title: European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe.
abstract: In order to better understand the epidemiology of fusariosis in Europe, a survey collecting information on the clinical characteristics of the patients infected by Fusarium as well as on the infecting isolates was launched. A total of 76 cases of invasive fusariosis occurring from January 2007 to June 2012 were collected and Fusarium isolates were identified by sequencing the translation elongation factor 1α (TEF) gene. Also, antifungal susceptibility was tested by broth microdilution according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Etest. Disseminated disease was considered proven in 46 cases and probable in 17 cases. Localised infection was seen in 13 cases. Gibberella fujikuroi species complex (SC), including Fusarium verticillioides and F. proliferatum, and F. solani SC were the most frequent aetiology of disseminated and localised infections, respectively. The crude mortality rate was 46 %, the highest associated with F. solani SC (67 %) and F. proliferatum (62.5 %). A wide range of antifungal susceptibilities was observed. Amphotericin B was the most potent antifungal in vitro, and itraconazole the least effective. The azoles exhibited lower minimum inhibitory concentrations (MICs) against F. verticillioides strains, with posaconazole having a slightly better performance, while F. solani SC isolates were resistant to all three azoles tested. The essential agreement between the Etest and the EUCAST method was 100 % for itraconazole and voriconazole, and 96 % for amphotericin B and posaconazole. In conclusion, we confirm that fusariosis is a rare but severe event in Europe, that G. fujikuroi SC is the predominant cause of deep infections and that different species have different antifungal in vitro susceptibility patterns.
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy, annamaria.tortorano@unimi.it.
authors.forename: A M
authors.initials: AM
authors.lastname: Tortorano
authors.forename: A
authors.initials: A
authors.lastname: Prigitano
authors.forename: M C
authors.initials: MC
authors.lastname: Esposto
authors.forename: V
authors.initials: V
authors.lastname: Arsic Arsenijevic
authors.forename: J
authors.initials: J
authors.lastname: Kolarovic
authors.forename: D
authors.initials: D
authors.lastname: Ivanovic
authors.forename: L
authors.initials: L
authors.lastname: Paripovic
authors.forename: L
authors.initials: L
authors.lastname: Klingspor
authors.forename: I
authors.initials: I
authors.lastname: Nordøy
authors.forename: P
authors.initials: P
authors.lastname: Hamal
authors.forename: S
authors.initials: S
authors.lastname: Arikan Akdagli
authors.forename: C
authors.initials: C
authors.lastname: Ossi
authors.forename: A
authors.initials: A
authors.lastname: Grancini
authors.forename: C
authors.initials: C
authors.lastname: Cavanna
authors.forename: G
authors.initials: G
authors.lastname: Lo Cascio
authors.forename: C
authors.initials: C
authors.lastname: Scarparo
authors.forename: A
authors.initials: A
authors.lastname: Candoni
authors.forename: M
authors.initials: M
authors.lastname: Caira
authors.forename: M
authors.initials: M
authors.lastname: Drogari Apiranthitou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D005656:Fungal Proteins / Q000235:genetics; D060585:Fusariosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005670:Fusarium / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D020648:Peptide Elongation Factor 1 / Q000235:genetics; D011446:Prospective Studies; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005656:Fungal Proteins; D020648:Peptide Elongation Factor 1