Abstract
Fusarium species are filamentous fungi widely encountered in nature, and may cause invasive disease in patients with hematologic conditions. Patients at higher risk are those with acute leukemia receiving induction remission chemotherapy or allogeneic hematopoietic cell transplant recipients. In these hosts, invasive fusariosis presents typically with disseminated disease, fever, metastatic skin lesions, pneumonia, and positive blood cultures. The prognosis is poor and the outcome is largely dependent on the immune status of the host, with virtually a 100% death rate in persistently neutropenic patients, despite monotherapy or combination antifungal therapy. In this paper, we will review the epidemiology, clinical manifestations, diagnosis, and management of invasive fusariosis affecting patients with hematologic diseases.
Highlights
Invasive fungal disease (IFD) is a serious complication in patients with hematologic malignancies, with the highest incidence occurring in patients with acute leukemia and in hematopoietic cell transplant (HCT) recipients [1,2]
Among allogeneic HCT recipients, variables associated with invasive fusariosis diagnosed in the pre–engraftment period were the receipt of antithymocyte globulin (HR 22.77, 95% CI 4.85–101.34), hyperglycemia (HR 5.17, 95% CI 1.40–19.11), treatment in one of the participating centers (HR 5.15, 95% CI 1.66–15.97) and acute myeloid leukemia (AML) as underlying disease (HR 4.38, 95% CI 1.39–13.81)
In a literature review of bone and joint infections caused by molds, five cases caused by Fusarium species were reported, one of which occurred in a patient with AML, in the context of disseminated fusariosis [56]
Summary
Invasive fungal disease (IFD) is a serious complication in patients with hematologic malignancies, with the highest incidence occurring in patients with acute leukemia and in hematopoietic cell transplant (HCT) recipients [1,2]. Until the 1980s, yeasts, Candida species, were the most frequent agents of IFD. With the introduction of fluconazole prophylaxis, IFD caused by molds became more prevalent [3]. While Aspergillus species account for the majority of cases of IFD in hematologic patients, infection caused by other molds, such as Fusarium species, may occur, with a relatively high incidence in some areas of the globe [4]. We will review the epidemiology, clinical manifestations, diagnosis, and management of invasive fusariosis in patients with hematologic diseases
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