Outbreak of Fusarium oxysporum infections in children with cancer: an experience with 7 episodes of catheter-related fungemia

Fabianne Carlesse,Ferry Hagen,Arnaldo L Colombo,Maria-Lucia M Lee,Abdullah M Al-Hatmi,Anna-Paula C Amaral,Hemilio Xafranski,Antonio S Petrilli,Sarah S Gonçalves,Victor Zecchin,Jacques F Meis

doi:10.1186/s13756-017-0247-3

Abstract

BackgroundFusarium species are widely spread in nature as plant pathogens but are also able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstream infections in a single pediatric cancer center.MethodsAll clinical and epidemiological data related to an outbreak involving seven cases of fungemia by Fusarium oxysporum during October 2013 and February 2014 were analysed. All cultured isolates (n = 14) were identified to species level by sequencing of the TEF1 and RPB2 genes. Genotyping of the outbreak isolates was performed by amplified fragment length polymorphism fingerprinting.ResultsIn a 5-month period 7 febrile pediatric cancer patients were diagnosed with catheter-related Fusarium oxysporum bloodstream infections. In a time span of 11 years, only 6 other infections due to Fusarium were documented and all were caused by a different species, Fusarium solani. None of the pediatric cancer patients had neutropenia at the time of diagnosis and all became febrile within two days after catheter manipulation in a specially designed room. Extensive environmental sampling in this room and the hospital did not gave a clue to the source. The outbreak was terminated after implementation of a multidisciplinary central line insertion care bundle. All Fusarium strains from blood and catheter tips were genetically related by amplified fragment length polymorphism fingerprinting. All patients survived the infection after prompt catheter removal and antifungal therapy.ConclusionA cluster with, genotypical identical, Fusarium oxysporum strains infecting 7 children with cancer, was most probably catheter-related. The environmental source was not discovered but strict infection control measures and catheter care terminated the outbreak.

Highlights

Fusarium species are widely spread in nature as plant pathogens but are able to cause opportunistic fungal infections in humans
We retrospectively studied all clinical and epidemiological data related to an outbreak enrolling seven cases of fungemia by Fusarium oxysporum occurring between October 2013 and February 2014 in the Pediatric Oncology Institute (IOP), located in Sao Paulo, Brazil
This finding led us to believe that we were facing an outbreak because only six cases of invasive fusariosis had been diagnosed in our hospital in the 11 years previously, all caused by Fusarium solani species complex strains

Summary

Introduction

Fusarium species are widely spread in nature as plant pathogens but are able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstream infections in a single pediatric cancer center. Due to prolonged survival of patients with cancer, invasive fungal diseases (IFD) emerged as important cause of morbidity and mortality. Candida species remain as the most important cause of IFD followed by invasive infections by Aspergillus spp. and other moulds [1,2,3]. Fusarium species are widely spread in nature as plant pathogens and are able to cause superficial, locally invasive and disseminated infections in humans [5]. The clinical presentation relies mostly on the hosts’ immune status, with disseminated infections been reported especially in severe immunocompromised individuals leading to high mortality rates [6, 8]

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