Invasive fusariosis with prolonged fungemia in a patient with acute lymphoblastic leukemia: case report and review of the literature

Abstract

Fusariumspp are rare but important opportunistic pathogens in immunocompromised patients. Disseminated fusarial infections occur mostly in patients with hematologic malignancies with myelosuppressive chemotherapy or in patients with severe immunodeficiency. Although more frequent than Aspergillus fungemia, Fusarium fungemia remains a rare event. We describe the case of a female patient with febrile neutropenia and persistent fungemia due to Fusarium solani, treated with posaconazole and liposomal amphotericin B. A review of the literature for Fusariumspp fungemia was carried out.

Disseminated fusariosis by Fusarium proliferatum in a patient with aplastic anaemia receiving primary posaconazole prophylaxis – case report and review of the literature

“…As in our patient, disseminated Fusarium infections are characterised by persistent fever during prolonged neutropenia, which is refractory to broad‐spectrum antibiotic treatment, and by painful skin lesions with a central necrosis . Studies show that skin lesions are present in more than 85% of reported fusariosis cases, often occur at an early stage of the disease, may precede positive blood cultures by up 5 days and are the typical clinical sign of this mycosis . Histopathology diagnosis in tissue samples is difficult because Fusarium spp.…”

“…The new triazole agents such as VOR and POS exhibit activity against Fusarium species and have been reported as successful treatment in haematological patients . AMB and its liposomal formulation are the most useful systemic drugs (primary treatment), despite numerous therapeutic failures . There are case reports on patients treated with a combination of amphotericin B and other agents such as VOR or POS, suggesting that combination therapy is a potential alternative for patients with this disease .…”

“…8 Studies show that skin lesions are present in more than 85% of reported fusariosis cases, often occur at an early stage of the disease, may precede positive blood cultures by up 5 days 15 and are the typical clinical sign of this mycosis. 9,15,16 Histopathology diagnosis in tissue samples is difficult because Fusarium spp. is often confused with Aspergillus spp.…”

“…[27][28][29] AMB and its liposomal formulation are the most useful systemic drugs (primary treatment), despite numerous therapeutic failures. 9,16 There are case reports on patients treated with a combination of amphotericin B and other agents such as VOR or POS, suggesting that combination therapy is a potential alternative for patients with this disease. 24,27 Despite the overall relative efficacy, all antifungal agents including new azoles have shown modest efficacy in most patients who had leukaemia with persistent neutropenia.…”

Breakthrough disseminated fusariosis in an immunocompromised patient on voriconazole therapy

“…Although Fusarium species are common in the soil and are important plant pathogens causing various diseases, 2 Fusarium is an uncommon human pathogen compared with Aspergillus or Candida . Fusarium infections remain rare but are clinically important as they tend to be disseminated and are resistant to many antifungal agents, resulting in poor prognosis 3 . Fusarium species account for 15% of invasive fungal infections in patients with hematologic malignancies 4 .…”