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Rev. Soc. Bras. Med. Trop ; 53: e20200013, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136810


Abstract Fusarium spp. has been associated with a broad spectrum of emerging infections collectively termed fusariosis. This review includes articles published between 2005 and 2018 that describe the characteristics, clinical management, incidence, and emergence of these fungal infections. Fusarium solani and F. oxysporum are globally distributed and represent the most common complexes. Few therapeutic options exist due to intrinsic resistance, especially for the treatment of invasive fusariosis. Therefore, the use of drug combinations could be an important alternative for systemic antifungal resistance. Increase in the number of case reports on invasive fusariosis between 2005 and 2018 is evidence of the emergence of this fungal infection.

Humans , Communicable Diseases, Emerging/parasitology , Fusariosis/parasitology , Fusarium/classification , Antifungal Agents/administration & dosage , Brazil/epidemiology , Incidence , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/epidemiology , Drug Resistance, Fungal , Fusariosis/drug therapy , Fusariosis/epidemiology
Rev. chil. infectol ; 35(4): 448-452, ago. 2018. graf
Article in Spanish | LILACS | ID: biblio-978057


Resumen Presentamos el caso clínico de un paciente con una leucemia linfoblástica aguda (LLA) que desarrolló una fusariosis diseminada por Fusarium verticillioides durante un episodio prolongado de neutropenia febril post quimioterapia. Fue exitosamente tratado cuando se usó terapia combinada de voriconazol más anfotericina B deoxicolato.

We report a case of a patient with acute lymphoblastic leukemia (ALL), who developed a disseminated infection by Fusarium verticillioides during chemotherapy-induced neutropenia. He was successfully treated only after combination therapy with voriconazole plus amphotericin B deoxycolate was used, but not when these compounds were used in an isolated form.

Humans , Male , Adolescent , Amphotericin B/therapeutic use , Deoxycholic Acid/therapeutic use , Fusariosis/drug therapy , Voriconazole/therapeutic use , Antifungal Agents/therapeutic use , Neutropenia/drug therapy , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Drug Combinations , Drug Therapy, Combination , Fusariosis/etiology , Fusariosis/pathology , Neutropenia/etiology , Neutropenia/pathology
Braz. j. infect. dis ; 20(4): 354-359, July-Aug. 2016. tab
Article in English | LILACS | ID: biblio-828120


Abstract Introduction Invasive mold disease is an important complication of patients with hematologic malignancies, and is associated with high mortality. A diagnostic-driven approach has been an alternative to the classical empiric antifungal therapy. In the present study we tested an algorithm that incorporated risk stratification using the D-index, serial serum galactomannan and computed tomographic-scan to guide the decision to start antifungal therapy in neutropenic patients. Patients and methods Between May 2010 and August 2012, patients with acute leukemia in induction remission were prospectively monitored from day 1 of chemotherapy until discharge or death with the D-index and galactomannan. Patients were stratified in low, intermediate and high risk according to the D-index and an extensive workup for invasive mold disease was performed in case of positive galactomannan (≥0.5), persistent fever, or the appearance of clinical manifestations suggestive of invasive mold disease. Results Among 29 patients, 6 (21%), 11 (38%), and 12 (41%) were classified as high, intermediate, and low risk, respectively. Workup for invasive mold disease was undertaken in 67%, 73% and 58% (p = 0.77) of patients in each risk category, respectively, and antifungal therapy was given to 67%, 54.5%, and 17% (p = 0.07). Proven or probable invasive mold disease was diagnosed in 67%, 45.5%, and in none (p = 0.007) of high, intermediate, and low risk patients, respectively. All patients survived. Conclusion A risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Aspergillosis/drug therapy , Algorithms , Fusariosis/drug therapy , Mannans/blood , Antifungal Agents/therapeutic use , Neutropenia/immunology , Aspergillosis/diagnosis , Aspergillosis/immunology , Myelodysplastic Syndromes/immunology , Myelodysplastic Syndromes/microbiology , Leukemia, Myeloid, Acute/immunology , Leukemia, Myeloid, Acute/microbiology , Tomography, X-Ray Computed , Prospective Studies , Sensitivity and Specificity , Risk Assessment , Fusariosis/diagnosis , Fusariosis/immunology , Mannans/immunology , Neutropenia/microbiology
Med. infant ; 22(3): 210-213, Sept.2015.
Article in Spanish | LILACS | ID: biblio-906583


Introducción: Fusarium spp. son hongos ubicuos que producen infecciones oportunistas en humanos incluyendo algunas severas en quemados. La literatura sobre infecciones por Fusarium spp. en pacientes quemados pediátricos es escasa. Objetivos: describir los hallazgos clínicos, epidemiológicos y evolutivos de infecciones por Fusarium spp. en pacientes quemados pediátricos. Pacientes y métodos: estudio retrospectivo, descriptivo de infecciones por Fusarium spp. en una unidad de cuidados intensivos pediátrica especializada entre enero de 2006 y marzo de 2015. Resultados: Quince pacientes presentaron infección por Fusarium spp. El 87% eran varones. La mediana de edad fue de 48 meses. En el 67% de los casos la quemadura fue por fuego directo. La superficie corporal quemada fue de una mediana de 45%. El 80% tuvo quemaduras profundas y el 93% presentó un índice de Garcés > 3. La infección fúngica se detectó con una mediana de 11 días desde la injuria. Todos los pacientes tuvieron catéteres centrales durante una mediana de 20 días y trece pacientes requirieron asistencia respiratoria mecánica durante una mediana de 16 días. En 14 pacientes el hongo fue aislado en la quemadura y en un paciente en el hueso. Trece pacientes tuvieron infecciones bacterianas concomitantes. Los antifúngicos de elección fueron anfotericina B y voriconazol. El tratamiento duró una mediana de 23 días. La mediana de internación fue de 55 días. Un solo paciente falleció debido a la infección fúngica. Conclusión: Fusarium spp. es un patógeno poco frecuente en pacientes quemados graves. La mortalidad fue baja (AU)

Introduction: Fusarium spp. are ubiquitous fungi recognized as opportunistic agents of human infections. They can produce severe infections in burn patients. The literature about Fusarium spp. infections in burn pediatric patients is scarce. Objectives: To describe clinical, epidemiological and outcome features of cases of Fusarium spp. infections in burn pediatric patients. Patients and Methods: Retrospective, descriptive study of Fusarium spp. infections in a specialized intensive care from January 2006 to March 2015. Results: 15 patients developed Fusarium spp infections. 87 % were male. Median age was 48 months. Direct fire injury was in ten patients. The affected burn surface was a median of 45%. Twelve patients had a full thickness burn. Fourteen patients had Garces Index>3. Fungal infection appears at a median of 11 days from injury. All patients had central lines during a median of 20 days and thirteen patients had mechanical ventilatory assistance for a median of sixteen days. Fungi vas isolated from burn wound in 14 patients and in bone in one patient. Thirteen patients had bacterial infection also. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of complete treatment was 23 days. The median hospital stay was 55 days. One patient died of fungal infection related causes. Conclusion: Fusarium spp. is an uncommon pathogen in severely burn patients. Mortality was low (AU)

Humans , Infant , Child, Preschool , Child , Burn Units , Burns/microbiology , Fusariosis/complications , Fusariosis/drug therapy , Fusarium/isolation & purification , Wound Infection/microbiology , Antifungal Agents/therapeutic use , Observational Study , Retrospective Studies