Successful Treatment of Disseminated Fusarium Infection in an Immunocompromised Child

Nj, Barrios; Dv, Kirkpatrick; Murciano, A. Attias de; Stine, Kimo C.; Rb, Van Dyke; Humbert,

doi:10.1097/00043426-199023000-00013

Cited by 57 publications

(36 citation statements)

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“…In fact, the use of AMB has shown good results in different clinical cases of systemic infection involving some of the species included in this study, such as F. chlamydosporum (23), F. sacchari (17), F. nygamai (24), F. dimerum (26), and F. proliferatum (6). Regardless of the antifungal used, for fusariosis neutrophil recovery is fundamental for resolving the infection, as demonstrated in practically all the cases.…”

Section: Discussionmentioning

confidence: 80%

“…Some of these species are Fusarium chlamydosporum, Fusarium dimerum, Fusarium incarnatum, and the following other species that are included into the Gibberella fujikuroi species complex: Fusarium napiforme, Fusarium nygamai, Fusarium proliferatum, and Fusarium sacchari (30,31). These species have been associated with different types of infection, in particular with keratomycoses and other ocular infections (10) and with disseminated infections in immunocompromised patients (2,6,17,20,23,24,26,39,41,43,44). The real incidence of these species is unknown since they are poorly known and laboratorians and clinical microbiologists are not generally aware of their possible presence in human infections.…”

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confidence: 99%

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Less-FrequentFusariumSpecies of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility

et al. 2009

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Forty-eight Fusarium isolates morphologically identified as belonging to seven species of clinical interest (i.e., Fusarium chlamydosporum, Fusarium dimerum, Fusarium incarnatum, Fusarium napiforme, Fusarium nygamai, Fusarium proliferatum, and Fusarium sacchari) were characterized molecularly by the analysis of the sequences of the TUB region of the ␤-tubulin gene. F. chlamydosporum and F. dimerum were the most genetically heterogeneous species. A high degree of correlation between the morphological and molecular identification was shown among the isolates studied. A table with the key morphological features for the identification of these Fusarium species is provided. The antifungal susceptibilities of the Fusarium isolates to 11 antifungal drugs were tested; terbinafine was the most active drug against all the species tested with the exception of F. incarnatum, for which amphotericin B was the most active.

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Section: Discussionmentioning

confidence: 80%

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confidence: 99%

Less-FrequentFusariumSpecies of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility

et al. 2009

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“…while harvesting wheat (266). The patient responded to a total dose of 47 mg of amphotericin B per kg and right lower lobe lobectomy; several other cases of lung involvement were reported in the setting of disseminated fusariosis (26,243,265 At least 58 patients with disseminated fusarial infections have been reported (3,4,16,18,51,63,64,72,87,119,143,145,161,181,189,190,198,201,219,237 these patients was 32 years, with a range of 2 to 69 years. The male-to-female ratio was 2.6:1, without apparent predilection for race.…”

Section: Pathogenesis Of Infectionmentioning

confidence: 97%

Taxonomy, biology, and clinical aspects of Fusarium species

1994

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There are several taxonomic systems available for identifying Fusarium species. The philosophy used in each taxonomic system is discussed as well as problems encountered in working with Fusarium species in culture. Fusarium species are toxigenic, and the mycotoxins produced by these organisms are often associated with animal and human diseases. The implications for the association of the carcinogens, fumonisins, produced by Fusarium moniliforme and other Fusarium species with human diseases are discussed. Foreign-body-associated fusarial infection such as keratitis in contact lens wearers, onychomycosis, skin infections, and disseminated multiorgan infections are discussed. Disseminated fusarial hyalohyphomycosis has emerged as a significant, usually fatal infection in the immunocompromised host. Successful outcome is determined by the degree of immunosuppression, the extent of the infection, and the presence of a removable focus such as an indwelling central venous catheter. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy, probably with one of the newer antifungal agents. Perhaps the use of such agents or the use of colony-stimulating factors may improve the outcome of this devastating infection. However, until new approaches for treatment develop, effective preventive measures are urgently needed.

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“…The most frequent human Fusarium isolates are (in order of decreasing frequency) F. solani, F. oxysporum, and F. proliferatum (7). Several reports, the earliest in 1988 (23), identify F. proliferatum as the etiology of disseminated fusariosis in profoundly immunosuppressed patients with hematologic malignancies (1,22). Several species, including F. proliferatum, produce mycotoxins that can sicken animals and people who ingest plants that are colonized or infected with those species (13,20).…”

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confidence: 99%

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

et al. 2010

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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...

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Successful Treatment of Disseminated Fusarium Infection in an Immunocompromised Child

Cited by 57 publications

References 0 publications

Less-FrequentFusariumSpecies of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility

Less-FrequentFusariumSpecies of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility

Taxonomy, biology, and clinical aspects of Fusarium species

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

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