Abstract
Introduction: Fusarium species cause severe infections in patients with hematologic malignancies. The types of infection caused by Fusarium spp. in humans range from infections of nail, skin, and eye in immunocompetent host to invasive and disseminated infections in mainly immunocompromised patients.
Methods: We retrospectively indentified patients with hematologic malignancy and positive cultures for Fusarium species at the University Hospital (1995-2014).
Results: Thirteen cases were identified over study period. Patient demographic and underlying risk factors for fusariosis are presented in Table I. Most patients had uncontrolled hematological malignancy. All patients were neutropenic at diagnosis. Pulmonary involvement was evident in 3/13 patients (23%). Skin lesions were present in 2/13 (15%) patients. Fusariosis presented as a breakthrough infection in 8/13 (62%) of patients (Table II). Positive blood cultures were in the 6/13 (46%).
Conclusions: Our study has several limitations due to its retrospective nature and its relatively small size. Fusariosis, althought uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia. The optimal therapy for fusariosis remains undefined, because of its rarity and the complex clinical scenarious in patients with severe immunosupression.
Characteristics of 13 patients with fusariosis
| No . | Sex/ age . | Underlying disease . | Duration of neutropenia before/after (days) . | Fusarium spp. . | Diagnosis . | Breakthrough infections . | Concomitant infections . | Treatment of fusarium infection . | Outcome of Fusarium infection . |
|---|---|---|---|---|---|---|---|---|---|
| 1 | F/41 | AML/Ri | 15 /6 | F. verticillioides | Blood | None | None | Amp- B | Eradicated, in 23 days |
| 2 | M/19 | Aplastic anemia | 67/54 | F. proliferatum | Bronchi lavage | None | C. kefyr, C. glabrata, P. aeruginosa | Amp- B, voriconazole | Eradicated, in 51 days |
| 3 | M/38 | AML/RÝ | 31/1 | F. proliferatum | Bronchi lavage | Fluconazole | C. albicans | Amp- B, voriconazole | Eradicated, in 199 days |
| 4 | M/50 | ALL/RÝ | 25/0 | F. proliferatum | Blood | Fluconazole | K. pneumoniae | Amp- B | Died |
| 5 | M/43 | AML/consolidation | 37/9 | F. solani SC haplotype 6 | Skin biopsy | Fluconazole | C. bovis, S. arolis | Voriconazole | Died |
| 6 | M/45 | Relapse AML/ RÝ | 37/5 | F. petroliphilum | Blood + tissue biopsy | Itraconazole, voriconazole | VRE, S. capitis, S. maltophilia | Amp- B, voriconazole | Died |
| 7 | M/65 | AML/ RÝ | 41/0 | F. andiyazi | Blood | Posaconazol | A. baumanii | Amp - B | Died |
| 8 | M/63 | MDS tr. AML/ RÝ | None | F. petroliphilum | Nasalbiopsy | Fluconazole | HSV, C. albicans, alternans spp. | Amp- B, voriconazole | Died |
| 9 | M/49 | Refractary MDS tr. AML/ RÝ | 67/94 | F. solaniss. | Nasal biopsy | None | S. hominis, S. saprophyticus | Voriconazole | Eradicated in 68 days |
| 10 | F/53 | Relapse MDS tr. AML/ RÝ | 25/27 | F. proliferatum | Nasalbiopsy | Posaconazole | VRE, Klebsiella, Enterobactericea | Amp- B, voriconazole | Eradicated, in 84 days |
| 11 | F/49 | ALL/ RÝ | 23/13 | F. petroliphilum | Nasal biopsy | None | Enterococcus, S. epidermidis, E. faecalis, MRS, BLPS | Amp- B, voriconazole | Died |
| 12 | M/50 | HCL | 65/4 | F. petroliphilum | Blood | None | None | Amp- B | Died |
| 13 | M/52 | Relapse AML/ consolidation | 34/3 | F. petroliphilum | Blood , skin biopsy | Posaconazole | C. parapsilosis, C. meningosepticum, S. capitis | Echinocandine, voriconazole | Eradicated , in 90 days |
| No . | Sex/ age . | Underlying disease . | Duration of neutropenia before/after (days) . | Fusarium spp. . | Diagnosis . | Breakthrough infections . | Concomitant infections . | Treatment of fusarium infection . | Outcome of Fusarium infection . |
|---|---|---|---|---|---|---|---|---|---|
| 1 | F/41 | AML/Ri | 15 /6 | F. verticillioides | Blood | None | None | Amp- B | Eradicated, in 23 days |
| 2 | M/19 | Aplastic anemia | 67/54 | F. proliferatum | Bronchi lavage | None | C. kefyr, C. glabrata, P. aeruginosa | Amp- B, voriconazole | Eradicated, in 51 days |
| 3 | M/38 | AML/RÝ | 31/1 | F. proliferatum | Bronchi lavage | Fluconazole | C. albicans | Amp- B, voriconazole | Eradicated, in 199 days |
| 4 | M/50 | ALL/RÝ | 25/0 | F. proliferatum | Blood | Fluconazole | K. pneumoniae | Amp- B | Died |
| 5 | M/43 | AML/consolidation | 37/9 | F. solani SC haplotype 6 | Skin biopsy | Fluconazole | C. bovis, S. arolis | Voriconazole | Died |
| 6 | M/45 | Relapse AML/ RÝ | 37/5 | F. petroliphilum | Blood + tissue biopsy | Itraconazole, voriconazole | VRE, S. capitis, S. maltophilia | Amp- B, voriconazole | Died |
| 7 | M/65 | AML/ RÝ | 41/0 | F. andiyazi | Blood | Posaconazol | A. baumanii | Amp - B | Died |
| 8 | M/63 | MDS tr. AML/ RÝ | None | F. petroliphilum | Nasalbiopsy | Fluconazole | HSV, C. albicans, alternans spp. | Amp- B, voriconazole | Died |
| 9 | M/49 | Refractary MDS tr. AML/ RÝ | 67/94 | F. solaniss. | Nasal biopsy | None | S. hominis, S. saprophyticus | Voriconazole | Eradicated in 68 days |
| 10 | F/53 | Relapse MDS tr. AML/ RÝ | 25/27 | F. proliferatum | Nasalbiopsy | Posaconazole | VRE, Klebsiella, Enterobactericea | Amp- B, voriconazole | Eradicated, in 84 days |
| 11 | F/49 | ALL/ RÝ | 23/13 | F. petroliphilum | Nasal biopsy | None | Enterococcus, S. epidermidis, E. faecalis, MRS, BLPS | Amp- B, voriconazole | Died |
| 12 | M/50 | HCL | 65/4 | F. petroliphilum | Blood | None | None | Amp- B | Died |
| 13 | M/52 | Relapse AML/ consolidation | 34/3 | F. petroliphilum | Blood , skin biopsy | Posaconazole | C. parapsilosis, C. meningosepticum, S. capitis | Echinocandine, voriconazole | Eradicated , in 90 days |
Patient characteristics
| Demographic and disease characteristics . | Number of patients, n=13 (%) . |
|---|---|
| Median age | 49(19-63) |
| Male | 49,5(19-63) |
| Female | 49(41-53) |
| Female patient | 3 (23) |
| Male patient | 10(77) |
| AML/ MDS tr. AML | 9 (69) |
| Relapse | 3 |
| Remission induction | 7 |
| Consolidation | 2 |
| Reinduction | 1 |
| ALL (remission induction) | 2 (15) |
| Hairy cell leukemia | 1 (8) |
| Aplastic anemia | 1 (8) |
| Median duration of neutropenia before diagnosis (day) | 34 (15-67) |
| Median duration of neutropenia after diagnosis (day) | 6 (0-94) |
| History of DM | 0 |
| Albümin <3.5 mg/dL | All |
| Hýgh dose corticosteroid treatment within 30 days of diagnosis | 1 |
| Breakthrough infections | 8 (62) |
| While receiving posaconazole | 3 (23) |
| While receiving voriconazole | 1 (8) |
| While receiving fluconazole | 4 (31) |
| Concominant infection | Bacterial, viral, fungal=11 (85) |
| Exitus | 7 (54) |
| Demographic and disease characteristics . | Number of patients, n=13 (%) . |
|---|---|
| Median age | 49(19-63) |
| Male | 49,5(19-63) |
| Female | 49(41-53) |
| Female patient | 3 (23) |
| Male patient | 10(77) |
| AML/ MDS tr. AML | 9 (69) |
| Relapse | 3 |
| Remission induction | 7 |
| Consolidation | 2 |
| Reinduction | 1 |
| ALL (remission induction) | 2 (15) |
| Hairy cell leukemia | 1 (8) |
| Aplastic anemia | 1 (8) |
| Median duration of neutropenia before diagnosis (day) | 34 (15-67) |
| Median duration of neutropenia after diagnosis (day) | 6 (0-94) |
| History of DM | 0 |
| Albümin <3.5 mg/dL | All |
| Hýgh dose corticosteroid treatment within 30 days of diagnosis | 1 |
| Breakthrough infections | 8 (62) |
| While receiving posaconazole | 3 (23) |
| While receiving voriconazole | 1 (8) |
| While receiving fluconazole | 4 (31) |
| Concominant infection | Bacterial, viral, fungal=11 (85) |
| Exitus | 7 (54) |
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal