Case Report

Disseminated Fusarium Infection in a Multiple Trauma Patient

Authors: George M. Testerman, MD, Melinda K. Steagald, MD, Landon A. Colquitt, MD, Anton Mak, MD, FRCPC, FCAP, FACP

Abstract

The hyalohyphomycetes (especially Fusarium sp.) have emerged as significant pathogens in severely immunocompromised patients. Human infections by Fusarium sp. can be superficial or limited to single organs in otherwise healthy patients. Such infections are rare and tend to respond well to therapy. By contrast, disseminated fusarial hylohyphomycosis affects the immunocompromised host and frequently is fatal. Successful outcome is determined by the degree of immunosuppression and the extent of the infection. These infections may be suspected clinically on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy.


Key Points


* Fusariosis is an important cause of morbidity and mortality in immunosuppressed patients, but has not been previously associated with the young trauma patient population.


* Disseminated fusariosis occurs frequently in patients with hematologic malignancies and has high mortality rates.


* Treatment needs to be instituted as soon as possible with an effective antifungal agent due to difficulty in reaching specific body compartments such as the brain.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Nucci M, Anaissie EJ. Emerging fungi. Infect Dis Clin N Am 2006;20:563–579.
 
2. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with haematological malignancy: ten years experience at a cancer centre and implications for management. Blood 1997;90:999.
 
3. Kauffman CA. Fusarium. Available at: http://www.uptodate.com. Accessed September 2007.
 
4. Martino P, Gastaldi R, Raccah R, et al. Clinical patterns of Fusarium infections in immunocompromised patients. J Infect 1994;28(suppl 1):7.
 
5. Enomoto M. Fungal toxins, in Braude AI, Davis CE, et al (eds): Infectious Diseases and Medical Microbiology. Philadelphia, Saunders, 1986, ed 2, p 131.
 
6. Guarro J, Nucci M, Akiti T, et al. Mixed infection caused by two species of Fusarium in a human immunodeficiency virus-positive patient. J Clin Microbiol 2000;38:3460.
 
7. Cho CT, Vats TS, Lowman JT, et al. Fusarium solani infection during treatment for acute leukemia. J Pediatr 1973;83:1028.
 
8. Wingard JR. The changing face of invasive fungal infections in hematopoietic cell transplant recipients. Curr Opin Oncol 2005;17:89.
 
9. Paugam A, Baixench MT, Frank N, et al. Localized oral Fusarium infection in an AIDS patient with malignant lymphoma. J Infect 1999;39:153.
 
10. Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect 2004;10(suppl 1):67.
 
11. Liakis MS, Kontoyiannis DP. Fusarium infections in critically ill patients. Semin Respir Crit Care Med 2004;25:159.
 
12. Smith M, McGinnis MR. Fusarium sporodochia on cutaneous wounds. Med Mycol 2005;43:83.
 
13. Latenser BA. Fusarium infections in burn patients: a case report and review of the literature. J Burn Care Rehabil 2003;24:285.
 
14. Venditti M, Micozzi, A, Gentile G, et al. Invasive Fusarium solani infections in patients with acute leukemia. Rev Infect Dis 1988;10:653.
 
15. Mays SR, Bogle MA, Bodey GP. Cutaneous fungal infections in the oncology patient: recognition and management. Am J Clin Dermatol 2006;7:31.
 
16. Ascioglu S, Rex JH, de Pauw B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7.
 
17. Perfect J. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis 2003;36:1122.
 
18. Herbrecht R. Voriconazole: therapeutic review of a new azole antifungal. Expert Rev Anti Infect Ther 2004;2:485.