Treatment and outcomes of invasive fusariosis: review of 65 cases from the PATH Alliance^® registry

Abstract

SummaryInvasive Fusarium infections occur in immunosuppressed patients, especially those with haematological malignancies. We conducted a descriptive analysis of data from patients with invasive fusariosis identified in the Prospective Antifungal Therapy Alliance registry, which collected data on invasive fungal infections in the United States and Canada from 2004 to 2008. In this series of 65 patients with proven (83.1%) and probable (16.9%) invasive fusariosis, the most common underlying condition was haematological malignancy, in which neutropenia and corticosteroid usage frequently occurred. Seven patients with invasive Fusarium infections had cross-reactive galactomannan assay results. The survival rate for all patients at 90 days was 44%, which was an improvement compared with historical data. Disseminated disease occurred frequently (35.4%), and patients with and without disseminated disease had survival rates of 33% and 50%, respectively. Posaconazole and voriconazole were the most frequently employed therapies and may be linked to the improved survival rate observed in this patient series. In summary, patients with invasive Fusarium infections continue to have high fatality rates, especially those with disseminated disease. Fusarium infections should be strongly considered in the absence of Aspergillus isolation in patients at high risk of mould infections with positive galactomannan assay test results.

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

“…The results of imaging studies may reveal suggestive abnormalities in lungs or sinuses and liver or spleen, but reimaging is often necessary after neutrophil recovery because radiologic abnormalities may not be obvious in neutropenic patients [43]. Except for Fusarium , [66] blood culture results are rarely used to diagnose molds. Mold infections are usually confirmed by the study of infected tissue [65].…”

“…Fungemia has been estimated to occur in one-third of patients with invasive candidiasis [69] and most of those with disseminated Fusarium [66], but occurs more rarely with molds, such as Aspergillus [70], which may require tissue specimens. The use of automated systems and even rapid identification systems (e.g., peptide nucleic acid fluorescence in situ hybridization/matrix-assisted laser desorption/ionization time-of-flight mass spectrometry [PNA-FISH/MALDI-TOF]) to identify bloodstream yeasts is becoming more widespread [71]; however, traditional characterization by morphologic and biochemical characteristics is still commonly used in LMICs [65, 72–74].…”

“…It is now the recommended drug for treating invasive aspergillosis, including infection of the CNS [43]. It is also a drug of choice for infections caused by Scedosporium apiospermum (but not for S. prolificans ) [111], most dematiaceous molds [112], some Fusarium species [66], and Trichosporon asahii [113]. Voriconazole is not active against Zygomycetes [52].…”

Global molecular epidemiology and genetic diversity of Fusarium , a significant emerging group of human opportunists from 1958 to 2015

“…10, 11, 12, 13, 14, 15, 16 Nucci et al 17 reported 233 cases from different hospitals on a global scale. Mohammed et al 18 reported 26 cases from the United States and reviewed 97 cases from the literature, and Horn et al 12 described 65 cases from the North American Path Alliance Registry. A major problem in comparative studies is the subdivision of the classical species into a series of molecular siblings, which renders the older literature without sequence data uninterpretable.…”

Combination Antifungal Therapy: When, Where, and Why

“…Due to its resistance to many of the antifungals including AmB, fusariosis treatment is even more complicated [53]. The only data for CAF therapy is a retrospective analysis of patients with invasive fusariosis from the literature.…”