Increased incidence of invasive fusariosis with cutaneous portal of entry, Brazil

Abstract

Invasive fusariosis (IF) is an infection with Fusarium spp. fungi that primarily affects patients with hematologic malignancies and hematopoietic cell transplant recipients. A cutaneous portal of entry is occasionally reported. We reviewed all cases of IF in Brazil during 2000-2010, divided into 2 periods: 2000-2005 (period 1) and 2006-2010 (period 2). We calculated incidence rates of IF and of superficial infections with Fusarium spp. fungi identified in patients at a dermatology outpatient unit. IF incidence for periods 1 and 2 was 0.86 cases versus 10.23 cases per 1,000 admissions (p<0.001), respectively; superficial fusarial infection incidence was 7.23 versus 16.26 positive cultures per 1,000 superficial cultures (p<0.001), respectively. Of 21 cases of IF, 14 showed a primary cutaneous portal of entry. Further studies are needed to identify reservoirs of these fungi in the community and to implement preventive measures for patients at risk.

Keywords: Brazil; Fusarium; Fusarium oxysporum; Fusarium solani; community; cutaneous; environmental; fungi; immunocompetent; immunocompromised; invasive fusariosis; portal of entry; skin; spread; transmission.

Figure 1

Primary skin lesions in patients with invasive fusariosis in the hematology unit at University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 2000–2010. A) Onychomycosis; B) ulcer; C) intertrigus; D) intertrigus evolving to lymphangitis before dissemination. (First image in D is the same patient as the first image in C; second image in D is the same patient as the fourth image in C.) E) Necrosis in a lesion of intertrigus (evolution of the lesion shown in the third image in C).

Figure 2

Incidence of invasive fusariosis among patients in the hematology unit at University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 2000–2010.

Figure 3

Incidence of superficial infections caused by Fusarium spp. among outpatients at the dermatology clinic of University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 2000–2010.