Infections Caused by Fusarium Species in Pediatric Cancer Patients and Review of Published Literature
Fusarium species have emerged as responsible for a broad spectrum of infections, including superficial, locally invasive and disseminated ones, especially in the hospital environment. Since there are few reports of invasive and disseminated fusariosis in children, the aim of this study was to report four cases of nosocomial infection caused by this microorganism in children with cancer hospitalized in a public children’s hospital located in Brazil. Two of these patients were female and two were male. All patients presented febrile neutropenia, while three patients had acute lymphocytic leukemia and one patient had Wilms’ tumor as underlying disease. In two cases, fungi were isolated from blood and identified as Fusarium oxysporum species complex after phenotypic and genotypic studies, while in two other cases fungi were isolated from skin biopsies and identified as Fusarium solani species complex. One patient died 12 days after the onset of cutaneous lesions. All isolates, after susceptibility testing, presented high levels of minimum inhibitory concentration for itraconazole, voriconazole and amphotericin B. Considering the emergence of filamentous fungi as etiologic agents of nosocomial infections, health professionals should be aware of the problems these infections, especially fungal ones, may cause to debilitated patients.
KeywordsFusarium spp. Children Cancer Nosocomial infection
We would like to thank “Fundação de Amparo à Pesquisa do Estado de São Paulo” (Fapesp - 2014/16507-0) for financial support and Letícia Campos for English review.
- 2.Georgiadou SP, Pongas G, Fitzgerald NE, Lewis RE, Rytting M, Marom EM, et al. Invasive mold infections in pediatric cancer patients reflect heterogeneity in etiology, presentation, and outcome: a 10-year, single-institution, retrospective study. J Pediatr Infect Dis Soc. 2012;1:125–35.CrossRefGoogle Scholar
- 11.White TJ, Bruns T, Lee S, Taylor J. Amplification and direct sequencing of fungal ribosomal RNA for phylogenetics. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, editors. PCR protocols: a guide to methods and applications. San Diego: Academic Press; 1990. p. 315–21.Google Scholar
- 14.Clinical and Laboratory Standarts Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; Approved standard, 2nd ed. CLSI document M38-A2. 2008. Clinical and Laboratory Standarts Institute, Villanova, PA; 2008.Google Scholar
- 26.Álves F, Figueras C. Representación del Grupo de Trabajo de Infecciones Fúngicas de la Sociedad Española de Infectología Pediátrica. Infecciones Fúngicas Invasivas Emergentes. Anales de Pediatría. 2010;73:52.e1–6.Google Scholar
- 33.Short DP, O’Donnell K, Thrane U, Nielsen KF, Zhang N, Juba JH, Geiser DM. Phylogenetic relationships among members of the Fusarium solani species complex in human infections and the descriptions of F. keratoplasticum sp. nov. and F. petroliphilum stat. nov. Fungal Genet Biol. 2013;53:59–70.CrossRefPubMedGoogle Scholar
- 37.Espinel-Ingroff A, Colombo AL, Cordoba S, Dufresne PJ, Fuller J, Ghannoum M, et al. International evaluation of MIC distributions and epidemiological cutoff value (ECV) definitions for Fusarium species identified by molecular methods for the CLSI broth microdilution method. Antimicrob Agents Chemother. 2015;60:1079–84.CrossRefPubMedGoogle Scholar
- 39.Lewis R, Hogan H, Howell A, Safdar A. Progressive fusariosis: unpredictable posaconazole bioavailability, and feasibility of recombinant interferon-gamma plus granulocyte macrophage-colony stimulating factor for refractory disseminated infection. Leuk Lymphoma. 2008;49(1):163–5.CrossRefPubMedGoogle Scholar
- 43.Groll AH, Castagnola E, Cesaro S, Dalle JH, Engelhard D, Hope W, et al. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. Lancet Oncol. 2014;15(8):327–40.CrossRefGoogle Scholar
- 48.Balajee SA, Borman AM, Brandt ME, Cano J, Cuenca-Estrella M, Dannaoui E, et al. Sequence-based identification of Aspergillus, Fusarium, and Mucorales species in the clinical mycology laboratory: where are we and where should we go from here? J Clin Microbiol. 2009;47:877–84.CrossRefPubMedGoogle Scholar
- 49.O’Donnell K, Sutton DA, Rinaldi MG, Gueidan C, Crous PW, Geiser DM. Novel multilocus sequence typing scheme reveals high genetic diversity of human pathogenic members of the Fusarium incarnatum, F. equiseti and F. chlamydosporum species complexes within the United States. J Clin Microbiol. 2009;47:3851–61.CrossRefPubMedPubMedCentralGoogle Scholar