapy. Among immunocompromised patients, mainly patients with haematological malignancies, Fusarium spp. are the second most common pathogenic mould. Risk factors for disseminated fusariosis include severe immunosuppression (neutropenia, lymphopenia, graft-versus-host disease, corticosteroids), colonisation, tissue damage, and receipt of a graft from an HLA-mismatched or unrelated donor. Clinical presentation includes refractory fever (> 90%), skin lesions and sino-pulmonary infections ( approximately 75%). Type of skin lesions includes ecthyma-like, target, and multiple subcutaneous nodules. Skin lesions lead to diagnosis in > 50% of patients and precede fungemia by approximately 5 days. In contrast to disseminated aspergillosis, disseminated fusariosis can be diagnosed by blood cultures in 40% of patients. Histopathology reveals hyaline acute-branching septate hyphae similar to those found in aspergillosis. Mortality from fusarial infections in immunocompromised patients ranges from 50% to 80%. Host immune status is the single most important factor predicting outcome. Persistent neutropenia and corticosteroid therapy significantly affect survival. Optimal treatment has not been established. Anecdotal successes have been reported with various agents (high-dose amphotericin B, lipid-based amphotericin B formulations, itraconazole, voriconazole) and with cytokine-stimulated granulocyte transfusions. Preventing fusariosis relies on detection and treatment of cutaneous damage prior to commencing immunosuppression and decreasing environmental exposure to Fusaria (via air and water).
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Affiliation(s)
- M C Dignani
- FUNDALEU (Foundation for the Fight against Leukemia), Uriburu 1450, Buenos Aires, Argentina
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42
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Vincent AL, Cabrero JE, Greene JN, Sandin RL. Successful voriconazole therapy of disseminated Fusarium solani in the brain of a neutropenic cancer patient. Cancer Control 2004; 10:414-9. [PMID: 14581897 DOI: 10.1177/107327480301000511] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Albert L Vincent
- Division of Infectious Diseases, Department of Internal Medicine, University of South Florida, Tampa, USA
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Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 Suppl 1:48-66. [PMID: 14748802 DOI: 10.1111/j.1470-9465.2004.00839.x] [Citation(s) in RCA: 385] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The emergence of less common but medically important fungal pathogens contributes to the rate of morbidity and mortality, especially in the increasingly expanding population of immunocompromised patients. These pathogens include septate filamentous fungi (e.g., Fusarium spp., Scedosporium spp., Trichoderma spp.), nonseptate Zygomycetes, the endemic dimorphic pathogen Penicillium marneffei, and non-Cryptococcus, non-Candida pathogenic yeast (e.g., Trichosporon spp.). The medical community is thus called upon to acquire an understanding of the microbiology, epidemiology and pathogenesis of these previously uncommon pathogens in order to become familiar with the options for prevention and treatment.
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Affiliation(s)
- T J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, The National Cancer Institute, Bethesda, MD 20892-1928, USA.
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44
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Consigny S, Dhedin N, Datry A, Choquet S, Leblond V, Chosidow O. Successsful voriconazole treatment of disseminated fusarium infection in an immunocompromised patient. Clin Infect Dis 2003; 37:311-3. [PMID: 12856225 DOI: 10.1086/375842] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Accepted: 03/17/2003] [Indexed: 11/03/2022] Open
Abstract
Fusarium infection is known to cause major morbidity and mortality in immunocompromised hosts. We report the successful treatment of disseminated Fusarium infection with skin manifestations in a severely neutropenic, immunocompromised host with voriconazole, a new second-generation triazole. Voriconazole might be an alternative therapy for patients with neutropenia who have fusariosis that is refractory or unresponsive to amphotericin B or its liposomal formulation.
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Affiliation(s)
- Sophie Consigny
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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45
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Abstract
As the number of immunocompromised patients increases, there is a concomitant increase in the number and diversity of fungal infections. Fungi that were once considered harmless or contaminants are now pathogenic in the immunocompromised host. Often these emerging pathogens are indistinguishable from the more familiar fungal infections; however, they are generally more recalcitrant to conventional antifungal therapies. With the antifungal armamentarium now expanding, the clinician now has many more options for these difficult-to-treat mycoses. We review many of the newer antifungal agents (second-generation triazoles, echinocandins, etc.) as therapeutic options for the recently emerging fungal pathogens.
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Affiliation(s)
- William J Steinbach
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Box 3499, Durham, NC 27710, USA.
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46
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Gallagher JC, Dodds Ashley ES, Drew RH, Perfect JR. Antifungal pharmacotherapy for invasive mould infections. Expert Opin Pharmacother 2003; 4:147-64. [PMID: 12562305 DOI: 10.1517/14656566.4.2.147] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of invasive mould infections is increasing and is associated with significant morbidity and mortality. Among the most prevalent of these infections are those caused by Aspergillus and Fusarium species. Invasive disease caused by moulds frequently presents as a pulmonary infection, but haematogenous infection can occur. Some moulds cause cutaneous disease through either direct inoculation of the skin or secondary spread to the skin after dissemination from another body site. Early diagnosis can often be difficult and, unfortunately, diagnosis occurs late in the course of illness in many cases. Treatment options have historically been limited by the need for intravenous administration (amphotericin B), significant toxicities (amphotericin B), lack of reliable in vitro activity (e.g., amphotericin B in Fusarium and Scedosporium apiospermum infections) and relative lack of clinical experience with newer agents. The recent approval of voriconazole (Vfend, Pfizer) introduces a treatment option that demonstrates both in vitro and in vivo activity against a variety of moulds. With the recent development of the new echinocandin class of antifungal agents and newer broad-spectrum azole antifungal agents with in vitro mould activity, there is a renewed emphasis on fungal treatment strategies. Antimould therapy presents challenges in adverse effect avoidance and management, drug interactions and pharmacoeconomic considerations. Furthermore, combination therapy is being explored with these various new antifungal agents. The administration of an optimal fungicidal therapy early in the course of the illness and control of the underlying disease are vital to prevent complications and mortality from these tenacious mycoses.
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Affiliation(s)
- Jason C Gallagher
- Duke University Medical Center, Division of Infectious Diseases, Box 3353, Durham, NC 27710, USA
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Lionakis MS, Kontoyiannis DP. The significance of isolation of saprophytic molds from the lower respiratory tract in patients with cancer. Cancer 2003; 100:165-72. [PMID: 14692037 DOI: 10.1002/cncr.11876] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Invasive infections caused by molds other than Aspergillus, Fusarium, and Zygomycetes have been reported sporadically in patients with leukemia and allogeneic bone marrow transplantation (BMT). However, the significance of lower respiratory tract cultures that are positive for these saprophytic molds in an unselected population of patients with cancer remains unclear. METHODS The authors evaluated the significance of respiratory specimens positive for saprophytic molds in patients with cancer using the criteria set by the European Organization for Research and Treatment of Cancer (EORTC)/Mycoses Study Group (MSG). They included the diagnostic category of indeterminate pulmonary invasive mold infection (IMI) for cases that met the criteria for probable IMI but had other pathogens concomitantly isolated from the respiratory tract. RESULTS Eighty-five cases with at least 1 positive culture were identified in 79 patients. Two cases were proven IMI, 29 were indeterminate IMI, 5 were possible IMI, and 49 were no IMI. All 38 cases from patients with solid tumors represented colonization compared with only 11 of the 47 cases (23%) from high-risk patients (P < 0.0001). The positive predictive value (PPV) of cultures was 0% in patients with solid tumors and ranged from 4.3% to 76.6%, depending on the analytic model used, in high-risk patients with leukemia and recipients of BMT. Cultures positive for Scedosporium spp. had a higher PPV (9.1-100%) than did cultures positive for non- Scedosporium spp. (2.8- 69.4%). CONCLUSIONS Adjustments of the EORTC/MSG criteria may be required for the diagnosis of invasive infections caused by saprophytic molds, especially non-Scedosporium spp., in patients with cancer.
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Affiliation(s)
- Michail S Lionakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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48
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Bodey GP, Boktour M, Mays S, Duvic M, Kontoyiannis D, Hachem R, Raad I. Skin lesions associated with Fusarium infection. J Am Acad Dermatol 2002; 47:659-66. [PMID: 12399756 DOI: 10.1067/mjd.2002.123489] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infections caused by Fusarium species are increasing in frequency among immunocompromised hosts. We identified 35 patients with cancer who had Fusarium skin lesions. Twenty patients had disseminated infection, 6 had primary localized skin infections, 4 had skin lesions associated with sinus infections, and 5 had onychomycosis. All patients (except 3 with onychomycosis) had hematologic malignancies and neutropenia. Skin lesions associated with disseminated infection included red or gray macules, papules (some with central necrosis or eschar), pustules, and subcutaneous nodules. Most patients had a variety of lesions simultaneously. Multiple red or gray macules with central ulceration or black eschar are characteristic of Fusarium infection. Disseminated infection may originate from skin lesions or onychomycosis. Most infections fail to respond to antifungal therapy unless there is resolution of the patient's neutropenia.
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Affiliation(s)
- Gerald P Bodey
- University of Texas M. D. Anderson Cancer Center, Houston, TX 77040, USA
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49
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Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis 2002; 35:909-20. [PMID: 12355377 DOI: 10.1086/342328] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2002] [Revised: 04/25/2002] [Indexed: 12/13/2022] Open
Abstract
Infections by Fusarium species frequently involve the skin, either as the primary or the metastatic site. To better understand the pathophysiology of these infections, 43 new patients with fusariosis were evaluated, and the literature was reviewed. A total of 259 patients (232 immunocompromised and 27 immunocompetent) were identified. Skin involvement was present in 70% of patients, particularly in immunocompromised patients (72% vs. 52%; P=.03). In immunocompetent patients, cutaneous infections were characterized by preceding skin breakdown, localized involvement, slow pace of progression, and good response to therapy. In contrast, skin involvement in immunocompromised patients was only occasionally preceded by skin breakdown and typically was presented as rapidly progressive disseminated lesions at various stages of evolution. Metastatic skin lesions were associated with fungemia, neutropenia, and death. Skin was the single source of diagnosis for the majority of immunocompromised and immunocompetent patients. Recommendations for the prevention of fatal fusariosis originating from skin are presented.
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Affiliation(s)
- Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro, Brazil
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50
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