The challenge of managing fusariosis

Abstract

Fusarium is the second most frequent mold involved in fungal infections and is particularly important among immunocompromised patients. Culture methods and microscopy are still routinely used in clinical laboratories to identify Fusarium spp, and more sophisticated, timely, and effective methods for detecting Fusarium spp. in laboratory samples could improve the outcome of the patient. These investigational diagnostic approaches include serological assays and specific nested PCR assays that can yield positive and negative predictive values of over 90%. Other assays in development, such as mass spectroscopy techniques, can provide accurate and consistent results. The treatment of fusariosis in immunocompromised patients remains a challenge and the prognosis of systemic fusariosis in this population remains poor. Successful treatment is highly dependent on the particular Fusarium species involved in the infection. High dose intravenous amphotericin B formulation is recommended as the first line of therapy in management of fusariosis in patients. Voriconazole is also effective in treating fusariosis. Intolerance, contraindication, or failure of the amphotericin B formulation warrants the use of voriconazole as an alternative agent, and posaconazole is licensed as salvage therapy against invasive fusariosis. Adjunctive therapies such as surgical debridement of infected tissue, granulocyte colony stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GM-CSF) infusions, or granulocyte transfusions are also tools for managing fusariosis. In conclusion, Fusarium infection is considered an emerging problem and should be suspected in immunocompromised patients experiencing systemic infection and should be treated accordingly.

Emergence of fusarioses in a university hospital in Turkey during a 20-year period

“…Species-specific differences in the susceptibility of Fusarium isolates was apparent in the MICs to amphotericin B, voriconazole, and posaconazole. In agreement with previous reports [16,37], amphotericin B was the most effective agent across all isolates. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) recommend amphotericin B and voriconazole as the first optional agents in the treatment of cases with fusariosis [18].…”

“…However, in the present study, these compounds were not effective against some of the species, sometimes indicating high degrees of intraspecific variability (Table 4). Some studies have reported that the MIC values in F. verticillioides were high for amphotericin B and low for posaconazole [16,37]. Similarly, we also observed activity of posaconazole against this species, but with a limited degree of confidence.…”

Mycoses and Antifungals: reviewing the basis of a current problem that still is a biotechnological target for marine products

“…are important infectious filamentous fungi, it is particularly important among immunocompromised and neutropenic patients and is typically invasive and disseminated. Infection occurs mainly through inhalation of airborne conidia or via breaks in the skin due to trauma and/or burns (Muhammed et al, 2011). Twelve species were associated with infection; Fusarium solani was the most frequent (∼50% of cases), followed by Fusarium oxysporum (∼20%) and Fusarium verticillioidis and Fusarium moniliforme (∼10% each) (Nucci et al, 2013).…”

In vitro synergistic combinations of pentamidine, polymyxin B, tigecycline and tobramycin with antifungal agents against Fusarium spp.

“…Fusarium is an emerging opportunistic fungal pathogen, with a significant increase in cases among immunocompromised patients (Muhammed et al, 2011). Invasive fusariosis is the second most common form of mould mycosis after invasive aspergillosis and primarily affects patients with haematological malignancies, transplant recipients and those with prolonged neutropenia (Muhammed et al, 2011;Nucci & Anaissie, 2007).…”