Refractory disseminated fusariosis by Fusarium verticillioides in a patient with acute myeloid leukaemia relapsed after allogeneic hematopoietic stem cell transplantation: a case report and literature review.
BACKGROUND
Fusarium species are among the leading fungal pathogens to cause invasive mould infections in patients with hematopoietic malignancy. The Fusarium species most frequently involved in human infections are Fusarium solani, Fusarium oxysporum and Fusarium verticillioides. However, identification is a cumbersome and time-consuming task. Fusarium is resistant in vitro to many of the antifungal agents and the management of fusariosis is not well defined.


OBJECTIVE
To emphasise the difficulty of identifying Fusarium spp. by conventional methods and the need of new rapid molecular tests to achieve earlier diagnosis and appropriate therapy.


METHODS
A disseminated Fusarium infection due to F. verticillioides was documented in a neutropenic refractory patient with acute myeloid leukaemia, relapsed after allogeneic hematopoietic stem cell transplantation.


RESULTS
The patient died despite liposomal amphotericin B and voriconazole combination and "in vitro" susceptibility of agents employed. Morphological and molecular identification of F. verticillioides was obtained only after the death of the patient.


CONCLUSIONS
This case highlights the poor outcome of an invasive fungal disease caused by Fusarium in aplastic patients. Identification of members of Fusarium genus remains restricted to selected laboratories and should be introduced into routine mycological diagnostics. In immunocompromised patients, diagnosis of fusariosis is directly related to prompt diagnosis and to patient's status. Current diagnosis methods and therapeutic options are discussed.
Haematology Unit, Careggi Hospital and University of Florence, Florence, Italy. rosa.fanci@unifi.it
Rosa
R
Fanci
Gabriella
G
Pini
Anna Maria
AM
Bartolesi
Patrizia
P
Pecile
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D026141:Drug Resistance, Multiple, Fungal; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D060585:Fusariosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005670:Fusarium / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D036102:Peripheral Blood Stem Cell Transplantation; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology; D011292:Premedication; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D016879:Salvage Therapy; D014184:Transplantation, Homologous; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D003561:Cytarabine; D017964:Itraconazole; D005047:Etoposide; D000666:Amphotericin B; D008942:Mitoxantrone; D065819:Voriconazole