Abstract
The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC), indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins) yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.
Highlights
Opportunistic fungal pathogens can enter the body via airways, skin at the site of tissue breakdown, and mucosal membranes
A 13-year-old boy diagnosed with acute lymphoblastic leukemia was immediately started with treatment via a central vascular catheter ((CVC), Broviac)
After 2-3 days of incubation, direct microscopy of blood culture medium revealed filamentous fungi in bottles seeded with blood taken from central venous catheters (CVC), but not in bottles seeded with blood taken from venous sites
Summary
Opportunistic fungal pathogens can enter the body via airways, skin at the site of tissue breakdown, and mucosal membranes. The incidence of infections by filamentous fungi is increasing due to the mounting use of central venous catheters (CVC), other indwelling medical devices, and treatments with antineoplastic and immunosuppressive drugs that, possibly, damage mucosae and reduce immune defenses. Broad-spectrum antibacterial treatment may represent a risk factor for opportunistic fungal infections [1]. Disseminated infections by Fusarium spp.—a fast-growing, angioinvasive, immunosuppressive, and adhesive opportunistic fungal pathogen—have been reported in patients with hematologic malignancies and are associated with poor outcome [2]. Treatment with glucocorticoids predisposes patients to fusariosis mainly via impairment of the anticonidial macrophage function [3]. In these cases, prompt detection of fungal colonization and identification of the responsible organism are critical for initiating appropriate treatment. Inappropriate therapy is associated with bloodstream dissemination and systemic disease [4]
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