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

Abstract

Introduction: Fusarium species are hyaline saprophytic fungi that are frequently found in the soil, air, and water. They can cause severe systemic infections in immunocompromised patients. Clinical manifestations depend on the way of entry of the mold and host immune system status. The main ways of entrance are the airways, skin, and mucosal membranes. Disseminated fusariosis often occurs in patients with hematological disorders, patients with cancer, and solid organ transplant recipients. Case Presentation: Herein we report a case of Fusarium fungemia in a patient with adrenocortical carcinoma from Isfahan, Iran. The patient was a 41-year-old female with stage III adrenal cortical carcinoma. Despite antifungal therapy with liposomal amphotericin B, the patient passed away 6 days after admission. Internal transcribed spacer region sequencing applied for species identification and its sequence deposited in the GenBank (accession number: MK880379). Conclusions: Since the ideal strategies against invasive fungal infections remain uncertain and the mortality rate is high, we recommend primary prophylaxis with a broad-spectrum antifungal agent for vulnerable patients particularly those admitted to high-risk units such as oncology, hematology, and transplant units.

Fusarium fungemia in a term neonate with renal cysts

“…In the first week of postnatal life, the innate immune cells are the sole source of immune defence responder, changes in this immune response promote early-onset sepsis [9]. Neutrophils and macrophages inhibit hyphal growth and spore germination, with neutrophils being the primary responder in infection [8,10]. In this case report, a clinical infection was evidenced by leucocytosis, fever and a positive blood culture.…”

“…Fusarium species is one of the most clinically significant moulds in the immunocompromised and is typically present in soil, water, and organic substrates [8]. Skin, mucous membranes, and airways serve as the primary entry points.…”

Trans-kingdom fungal pathogens infecting both plants and humans, and the problem of azole fungicide resistance

“…Fusarioses are relatively rare compared to invasive candidiasis and aspergillosis, but FSSC can cause life-threatening opportunistic infections in immunocompromised and immunosuppressed patients (O'Donnell et al, 2020 ; Bupha-Intr et al, 2021 ). Invasive fusarioses, including bloodstream infections, have a high mortality due to the widespread antifungal resistance and frequently delayed diagnosis (Rajabzadeh et al, 2020 ; Huang et al, 2023 ). Nevertheless, FSSC can cause disease either on superficial or traumatized tissues in immunocompetent individuals, like keratitis, often associated with improper contact lens wear (Chang et al, 2006 ; Niu et al, 2020 ) and eumycetoma in patients with diabetes mellitus (Das et al, 2021 ).…”

“…Bloodstream infection represents minority, only the 1% of all Fusarium infections (Thomas et al, 2020 ), although the high mortality highlights its importance (Rajabzadeh et al, 2020 ; Huang et al, 2023 ). Especially in immunocompromised patients, a broad-spectrum antifungal agent and combination therapy with systemic antifungals are recommended (Rajabzadeh et al, 2020 ; Huang et al, 2023 ).…”