Invasive Fusariosis in Patients with Hematologic Malignancies at a University Hospital
Authors: Ozkocaman Vildan , Ozkalemkas Fahir , Dalyan Cilo Burcu , Alp Tugcan , Ersal Tuba , Gozden Erdem , Serenli Yegen Zafer , Ridvan Ali , Ener Beyza 
Published: November 2019

Abstract
Introduction: Fusarium species cause severe infections in patients with hematologic malignancies. The types of infection caused by Fusarium spp. in humans range from infections of nail, skin, and eye in immunocompetent host to invasive and disseminated infections in mainly immunocompromised patients.
Methods: We retrospectively indentified patients with hematologic malignancy and positive cultures for Fusarium species at the University Hospital (1995-2014).
Results: Thirteen cases were identified over study period. Patient demographic and underlying risk factors for fusariosis are presented in Table I. Most patients had uncontrolled hematological malignancy. All patients were neutropenic at diagnosis. Pulmonary involvement was evident in 3/13 patients (23%). Skin lesions were present in 2/13 (15%) patients. Fusariosis presented as a breakthrough infection in 8/13 (62%) of patients (Table II). Positive blood cultures were in the 6/13 (46%).
Conclusions: Our study has several limitations due to its retrospective nature and its relatively small size. Fusariosis, althought uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia. The optimal therapy for fusariosis remains undefined, because of its rarity and the complex clinical scenarious in patients with severe immunosupression.
Table 1. Characteristics of 13 patients with fusariosis No Sex/age Underlying disease Duration of neutropenia before/after (days) Fusarium spp. Diagnosis Breakthrough infections Concomitant infections Treatment of fusarium infection Outcome of Fusarium infection 1 F/41 AML/Ri 15 /6 F. verticillioides Blood None None Amp- B Eradicated, in 23 days 2 M/19 Aplastic anemia 67/54 F. proliferatum Bronchilavage None C. kefyr, C. glabrata, P. aeruginosa Amp- B, voriconazole Eradicated, in 51 days 3 M/38 AML/RÝ 31/1 F. proliferatum Bronchi lavage Fluconazole C. albicans Amp- B, voriconazole Eradicated, in 199 days 4 M/50 ALL/RÝ 25/0 F. proliferatum Blood Fluconazole K. pneumoniae Amp- B Died 5 M/43 AML/consolidation 37/9 F. solani SC haplotype 6 Skin biopsy Fluconazole C. bovis, S. arolis Voriconazole Died 6 M/45 Relapse AML/ RÝ 37/5 F. petroliphilum Blood + tissuebiopsy Itraconazole, voriconazole VRE, S. capitis, S. maltophilia Amp- B, voriconazole Died 7 M/65 AML/ RÝ 41/0 F. andiyazi Blood Posaconazol A. baumanii Amp - B Died 8 M/63 MDS tr. AML/ RÝ None F. petroliphilum Nasalbiopsy Fluconazole HSV, C. albicans, alternans spp. Amp- B, voriconazole Died 9 M/49 Refractary MDS tr. AML/ RÝ 67/94 F. solaniss. Nasalbiopsy None S. hominis, S. saprophyticus Voriconazole Eradicatedin 68 days 10 F/53 Relapse MDS tr. AML/ RÝ 25/27 F. proliferatum Nasalbiopsy Posaconazole VRE, Klebsiella, Enterobactericea Amp- B, voriconazole Eradicated, in 84 days 11 F/49 ALL/ RÝ 23/13 F. petroliphilum Nasalbiopsy None Enterococcus, S. epidermidis, E. faecalis, MRS, BLPS Amp- B, voriconazole Died 12 M/50 HCL 65/4 F. petroliphilum Blood None None Amp- B Died 13 M/52 Relapse AML/ consolidation 34/3 F. petroliphilum Blood , skin biopsy Posaconazole C. parapsilosis, C. meningosepticum, S. capitis Echinocandine, voriconazole Eradicated , in 90 days
Table 2. Patient characteristics Demographic and disease characteristics Number of patients, n=13 (%) Median age 49(19-63) Male 49,5(19-63) Female 49(41-53) Female patient 3 (23) Male patient 10(77) AML/ MDS tr. AML 9 (69) Relapse 3 Remission induction 7 Consolidation 2 Reinduction 1 ALL (remission induction) 2 (15) Hairy cell leukemia 1 (8) Aplastic anemia 1 (8) Median duration of neutropenia before diagnosis (day) 34 (15-67) Median duration of neutropenia after diagnosis (day) 6 (0-94) History of DM 0 Albümin <3.5 mg/dL All Hýgh dose corticosteroid treatment within 30 days of diagnosis 1 Breakthrough infections 8 (62) While receiving posaconazole 3 (23) While receiving voriconazole 1 (8) While receiving fluconazole 4 (31) Concominant infection Bacterial, viral, fungal=11 (85) Exitus 7 (54)

Disclosures
No relevant conflicts of interest to declare.