Fusarium (Fusariosis)

Epidemiology

Risk Factors


Mycology

Fusarium Species

  • Fusarium Oxysporum
  • Fusarium Proliferatum
  • Fusarium Solani Complex
  • Fusarium Verticillioides

Diagnosis

Serum (1,3)-β-D-Glucan (see Serum (1–3)-β-D-Glucan, Serum (1-3)-β-D-Glucan)

  • May Be Helpful

Pathology


Clinical Manifestations

Dermatologic Manifestations

  • Cellulitis (see Cellulitis, Cellulitis)
    • Epidemiology
      • May Occasionally Occur in Immunocompetent Host at a Site of Skin Breakdown (Due to Trauma, Burns, or Preexisting Onychomycosis)
      • More Commonly Occurs in Immunocompromised Host
        • Skin Involvement May Occur Secondary to Hematogenous Dissemination
    • Physiology
      • In Immunocompromised Hosts, May Result in Hematogenous Dissemination
    • Clinical-Immunocompetent Host
      • Skin Involvement is Typically Localized
    • Clinical-Immunocompromised Host
      • Erythematous Papular or Nodular Painful Skin Lesions (see Papular-Nodular Skin Lesions, Papular-Nodular Skin Lesions)
        • May Involve Any Site: most common on the extremities
        • Skin Lesions Evolve Rapidly (Over Days)
        • Skin Lesions May Simultaneously Manifest at Different Stages of Evolution (Papules, Nodules, and Necrotic Ulcers)
        • Skin Lesions May Manifest Central Necrosis: mimicking that seen in ecthyma gangrenosum
        • Myalgias May Occur Concomitantly in 15% of Cases (Clin Infect Dis, 2002) [MEDLINE]: suggests underlying muscle Involvement
      • Bullae Occur Very Rarely
      • Lymphangitic Spread May Be Observed
  • Onychomycosis (see Onychomycosis, Onychomycosis)
    • Epidemiology: may occur in immunocompetent host
  • Interdigital Intertrigo
    • Epidemiology: may occur in immunocompetent host
  • Skin Abscess (see Skin Abscess, Skin Abscess)
    • Epidemiology: may occur in an immunocompetent host at a site of skin breakdown (due to trauma, burns, or preexisting onychomycosis)
    • Clinical: localized skin involvement
  • Skin Ulcer (see Mucocutaneous Ulcers, Mucocutaneous Ulcers)
    • Epidemiology: may occur in an immunocompetent host at a site of skin breakdown (due to trauma, burns, or preexisting onychomycosis)
    • Clinical: localized skin involvement
  • Tinea Pedis (see Dermatophytosis, Dermatophytosis)
    • Epidemiology: may occurs in immunocompetent host

Gastroenterologic Manifestations

  • Alimentary Toxic Aleukia
    • Epidemiology:
      • Associated with Outbreak Related to Consumption of Fusarium-Contaminated Wheat Flour in the Soviet Union in the 1930’s-1940’s
    • Physiology
      • Trichothecene T-2 Mycotoxin from Fusarium Sporotrichoides was Found to Be Etiologic
  • Peritonitis (see Peritonitis, Peritonitis)
    • Epidemiology: may occasionally occur in immunocompetent host

Neurologic Manifestations

  • Brain Abscess (see Brain Abscess, Brain Abscess)
    • Epidemiology
      • May Occasionally Occur in Immunocompetent Host
      • More Commonly Occurs in Immunocompromised Host

Ophthalmologic Manifestations

  • Endophthalmitis (see Endophthalmitis, Endophthalmitis)
    • Epidemiology
      • May Occasionally Occur in Immunocompetent Host
      • More Commonly Occurs in Immunocompromised Host
  • Keratomycosis/Mycotic Keratitis (see Keratitis, Keratitis)
    • Epidemiology: may occur in immunocompetent host

Otolaryngologic Manifestations

  • Chronic Sinusitis (see Chronic Rhinosinusitis, Chronic Rhinosinusitis)
    • Epidemiology
      • May Occasionally Occur in Immunocompetent Host
      • More Commonly Occurs in Immunocompromised Host with or without Coexisting Pneumonia
        • Sinus Involvement May Occur Secondary to Hematogenous Dissemination
    • Physiology
      • In Immunocompromised Hosts, Angioinvasion is Common and Hematogenous Dissemination May Occur
    • Clinical
      • In Immunocompromised Hosts, Clinical Findings Mimic Those Seen in Aspergillus Sinusitis: including nasal discharge, nasal obstruction, mucosal necrosis, periorbital cellulitis, and paranasal cellulitis

Pulmonary Manifestations

Renal Manifestations

Rheumatologic Manifestations

Disseminated Fusariosis

  • Epidemiology
    • Occurs in Immunocompromised (Typically Neutropenic) Host
    • Disseminated Fusarium Infection is the Most Common Clinical Manifestation in Immunocompromised Patients (Accounting for 70% of Cases)
  • Clinical
    • Fever (see Fever, Fever)
    • Fungemia (see Blood Culture, Blood Culture)
      • Fungemia Typically Occurs in the Setting of Disseminated Disease (Although Cases Originating from Central Venous Catheters May Manifest Fungemia without Organ Involvement)
      • Blood Cultures are Positive in Approximately 40% of Disseminated Fusarium Cases: due to the fact that Fusarium sporulates in vivo, facilitating hematogenous dissemination
    • Generalized Skin Lesions
    • Secondary Organ Involvement Due to Hematogenous Dissemination
      • Cellulitis
      • Pneumonia
      • Sinusitis

Treatment

Azole Antifungals (see Azole Antifungals, Azole Antifungals)

Liposomal Amphotericin B (see Amphotericin, Amphotericin)

  • Effective

Echinocandins (see Echinocandins, Echinocandins)

  • Ineffective

References

  • Fusarium allergic fungal sinusitis. J Allergy Clin Immunol. 1993;92(4):624 [MEDLINE]
  • Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev. 1994;7(4):479 [MEDLINE]
  • Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis. 2002;35(8):909 [MEDLINE]
  • Emerging fungi. Infect Dis Clin North Am. 2006;20(3):563 [MEDLINE]
  • Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007;20(4):695 [MEDLINE]
  • Fusariosis. Semin Respir Crit Care Med. 2015 Oct;36(5):706-14 [MEDLINE]