Fatal Cases of Bloodstream Infection by Fusarium solani and Review of Published Literature

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.

A Fatal Case of Bloodstream Infection by Fusarium Solani in a Patient with Adrenocortical Carcinoma From Isfahan, Iran

“…Fusarium is a common saprophytic fungus that is found in the soil, air, and water. Although Fusarium species were first isolated as phytopathogens (plant pathogens), they can cause fixed (onychomycosis and fungal keratitis) and systemic infections in humans, especially in immunocompromised patients (4,5,9). These opportunistic fungi caused high morbidity and mortality rates among patients with malignancies, severe T cell immunodeficiency, and prolonged neutropenia.…”

“…Persistent fever and skin lesions are the main symptoms despite antibacterial therapy (3). Recent studies have shown that Fusarium species, mostly cause fungemia in immunosuppressed patients (4)(5)(6). Limited infections occur in both immunocompetent and immunocompromised hosts, however disseminated fusariosis regularly occur in patients with hematological disorders, cancer pa-tients, and the solid organ transplant recipients (7).…”

“…Despite antifungal therapy with fluconazole (200 mg PO/day), voriconazole (2 × 300 mg IV/day), and liposomal amphotericin B (5 mg/kg/day IV), she died 16 days after infection. In 2016, Dabas et al(5) reported two cases of systemic fusariosis in 17 and 65 years old patients with acute myeloid leukaemia and cutaneous T cell large anaplastic lymphoma erythroderma. Fusarium solani was isolated from two patients and both of them expired due to the severe sepsis and septic shock.…”

The Curious Case of “Case Report” of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool, an Online Archive, or a Format in Need of Retooling

“…Severe paracoccidioidomycosis in a 14-year-old boy 200 1/1 [63] a Google Scholar/Scopus [41,42], France [43,44], India [45,46], Italy [47], Iran [48], Japan [49], Malaysia [50], Poland [51], UK [52], and USA [53,54]. There were no other discernible features among this group of case reports to account for the high downloads and citations except for a novelty or rarity of fungal pathogens, for example reports of two cases of multidrug-resistant yeast (Fereydounia khargensis) and of black-grain eumycetoma caused by the rare fungal pathogen Medicopsis romeroi [50,52].…”

Human fusariosis: An emerging infection that is difficult to treat

“…is responsible for significant economic losses in the agricultural field worldwide 3 due to difficulties in management of diseases caused by this species 4 . Similarly, in the medical field, different Fusarium species have been related to local or invasive infections in both immunodepressed and immunocompetent individuals 5,6,7 .…”