Fusarium proliferatum Soft Tissue Infection at the Site of a Puncture by a Plant: Recovery, Isolation, and Direct Molecular Identification

Abstract

After allogeneic stem cell transplantation, a 49-year-old man developed fever and inflammation at the site of a plant puncture on a finger. A hyalohyphomycete was recovered by incubating the plant spine fragment following surgery. Amplification of the internal transcribed spacer region and 5.8S rRNA, ␤-tubulin, and translation elongation factor coding genes identified Fusarium proliferatum, which was confirmed later by culture. CASE REPORTA febrile 49-year-old Ecuadorian man was evaluated at the National Institutes of Health Clinical Center 8 days after allogeneic hematopoietic stem cell transplantation for pain, erythema, and swelling in the right third finger. The patient had been neutropenic for 8 days and had been started empirically on ceftazidime and vancomycin for fevers that began 4 days earlier. Finger pain and swelling had also begun 4 days earlier, but he did not report the symptoms until they became severe. The patient described a puncture injury to the finger from the spine of a Chinese palm tree (Trachycarpus fortunei) 8 months before. Since the injury, he had experienced two flares of erythema and swelling at the site, most recently 3 months ago; each episode resolved spontaneously. There had been no skin breakdown or drainage from the finger.The patient underwent hematopoietic stem cell transplantation for myelodysplastic syndrome (refractory anemia with excess blasts) diagnosed 4 months earlier. The patient lived in Quito, Ecuador, where he owned an avocado farm but did not operate it directly. He had an urban home with a plant-filled patio and no pets.Upon examination, the patient was found to have rigors and appeared to be very uncomfortable. His temperature was 38.4°C, his blood pressure was 113/59 mm Hg, his heart rate was 82 beats per min, his respiratory rate was 20 breaths per min, and his pulse oximetry reading was 100% on room air. The volar surface of the right third finger slightly distal to the proximal interphalangeal joint was erythematous, warm, focally indurated and tender, but with intact skin (Fig. 1a). He was able to flex but not fully extend the finger. There were no other cutaneous lesions and no onychomycosis.Laboratory studies revealed a white blood cell count of 14 cells/mm 3 , a hemoglobin level of 9.7 g/dl, a platelet count of 26,000/mm 3 , and a C-reactive protein level of 1.97 mg/liter.Magnetic resonance imaging (MRI) of the finger (Fig. 1b) revealed enhancement of the superficial and peritendinous soft tissues, as well as a punctate foreign body in the superficial volar aspect of the finger. Fungal and bacterial blood cultures were negative. Intravenous voriconazole at 4 mg/kg every 12 h was initiated as empirical therapy for prolonged fever and persistent neutropenia. The patient was taken to the operating room, where incision and drainage of the finger lesion yielded gray fluid and a tiny (ϳ2-mm) plant spine fragment. The spine and abscess material were sent for microbiological studies. At surgery, there was no evidence that the infection extended into the joint sp...

Fusarium Infection

“…We identified 97 cases of invasive fusariosis from the literature published since 2000. 1 – 4 , 6 – 13 , 16 , 18 , 20 – 27 , 31 – 33 , 37 – 39 , 42 – 44 , 46 , 48 , 50 – 57 , 59 , 61 , 62 , 65 – 67 , 69 – 71 , 74 – 81 , 83 – 85 , 87 , 89 , 91 , 97 , 99 , 100 – 103 , 105 – 108 , 111 – 113 , 115 – 121 , 124 – 126 , 128 – 135 , 139 , 140 The patients’ mean age was 45 years (range, 3 mo to 85 yr). Fifty-four patients were male and 41 female (sex was not reported in 2 cases).…”

Emerging Fungal Infections in Solid Organ Transplant Recipients

“…Patients with impaired cutaneous barriers due to traumatic injury or an invasive medical procedure are also at risk. Skin infections due to the Zygomycetes, Scedosporium, Fusarium and the dark molds have been described in such circumstances (14, 26-28). …”

Crossing the kingdom border: Human diseases caused by plant pathogens

“…In addition to illnesses caused by fungal toxins, hospital case studies showed that plantassociated fungi were capable of causing diseases through direct human infection (Sexton and Howlett, 2006;Bebber and Gurr, 2015). For example, the plant pathogenic fungi Fusarium proliferatum and Colletotrichum truncatum were isolated from human tissues after infection via a puncture site and via ophthalmic infection respectively (Palmore et al, 2010;Shivaprakash et al, 2011).…”