title: Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive fusariosis.
abstract: OBJECTIVE
  To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive fusariosis.
  
  
  METHODS
  We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed.
  
  
  RESULTS
  Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive fusariosis (p = 0.04).
  
  
  CONCLUSIONS
  Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
authors.affiliation: University Hospital, Federal University of Rio de Janeiro, Brazil.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Varon
authors.forename: Simone A
authors.initials: SA
authors.lastname: Nouer
authors.forename: Gloria
authors.initials: G
authors.lastname: Barreiros
authors.forename: Beatriz Moritz
authors.initials: BM
authors.lastname: Trope
authors.forename: Fabiana
authors.initials: F
authors.lastname: Magalhães
authors.forename: Tiyomi
authors.initials: T
authors.lastname: Akiti
authors.forename: Marcia
authors.initials: M
authors.lastname: Garnica
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D060585:Fusariosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005670:Fusarium / Q000302:isolation & purification*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Fusariosis; Hematologic disease; Invasive fungal disease; Onychomycosis; Risk factor