title: Fusarium species causing eumycetoma: Report of two cases and comprehensive review of the literature.
abstract: Recently, mycetoma was added to the World Health Organization's list of neglected tropical disease priorities. Fusarium as a genus has been reported to cause eumycetoma, but little is known about the species involved in this infection and their identification. In this study, molecular tools were applied to identify Fusarium agents from human eumycetoma cases. The partial translation elongation factor 1-alpha (TEF-1α) gene was used as diagnostic parameter. Two additional cases of eumycetoma, due to F. keratoplasticum and F. pseudensiforme, respectively, are presented. A systematic literature review was performed to assess general features, identification, treatment and outcome of eumycetoma infections due to Fusarium species. Of the 20 reviewed patients, the majority (75%) were male. Most agents belonged to the F. solani species complex, ie F. keratoplasticum, F. pseudensiforme, and an undescribed lineage of F. solani. In addition, F. thapsinum, a member of Fusarium fujikuroi species complex was encountered. The main antifungal drugs used were itraconazole, ketoconazole and amphotericin B, but cure rates were low (15%). Partial response or relapse was observed in some cases, and a case ended in amputation. Clinical management of eumycetoma due to Fusarium is complex and combination therapy might be required to increase cure rates.
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.|Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.|Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman.
authors.forename: Abdullah M S
authors.initials: AM
authors.lastname: Al-Hatmi
authors.affiliation: Hospital General de México, O.D, Mexico City, Mexico.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Bonifaz
authors.affiliation: Hospital General de México, O.D, Mexico City, Mexico.
authors.forename: Andrés
authors.initials: A
authors.lastname: Tirado-Sánchez
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.|Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Meis
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.|Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.|Basic Pathology Department, Federal University of Paraná State, Curitiba, Brazil.|Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
authors.affiliation: Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan.
authors.forename: Sarah A
authors.identifier: http://orcid.org/0000-0003-0155-8113
authors.initials: SA
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology / Q000627:therapeutic use; D000671:Amputation, Surgical; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D060585:Fusariosis / Q000188:drug therapy* / Q000382:microbiology*; D005670:Fusarium / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification* / Q000648:ultrastructure; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D058069:Neglected Diseases / Q000382:microbiology; D020648:Peptide Elongation Factor 1 / Q000235:genetics; D010802:Phylogeny; D012008:Recurrence; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D020648:Peptide Elongation Factor 1; D017964:Itraconazole; D000666:Amphotericin B
keywords: 
  Fusarium
  ; TEF-1α; molecular diagnostics; mycetoma; review