Fusarium
Mycotoxins:

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Washington University Infectious Diseases Division Fusarium handouts

Fusarium infections (July 95)

Members of the genus Fusarium are ubiquitous fungi uncommonly associated with infection. Human infection usually occurs as a result of inoculation of the organism through the body surface, thus causing skin infection, onychomycosis, keratitis, endophthalmitis and arthritis. Fusarium is one of the fungi that can produce micetoma. Dissemination may occur in subjects with underlying immunodeficiency Disseminated fusariosis typically occurs in neutropenic hosts and carries a high mortality rate. Characteristically, a profoundly neutropenic patient has had the abrupt onset of fever, sometimes with myalgia, followed in 66 percent of cases by distinctive skin lesions: multiple sites, predominantly on the extremities, develop painful erythematous macules or papules. Central pallor is followed by necrosis and ulceration. Blood cultures have been positive in 59 percent of cases, including a few that seemed to be due to infected central venous catheters. Amphotericin B is the drug of choice, although it appears to be poor correlation between in vitro susceptibility and clinical response. Prognosis is poor, with a mortality of 76% in the 85 reported cases. Survival was related to the resolution of the neutropenia.

Bibliography

1. Rabodonirina M, Piens MA, Monier MF et al. Fusarium infections in immunocompromised patients: case reports and literature review. Eur J Clin Microbiol Infect Dis 1994;13:152-61.

"The review". From France. Their experience with 5 cases and review of all cases from the literature.

2. Martino P, Gastaldi R, Raccah R, Girmenia C. Clinical patterns of Fusarium infections in immunocompromised patients. J Infect 1994;28 Suppl 1:7-15.

Another review, (this from Italy, shorter, but easier to read). Since 1973, when the first disseminated fusariosis in a child with acute leukemia was reported, about 80 new cases have been reported, mainly occurring in patients with haematologic malignancies. Specific Fever, positive blood cultures, severe myalgias, disseminated ecthyma gangrenosum-like skin lesions, ocular symptoms and multiple-organ-system involvement are distinctive features in most cases of disseminated fusariosis. The prognosis is very poor. All available antifungal drugs show a low activity against the various species of Fusarium.

3. Ammari LK; Puck JM; McGowan KL. Catheter-related Fusarium solani fungemia and pulmonary infection in a patient with leukemia in remission. Clin Infect Dis 1993;16:148 - 50.

A case of disseminated fusariosis with fungemia and pulmonary nodules. A summary of the literature is also presented.

4. Ellis ME, Clink H, Younge D, Hainau B. Successful combined surgical and medical treatment of fusarium infection after bone marrow transplantation. Scand J Infect Dis 1994;26:225-8

Fusarium in the foot, treatment: remove the foot...

5. Gamis AS, Gudnason T, Giebink GS, Ramsay NK. Disseminated infection with Fusarium in recipients of bone marrow transplants. Rev Infect Dis 1991;13:1077-88

Clinical data from 10 episodes of disseminated infection with Fusarium among eight recipients of bone marrow transplants and from 31 cases reported previously in the literature.