Infections Caused by Fusarium Species in Pediatric Cancer Patients and Review of Published Literature

Abstract

Fusarium species have emerged as responsible for a broad spectrum of infections, including superficial, locally invasive and disseminated ones, especially in the hospital environment. Since there are few reports of invasive and disseminated fusariosis in children, the aim of this study was to report four cases of nosocomial infection caused by this microorganism in children with cancer hospitalized in a public children's hospital located in Brazil. Two of these patients were female and two were male. All patients presented febrile neutropenia, while three patients had acute lymphocytic leukemia and one patient had Wilms' tumor as underlying disease. In two cases, fungi were isolated from blood and identified as Fusarium oxysporum species complex after phenotypic and genotypic studies, while in two other cases fungi were isolated from skin biopsies and identified as Fusarium solani species complex. One patient died 12 days after the onset of cutaneous lesions. All isolates, after susceptibility testing, presented high levels of minimum inhibitory concentration for itraconazole, voriconazole and amphotericin B. Considering the emergence of filamentous fungi as etiologic agents of nosocomial infections, health professionals should be aware of the problems these infections, especially fungal ones, may cause to debilitated patients.

<p>An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies</p>

“… 196 – 198 These microorganisms are not susceptible to echinocandins and itraconazole, and in general, LAMB, voriconazole, and posaconazole have been recommended or applied for the treatment and prophylaxis of fusariosis in adults, although the clinical response to these drugs were merely modest. 199 , 200 Harada and his colleagues reported that a patient with AML who also had a pre-engraftment disseminated fusariosis was treated with high doses of LAMB, and the results of another study also showed that a combination of LAMB and voriconazole in an ALL patient with disseminated fusariosis leads to complete recovery of the patient. 117 , 201 On the other hand, the results of another study on two acute leukemia patients who developed disseminated fusariosis showed that the F. solani isolated from the patients were resistant to amphotericin, and both patients died despite antifungal treatment.…”

Dermatological manifestations of fungal infection in patients with febrile neutropaenia: A review of the literature

“…We discovered 54 publications with a total of 215 reported cases of cutaneous manifestations of fungal injury in patients with FNP (Table ). Descriptions of all lesions were either cited as described by the presenters of the case, or if such descriptions were lacking, described by the authors herein.…”

Multisystemic fusariosis with fulminant evolution

“…are resistant to multiple antifungals, but are highly susceptible to amphotericin B and voriconazole. 1 , 9 , 10 However, severe neutropenia is the most important prognostic factor, determining lethality of up to 75% of cases. 6 , 10 …”