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Barrios EL, Drabick Z, Rodriguez J, Fahy BG, Cochran AL, Driscoll IR, Munden AM. Precision Medicine Approach Using Triple Combination Antifungal Therapy for Fusarium Brain Abscesses and Endocarditis in an Adult Burn Patient. Mil Med 2024:usae284. [PMID: 38836840 DOI: 10.1093/milmed/usae284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/16/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
We report a management strategy for disseminated Fusarium solani fungal infection in an adult 35% total body surface area burn patient with brain abscesses and concomitant pulmonic valve endocarditis resulting in the longest survival reported in a burn patient. Early in his hospital course, the patient was diagnosed with a Fusarium burn wound infection with concomitant fungemia and was treated with a prolonged course of intravenous (IV) antifungal monotherapy. Shortly thereafter, he developed focal neurologic deficits and was found to have brain abscesses on MRI. He underwent emergent craniotomy with debridement, and triple antifungal therapy was initiated. Transesophageal echocardiography demonstrated pulmonic valve vegetations, which resolved with triple antifungal therapy. Disseminated Fusarium solani infection is quite rare with mortality approaching 100%. Given the rarity of this disease process, there are no established antifungal treatment guidelines. However, this patient survived for approximately 1 year after diagnosis with treatment including source control via craniotomy and debridement coupled with prolonged courses of combination antifungal therapy (given the near pan-resistance of his fungal infection). Pharmacogenomic testing was utilized to establish the patient's metabolism of voriconazole and dosing adjusted accordingly to improve the efficacy of the combination therapy. To our knowledge, an adult burn patient surviving this length of time after Fusarium brain abscesses with disseminated infection has not been previously described.
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Affiliation(s)
- Evan L Barrios
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0108, USA
| | - Zachary Drabick
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL 32608, USA
| | - John Rodriguez
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0108, USA
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA
| | - Amalia L Cochran
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0108, USA
| | - Ian R Driscoll
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0108, USA
| | - Andrea M Munden
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0108, USA
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Strong N, Ostrosky-Zeichner L. Fusarium species central nervous system infection. Curr Opin Infect Dis 2024; 37:185-191. [PMID: 38518108 DOI: 10.1097/qco.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Fusarium species are an increasingly important cause of meningitis and invasive disease in immunocompromised patients as well as in otherwise healthy patients as observed in two recent healthcare-associated outbreaks. This review summarizes recently published information on treatment and diagnosis of this infection. RECENT FINDINGS Incidence of Fusarium species meningitis and invasive fusariosis are increasing. Molecular techniques are improving the speed of diagnosis. New antifungal agents in development show good in vitro activity against some Fusarium species. New technologies, including cerebrospinal fluid (CSF) filtration, may play a role in treatment of central nervous system (CNS) disease. Due to the continued prime importance of the host immune system in recovery, immunomodulatory treatments may play a role in treatment. SUMMARY The overall incidence of CNS fusariosis is increasing with a continued poor prognosis, but new diagnostic and treatment modalities are in development which may offer improvements.
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Affiliation(s)
- Nora Strong
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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García-Rodríguez G, Duque-Molina C, Kondo-Padilla I, Zaragoza-Jiménez CA, González-Cortés VB, Flores-Antonio R, Villa-Reyes T, Vargas-Rubalcava A, Ruano-Calderon LÁ, Tinoco-Favila JC, Sánchez-Salazar HC, Rivas-Ruiz R, Castro-Escamilla O, Martínez-Gamboa RA, González-Lara F, López-Martínez I, Chiller TM, Pelayo R, Bonifaz LC, Robledo-Aburto Z, Alcocer-Varela J. Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango, Mexico, 2022-2023. Open Forum Infect Dis 2024; 11:ofad690. [PMID: 38370296 PMCID: PMC10873708 DOI: 10.1093/ofid/ofad690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
Background Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico. Methods The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival. Results A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05). Conclusions The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.
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Affiliation(s)
| | - Célida Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Irasema Kondo-Padilla
- Dirección de los Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | | | - Vladimir Brian González-Cortés
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Rocio Flores-Antonio
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Tania Villa-Reyes
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Adriana Vargas-Rubalcava
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Luis Ángel Ruano-Calderon
- Servicio de Neurología, Hospital General 450, Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | - Juan Carlos Tinoco-Favila
- Clínica de Infectología, Hospital General 450, Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | | | - Rodolfo Rivas-Ruiz
- División de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Octavio Castro-Escamilla
- División de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología Clínica, Servicio de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernanda González-Lara
- Laboratorio de Microbiología Clínica, Servicio de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irma López-Martínez
- Dirección de Diagnóstico y Referencia, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City, Mexico
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rosana Pelayo
- Unidad de Educación e Investigación, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Bonifaz
- Coordinación de Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zoe Robledo-Aburto
- Dirección General, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Hoenigl M, Jenks JD, Egger M, Nucci M, Thompson GR. Treatment of Fusarium Infection of the Central Nervous System: A Review of Past Cases to Guide Therapy for the Ongoing 2023 Outbreak in the United States and Mexico. Mycopathologia 2023; 188:973-981. [PMID: 37653167 PMCID: PMC10687128 DOI: 10.1007/s11046-023-00790-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Fusariosis of the central nervous system (CNS) is extremely uncommon. Treatment and outcome data from previously published cases may provide some guidance in light of the ongoing fungal meningitis outbreak in 2023 involving Fusarium spp. in the United States and Mexico. METHODS We reviewed the published literature describing cases of invasive fusariosis of the (CNS) that included data on patient demographic characteristics, treatment, and outcome. RESULTS Twenty-six cases met inclusion criteria. The mean age was 36 years, 55% involved females, 60% had underlying hematologic malignancy, and another 16% were on immunosuppressants. The majority of infections were from Fusarium solani species complex. Overall 72% of patients died. The majority received monotherapy with amphotericin B, although some received voriconazole monotherapy or combination therapy with amphotericin B plus voriconazole with or without adjuvant surgery. Among the survivors, 3 received amphotericin B monotherapy, 2 voriconazole monotherapy, 1 combination therapy of both, and one surgery only. CONCLUSION The overall mortality rate in published cases of fusariosis of the CNS was high, although-unlike during the current outbreak-the preponderance of patients were severely immunocompromised. While historically the majority were treated with amphotericin B monotherapy, some recent patients were treated with voriconazole monotherapy or combination therapy with amphotericin B plus voriconazole. Current guidelines recommend monotherapy with voriconazole or lipid formulations of amphotericin B or combination of both for the treatment of invasive fusariosis, which is in line with the findings from our literature review and should be considered during the ongoing 2023 outbreak.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- BioTechMed, Graz, Austria.
| | - Jeffrey D Jenks
- Durham County Department of Public Health, Durham, NC, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| | - Matthias Egger
- Division of Infectious Diseases, Department of Internal Medicine, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- BioTechMed, Graz, Austria
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Grupo Oncoclinicas, Rio de Janeiro, RJ, Brazil
| | - George R Thompson
- University of California Davis Center for Valley Fever, Davis, CA, USA.
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, University of California-Davis Health, 1450 V Street, Suite G500, Sacramento, CA, USA.
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA.
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Stevens A, Waldrop C, Mandell S, Abdelfattah K, Arnoldo B, Akarichi CO, Clark AT. Fungal brain abscess in a severely burned patient. J Burn Care Res 2023; 44:1253-1257. [PMID: 37486798 DOI: 10.1093/jbcr/irad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 07/26/2023]
Abstract
Burn patients are particularly susceptible to atypical and opportunistic infections. Here we report an unusual case of a 40-year-old previously healthy man with a 74% TBSA burn injury who developed a presumed Fusarium brain abscess. This patient had a complicated infectious course including ESBL E. coli and Elizabethkingia bacteremia and pneumonia, MRSA ventilator-associated pneumonia, Mycobacterium abscessus bacteremia, and Fusarium fungemia. After diagnosis with a fungal abscess on magnetic resonance imaging of the brain, the patient was treated with aspiration and appropriate antifungal therapies. The patient was eventually transitioned to comfort care and died on hospital day 167. This is the first published report of a Fusarium-related brain abscess since it was first reported in a case report of a burned child in 1974.
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Affiliation(s)
- Audrey Stevens
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlyn Waldrop
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samuel Mandell
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kareem Abdelfattah
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett Arnoldo
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chiaka O Akarichi
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Audra T Clark
- Department of Surgery, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Frederick V, Frederik V, Michaël B, Liselotte C, Annelies DB. Bisifusarium dimerum species complex central line-associated bloodstream infection in an immunocompetent patient. Med Mycol Case Rep 2023; 41:33-35. [PMID: 37706046 PMCID: PMC10495382 DOI: 10.1016/j.mmcr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/15/2023] Open
Abstract
Albeit invasive fusariosis is extremely rare in immunocompetent patients, we describe an immunocompetent patient suffering from a central line-associated blood stream infection (CLABSI) and the difficulties in distinguishing between blood culture contamination and clinical significance.
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Affiliation(s)
- Verbeke Frederick
- Dept of Laboratory Medicine, General Hospital Groeninge, P. Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Vanhee Frederik
- Dept of Neurology, General Hospital Groeninge, P. Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Boudewijns Michaël
- Dept of Laboratory Medicine, General Hospital Groeninge, P. Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Coorevits Liselotte
- Dept of Laboratory Medicine, General Hospital Groeninge, P. Kennedylaan 4, 8500, Kortrijk, Belgium
| | - De Bel Annelies
- Dept of Laboratory Medicine, General Hospital Groeninge, P. Kennedylaan 4, 8500, Kortrijk, Belgium
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Omotayo OP, Babalola OO. Fusarium verticillioides of maize plant: Potentials of propitious phytomicrobiome as biocontrol agents. FRONTIERS IN FUNGAL BIOLOGY 2023; 4:1095765. [PMID: 37746120 PMCID: PMC10512380 DOI: 10.3389/ffunb.2023.1095765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/26/2023] [Indexed: 09/26/2023]
Abstract
Disease outbreaks have been recorded due to exposure to Fusarium verticillioides and fumonisin, a mycotoxin produced by this fungus. F. verticillioides is a fungal pathogen of maize that causes infections, such as wilting and rotting, while contact with its fumonisin derivative manifests in the form of mild to severe illnesses in humans and animals. Maize infection by F. verticillioides causes loss or reduction in expected crop yield, thereby influencing households and nations' economies. While several efforts have been made to control the pathogenic fungus and its occurrence in the environment, it remains a challenge in agriculture, particularly in maize production. Several microorganisms which are plant-associated, especially those associated with the rhizosphere niche have been noted to possess antagonistic effects against F. verticillioides. They can inhibit the pathogen and tackle its debilitating effects on plants. Hence this study reviews the use of rhizosphere-associated biocontrol agents, such as Bacillus spp., Pseudomonas, Enterobacter, and Microbacterium oleivorans which forms part of the phytomicrobiome in other to prevent and control this toxicogenic fungus. These microorganisms were found to not only be effective in controlling its occurrence on maize plants but are environmentally safe and promote crop yield.
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Affiliation(s)
| | - Olubukola Oluranti Babalola
- Food Security and Safety Focus Area, Faculty of Natural and Agricultural Science, North-West University, Mmabatho, South Africa
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Karthigeyan M, Singh K, Kaur H, Salunke P, Pandey J, Nallasamy K. Multiple Fusarium brain abscesses in a young child. Childs Nerv Syst 2022; 38:1017-1021. [PMID: 34378119 DOI: 10.1007/s00381-021-05320-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
Isolated intracranial fungal infection is infrequent and mostly seen in high-risk, immunocompromised patients. Fusarium, a primary plant fungus, rarely contributes to such disease. Amongst the very few cases of Fusarium brain abscess that have been reported, the infection has occurred mostly in adults. We present a case of a 6-year-old boy with tuberculous meningitis diagnosed with multiple Fusarium brain abscess caused by Fusarium falciforme during his clinical course. An immunocompromised state secondary to tuberculous meningitis presumably led to this infection. After tapping the abscesses, the child was treated with a combination of amphotericin B, voriconazole and terbinafine. Despite an aggressive therapy, he remained in poor neurological state. This is the second report of an isolated Fusarium abscess in pediatric age and the first one in a young child and provides pertinent review of this unusual central nervous system fungal infection. Such unusual infectious spectrum should be borne in mind in patients with co-existent immunosuppression.
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Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Madhya Marg, Sector 12, Chandigarh, 160012, India.
| | - Kavindra Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Madhya Marg, Sector 12, Chandigarh, 160012, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Mycology Division, Center of Advanced Research in Medical Mycology & WHO Collaborating Center, PGIMER, Madhya Marg, Sector 12, Chandigarh, 160012, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Madhya Marg, Sector 12, Chandigarh, 160012, India
| | - Jaya Pandey
- Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, PGIMER, Madhya Marg, Sector 12, Chandigarh, 160012, India
| | - Karthi Nallasamy
- Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, PGIMER, Madhya Marg, Sector 12, Chandigarh, 160012, India
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Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds. J Fungi (Basel) 2019; 5:jof5030079. [PMID: 31480311 PMCID: PMC6787746 DOI: 10.3390/jof5030079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Central nervous system infections due to Aspergillus spp and other hyaline molds such as Fusarium and Scedosporium spp are rare but fatal conditions. Invasion of the central nervous system (CNS) tends to occur as a result of hematogenous dissemination among immunocompromised patients, and by local extension or direct inoculation secondary to trauma in immunocompetent hosts. Efforts should be directed to confirm the diagnosis by image-guided stereotactic brain biopsy when feasible. Non-culture methods could be useful to support the diagnosis, but they have not been validated to be performed in cerebral spinal fluid. Treatment of these infections is challenging given the variable susceptibility profile of these pathogens and the penetration of antifungal agents into the brain.
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Abstract
BACKGROUND Fungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences. METHODS One hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: "fungi and CNS mycoses", CNS fungal infections", "fungal brain infections", " fungal cerebritis", fungal meningitis", "diagnostics of fungal infections", and "treatment of CNS fungal infections". All were published in English with the majority in the period 2000-2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS. RESULTS The FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS. CONCLUSION Although the number of fungal species causing CNS mycosis is increasing, only some possess well-defined treatment standards (e.g., cryptococcal meningitis and CNS aspergillosis). The early diagnosis of fungal infection, accompanied by identification of the etiological factor, is needed to allow the selection of effective therapy in patients with FIs-CNS and limit their high mortality.
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Affiliation(s)
- Katarzyna Góralska
- Department of Biomedicine and Genetics, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland.
| | - Joanna Blaszkowska
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
| | - Magdalena Dzikowiec
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
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Dananjaya S, Erandani W, Kim CH, Nikapitiya C, Lee J, De Zoysa M. Comparative study on antifungal activities of chitosan nanoparticles and chitosan silver nano composites against Fusarium oxysporum species complex. Int J Biol Macromol 2017; 105:478-488. [DOI: 10.1016/j.ijbiomac.2017.07.056] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 01/22/2023]
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12
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Reduced Multidrug Susceptibility Profile Is a Common Feature of Opportunistic Fusarium Species: Fusarium Multi-Drug Resistant Pattern. J Fungi (Basel) 2017; 3:jof3020018. [PMID: 29371536 PMCID: PMC5715927 DOI: 10.3390/jof3020018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/27/2017] [Accepted: 04/07/2017] [Indexed: 01/26/2023] Open
Abstract
The resistance among various opportunistic Fusarium species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical significance to combat microbial infections. The search platform PubMed/MEDLINE and a review of 32 cases revealed a common multidrug-resistant profile exists, and clinically relevant members of Fusarium are intrinsically resistant to most currently used antifungals. Dissemination occurs in patients with prolonged neutropenia, immune deficiency, and especially hematological malignancies. Amphotericin B displayed the lowest minimum inhibitory concentrarions (MICs) followed by voriconazole, and posaconazole. Itraconazole and fluconazole showed high MIC values, displaying in vitro resistance. Echinocandins showed the highest MIC values. Seven out of ten (70%) patients with neutropenia died, including those with fungemia that progressed to skin lesions. Clinical Fusarium isolates displayed a common MDR profile and high MIC values for the most available antifungal agents with species- and strain-specific differences in antifungal susceptibility. Species identification of Fusarium infections is important. While the use of natamycin resulted in a favorable outcome in keratitis, AmB and VRC are the most used agents for the treatment of fusariosis in clinical settings.
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Salah H, Al-Hatmi AMS, Theelen B, Abukamar M, Hashim S, van Diepeningen AD, Lass-Florl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Phylogenetic diversity of human pathogenic Fusarium and emergence of uncommon virulent species. J Infect 2015; 71:658-66. [PMID: 26348828 DOI: 10.1016/j.jinf.2015.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Fusarium species cause a broad spectrum of infections. However, little is known about the etiological agents to the species level. We identified Fusarium species isolated from clinical specimens including those of high risk patients to better understand the species involved in the pathogenesis. METHODS A set of 44 Fusarium isolates were identified by two-locus sequence typing using partial sequences of the second largest subunit of RNA polymerase (RPB2) and translation elongation factor 1 alpha (TEF-1α). RESULTS The identified species belonged to four species complexes (SC); the most common SC was Fusarium solani (FSSC) (75%), followed by Fusarium oxysporum (FOSC) (4.5%), Fusarium fujikuroi (FFSC) (13.6%), and Fusarium dimerum (FDSC) (6.8%). Sites of infections were nails (n = 19, 43.2%), skin (n = 7, 15.9%), cornea (n = 6, 13.6%), blood (n = 3, 9%), wound (n = 4, 6.8%), burn (n = 2, 4.5%), tissue (n = 2, 4.5%), and urine (n = 1, 2.27%). Fusarium acutatum was rare and seem restricted to the Middle East. Comorbidities associated with invasive infections were hematological malignancy and autoimmune disorders. CONCLUSIONS Members of the FSSC predominantly caused cornea, nail and bloodstream infections. Less frequently encountered were the FOSC, FFSC and FDSC. More accurate molecular identification of Fusarium species is important to predict therapeutic outcome and the emergence of these species.
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Affiliation(s)
- Husam Salah
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Abdullah M S Al-Hatmi
- 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, Ministry of Health, Ibri Hospital, Ibri, Oman
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammed Abukamar
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | | | - Cornelia Lass-Florl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Institute of Dermatology and Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; Institute of Microbiology, Chinese Academy of Science, Beijing, People's Republic of China
| | - Muna Almaslamani
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar.
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14
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Cutuli M, Gibello A, Rodriguez-Bertos A, Blanco MM, Villarroel M, Giraldo A, Guarro J. Skin and subcutaneous mycoses in tilapia (Oreochromis niloticus) caused by Fusarium oxysporum in coinfection with Aeromonas hydrophila. Med Mycol Case Rep 2015; 9:7-11. [PMID: 26155462 PMCID: PMC4491647 DOI: 10.1016/j.mmcr.2015.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 01/30/2023] Open
Abstract
Subcutaneous mycoses in freshwater fish are rare infections usually caused by oomycetes of the genus Saprolegnia and some filamentous fungi. To date, Fusarium infections in farmed fish have only been described in marine fish. Here, we report the presence of Fusarium oxysporum in subcutaneous lesions of Nile tilapia (Oreochromis niloticus). Histopathologic evaluation revealed granuloma formation with fungal structures, and the identity of the etiological agent was demonstrated by morphological and molecular analyses. Some of the animals died as a result of systemic coinfection with Aeromonas hydrophila.
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Affiliation(s)
- M. Teresa Cutuli
- Department of Animal Health, Faculty of Veterinary Sciences, Complutense University, Madrid 28040, Spain
| | - Alicia Gibello
- Department of Animal Health, Faculty of Veterinary Sciences, Complutense University, Madrid 28040, Spain
| | - Antonio Rodriguez-Bertos
- Department of Internal Medicine and Animal Surgery, Faculty of Veterinary Sciences, Complutense University, Madrid 28040, Spain
| | - M. Mar Blanco
- Department of Animal Health, Faculty of Veterinary Sciences, Complutense University, Madrid 28040, Spain
| | - Morris Villarroel
- Department of Animal Science, E.T.S.I.A. Polytechnic University of Madrid, Madrid 28040, Spain
| | - Alejandra Giraldo
- Mycology Unit, School of Medicine and Health Sciences, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus 43201, Spain
| | - Josep Guarro
- Mycology Unit, School of Medicine and Health Sciences, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus 43201, Spain
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15
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A Case of Fungus Ball-Type Pansinusitis Due to Fusarium proliferatum. Mycopathologia 2015; 180:251-5. [PMID: 26025662 DOI: 10.1007/s11046-015-9906-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Incidence of fungal sinusitis due to the genus Fusarium has increased during the last two decades. We report a case of fungus ball sinusitis with multiple sinuses involvement in an Iranian 21-year-old woman. The patient was diagnosed as having a fungus ball-type sinusitis in computed tomography scan. The sinus biopsy revealed fungal structures on histopathological and direct microscopic examinations and a Fusarium species arose in culture. Partial sequencing of the translation elongation factor 1-alpha identified the isolate as F. proliferatum. Removal of all lesions by endoscopic surgery resulted in a favorable outcome. To the best of our knowledge, this is the first case of F. proliferatum-associated fungus ball which involved multi-sinus and highlights the efficiency of molecular methods for discrimination of fungal agents involved.
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