Invasive fusariosis

Abstract

Invasive fusariosis is a serious invasive fungal disease, affecting immunocompetent and, more frequently, immunocompromised patients. Localized disease is the typical clinical form in immunocompetent patients. Immunocompromised hosts at elevated risk of developing invasive fusariosis are patients with acute leukemia receiving chemotherapeutic regimens for remission induction, and those undergoing allogeneic hematopoietic cell transplant. In this setting, the infection is usually disseminated with positive blood cultures, multiple painful metastatic skin lesions, and lung involvement. Currently available antifungal agents have poor in vitro activity against Fusarium species, but a clear-cut correlation between in vitro activity and clinical effectiveness does not exist. The outcome of invasive fusariosis is largely dependent on the resolution of immunosuppression, especially neutrophil recovery in neutropenic patients.

Keywords: Fusarium; fungal infection; fusariosis; immunocompromised.

Fig 1

Culture of Fusarium species on potato dextrose agar after 7 days showing colony with white cottony margins and velvety center with shades of gray. (Courtesy of Dr. Geovanni Breda, reproduced with permission.)

Fig 2

Microscopic morphology (×400) showing hyaline septate hyphae with banana-shaped macroconidia. (Courtesy of Dr. Geovanni Breda, reproduced with permission.)

Fig 3

Periungueal cellulitis. (Courtesy of Dr. Marcia Matos, reproduced with permission.)

Fig 4

Periungueal cellulitis with tissue destruction. (Courtesy of Dr. Marcia Matos, reproduced with permission.)

Fig 5

Nodular skin lesion with an area of central necrosis, with a typical appearance of ecthyma gangrenosum. (Courtesy of Dr. Marcia Matos, reproduced with permission.)

Fig 6

Interdigital intertrigo with cellulitis. (Courtesy of Dr. Marcia Matos, reproduced with permission.)

Fig 7

Interdigital intertrigo with cellulitis. (Courtesy of Dr. Hugo Morales, reproduced with permission.)

Fig 8

Interdigital intertrigo with cellulitis. (Courtesy of Dr. Marcia Matos, reproduced with permission.)

Fig 9

Chest computed tomography showing macronodules in both lungs.

Fig 10

Chest computed tomography showing a large nodule with a halo sign in the left lung.

Fig 11

Disseminated skin lesions and toxemic appearance. Lesions at various stages of evolution: papular and nodular lesions with and without central necrosis. (Courtesy of Dr. Marilza Campos Magalhães, reproduced with permission.)

Fig 12

Disseminated skin lesions and toxemic appearance. Lesions at various stages of evolution: papular and nodular lesions with and without central necrosis. (Courtesy of Dr. Marilza Campos Magalhães, reproduced with permission.)

Fig 13

Nodules in the spleen.

Fig 14

Endophthalmitis with periorbital cellulitis. (Courtesy of Dr. Clara Rosemberg, reproduced with permission.)

Fig 15

Endophthalmitis with periorbital cellulitis. (Courtesy of Dr. Clara Rosemberg, reproduced with permission.)

Fig 16

Endophthalmitis with periorbital cellulitis. (Courtesy of Dr. Clara Rosemberg, reproduced with permission.)