Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998-2009

Abstract

Background: Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of fusariosis in the era of the expanding antifungal armamentarium.

Methods: We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998-2009). The diagnosis of proven or probable fusariosis was made according to modified EORTC/MSG criteria.

Results: Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% < 100/mm(3)). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium. Factors associated with increased likelihood of death at 12 weeks, included albumin <3.5 mg/dL, fungemia, and ICU admission; neutrophil recovery and fusariosis limited to skin were associated with improved survival (P < 0.05). Fungemia with Fusarium spp (OR 15.9; 1.1-231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks.

Conclusions: Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia.