Invasive hyalohyphomycosis due to Fusarium solani in a patient with acute lymphocytic leukemia

Fusarium Infections in Critically Ill Patients

“…Since the description of the first case of disseminated fusariosis in a child with acute leukemia in 1973, 14 reports of this opportunistic mycosis have dramatically increased; in fact, invasive fusariosis has emerged in many tertiary-care cancer centers as the second most common invasive mold infection (IMI) in profoundly immunocompromised patients behind IA. 1,2,[4][5][6][7][8][10][11][12][15][16][17][18][19][20][21][22] There seems to be a distinct seasonal peak and geographic distribution of invasive fusariosis. 7,8 Specifically, the majority of the cases occur during the rainy summer season, when the dispersion of fusarial conidia in the air is more pronounced.…”

“…7,8,22 The skin and respiratory tract are the primary portals of entry for Fusarium infection. 4,[7][8][9][19][20][21][22][23][24][25][26] For instance, the use of central venous catheters (CVCs) and continuous ambulatory peritoneal dialysis catheters has been associated with invasive fusariosis. 23,24 Moreover, patients with extensive burns are susceptible to colonization by Fusarium spp.…”

“…31,32 Neutrophils probably play the most critical role in the control of human Fusarium infections. [4][5][6][7][8][10][11][12][15][16][17][18][19][20][21][22]34,35 Several studies have demonstrated that the prognosis for patients with fusariosis is clearly associated with prompt recovery of neutrophil counts. In fact, the mortality rate for fusariosis in the setting of profound, prolonged neutropenia is essentially 100%, even with aggressive antifungal treatment, whereas it has been reported to be as low as 30% when neutrophil counts are or promptly return to normal.…”

“…4 More than 90% of human invasive fusariosis cases occur in neutropenic patients with hematologic malignancies, especially those with acute leukemia, in whom over 50% of all cases have been reported. 4,7-9,10-12, [16][17][18][19][20] Moreover, allogeneic BMT recipients are at risk for fusariosis, especially in the early posttransplant period when engraftment is delayed and later in the setting of iatrogenic hypercortisolism for the treatment of acute or chronic graft-versus-host disease. 4,[10][11][12]21 It has been estimated that the incidence of fusariosis in allogeneic and autologous BMT recipients is 1.2% and 0.2%, respectively.…”

“…2,4,5 In contrast with Fusarium infections in normal hosts, which are typically localized (e.g., skin and eye infections and osteomyelitis) and fre-quently do not require systemic therapy, fusariosis in profoundly immunocompromised patients manifests in four major patterns: refractory fever of unknown origin, sinopulmonary infection or pneumonia, disseminated infection, and a variety of focal single-organ infections. 2,5,9,[10][11][12][15][16][17][18][19][20][21][22][23] The usual initial presentation of invasive fusariosis is a fever that persists despite broad-spectrum antimicrobial coverage in a profoundly neutropenic patient. 4,5 Because Fusarium spp.…”