Fusarium species causing eumycetoma: Report of two cases and comprehensive review of the literature

Abstract

Recently, mycetoma was added to the World Health Organization's list of neglected tropical disease priorities. Fusarium as a genus has been reported to cause eumycetoma, but little is known about the species involved in this infection and their identification. In this study, molecular tools were applied to identify Fusarium agents from human eumycetoma cases. The partial translation elongation factor 1-alpha (TEF-1α) gene was used as diagnostic parameter. Two additional cases of eumycetoma, due to F. keratoplasticum and F. pseudensiforme, respectively, are presented. A systematic literature review was performed to assess general features, identification, treatment and outcome of eumycetoma infections due to Fusarium species. Of the 20 reviewed patients, the majority (75%) were male. Most agents belonged to the F. solani species complex, ie F. keratoplasticum, F. pseudensiforme, and an undescribed lineage of F. solani. In addition, F. thapsinum, a member of Fusarium fujikuroi species complex was encountered. The main antifungal drugs used were itraconazole, ketoconazole and amphotericin B, but cure rates were low (15%). Partial response or relapse was observed in some cases, and a case ended in amputation. Clinical management of eumycetoma due to Fusarium is complex and combination therapy might be required to increase cure rates.

A 23 bp cyp51A Promoter Deletion Associated With Voriconazole Resistance in Clinical and Environmental Isolates of Neocosmospora keratoplastica

“…The species distribution of the 15 clinical FSSC isolates agreed with previous reports that identified N. petroliphila and N. keratoplastica (FSSC types 1 and 2) as the most frequent FSSC species isolated in the clinic (Chang et al, 2006;O'Donnell et al, 2012). N. keratoplastica was reported to cause invasive fusariosis in hematologic patients (Chiewchanvit et al, 2017), keratitis (Tupaki-Sreepurna et al, 2017), onychomycoses (Guevara-Suarez et al, 2016), and eumycetoma (Al-Hatmi et al, 2017a). It has also been reported to cause disease in equine and marine vertebrates and invertebrates (O'Donnell et al, 2016).…”

In vitro Antifungal Susceptibility Testing of Clinical and Environmental Fusarium Isolates in Iran

“…For instance, F. acutatum has been reported from nail infections as an emerging human opportunist which has thus far been detected in Asia and appears to be restricted to the Middle East (34,35). In other studies, F. thapsinum, has been reported as causing eumycetoma and has been also isolated from environmental sources (23,35). Their patterns of in vitro susceptibility to antifungal both species, which demonstrated resistance of these two rare species.…”

Antifungal Susceptibility Testing of Fusarium: A Practical Approach

“…It seems that prediction of the therapeutic success based on the MIC of a fungal strain is not always possible, because studies conducted until now have shown a poor correlation between the in vitro data with the in vivo outcome. For example, high MICs of itraconazole for a Fusarium strain isolated from a mycetoma case have been found, but the patient improved and completely recovered using itraconazole [ 36 ]. Various host factors affect the response to antifungal drugs, such as underlying disease, host immune function, catheter removal, surgical interventions, and pharmacokinetic parameters [ 37 ].…”