Clinical Features and Outcomes of Invasive Fusarium Infections from a Singaporean Centre: Is It Time to Redefine How We Assess Treatment Outcomes?

Abstract

Invasive Fusarium infections pose a significant threat to immunocompromised patients and are characterised by high mortality rates. In this study, we examined 22 unique episodes of proven and probable Fusarium infections over a 14-year period at a tertiary hospital in Singapore. Cases were analysed from clinical, microbiological, and radiological perspectives. The most common risk factor for invasive Fusarium infections was hematologic malignancy. Fifty percent of patients achieved resolution of infection and were alive at the end of treatment. Conversely, the overall mortality was 50%, with 90% of deaths occurring within three months of the diagnosis of invasive fusariosis; associated risk factors include neutropenia, disseminated infection, and corticosteroid use. Although these deaths would be classified as treatment failures by established criteria; many (8/10; 80%) were due to causes not directly related to invasive fusariosis; such as progression of the underlying malignancy or another infection. We believe that it may be time to redefine how we assess treatment outcomes for invasive mould infections. Nevertheless; invasive fusariosis remains a formidable foe in the immunocompromised host. Early; aggressive treatment with appropriate adjunctive therapies; such as surgery; is crucial for controlling the infection and achieving the best outcomes.

Keywords: Fusarium; anti-fungal treatment; invasive fungal infections; invasive fusariosis.