Fusarium, a significant emerging pathogen in patients with hematologic malignancy : Ten years' experience at a cancer center and implications for management

• Published in: Blood Vol. 90; no. 3; pp. 999 - 1008
• Main Authors: BOUTATI, E. I, ANAISSIE, E. J
• Format: Journal Article
• Language: English
• Published: Washington, DC The Americain Society of Hematology 01-08-1997
• Subjects: Adolescent; Adult; Aged; Antifungal Agents - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation; Cancer Care Facilities; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - microbiology; Female; Fungemia - drug therapy; Fungemia - epidemiology; Fungemia - etiology; Fungemia - microbiology; Fusarium - isolation & purification; Fusarium - pathogenicity; Hematologic and hematopoietic diseases; Hematologic Neoplasms - complications; Hematologic Neoplasms - drug therapy; Hematologic Neoplasms - therapy; Humans; Immunocompromised Host; Incidence; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocyte Transfusion; Lung Diseases, Fungal - drug therapy; Lung Diseases, Fungal - epidemiology; Lung Diseases, Fungal - etiology; Lung Diseases, Fungal - microbiology; Male; Medical sciences; Middle Aged; Mycoses - drug therapy; Mycoses - epidemiology; Mycoses - etiology; Mycoses - microbiology; Neutropenia - etiology; Neutropenia - therapy; Recurrence; Retrospective Studies; Skin - microbiology; Treatment Outcome; Human; Mycosis; Pathogenesis; Malignant hemopathy; Fungi; Infection; Prevention; Treatment; Follow up study; Fusarium; Complication; Fungi Imperfecti; Thallophyta
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V90.3.999

Despite increasing reports of life-threatening Fusarium infections, little is known about its pathogenesis and management. To evaluate the epidemiology, clinicopathologic features, and outcome of invasive fusariosis in patients with hematologic cancer, we conducted a retrospective study of invasive fusarial infections in patients with hematologic malignancy treated at a referral cancer center over a 10-year period (1986 to 1995), as well as a literature review. Forty patients with disseminated and three patients with invasive lung infection were included in the analysis. All patients were immunocompromised. The infection occurred in three patients postengraftment following bone marrow transplantation. All patients were diagnosed antemortem. Thirteen patients responded to therapy, but the infection relapsed in two of them. Response was associated with granulocyte transfusions, amphotericin B lipid formulations (four patients each), and an investigational triazole (two patients). Resolution of infection was only seen in patients who ultimately recovered from myelosuppression. Portal of entry was the skin (33%), the sinopulmonary tree (30%), and unknown (37%). Fusarium causes serious morbidity and mortality, and may mimic aspergillosis. The infection seems to respond to newer therapeutic approaches, but only in patients with ultimate recovery from myelosuppression, and it may relapse if neutropenia recurs.