A propos d'un cas de mycose profonde

Fusarium infections in immunocompromised patients: case reports and literature review

Five cases are reported of Fusarium infection in patients with aplasia following chemotherapy of leukemia. The clinical signs, diagnosis and course of the infection during treatment are outlined and discussed in conjunction with the characteristics of other cases already reported in the literature. Sixty-three cases of Fusarium infection have been reported in immunocompromised patients, 44 cases since 1985. These included patients with hematological malignancies (58 cases), especially acute leukemia (43 cases). The main sites of infection were the skin (46 cases), blood (28 cases) and lungs (13 cases). The infection was mostly diagnosed by means of skin biopsy but also by means of positive blood cultures. Forty-three strains were identified, 19 of which were Fusarium solani. Amphotericin B treatment was given in 55 cases, often combined with other antifungal agents, leukocyte transfusions or granulocyte-macrophage-colony stimulating factor. The outcome was fatal in 36 of the 63 cases reported, often due to resistance of the strain to antifungal agents, particularly amphotericin B (20 of 33 strains tested). The most important risk factor seems to be profound and prolonged aplasia. Deep mycoses due to Fusarium species thus pose an important problem and are occurring in increasing numbers in immunocompromised patients. Treatment of these infections is difficult and the prognosis is poor.

Fusarium infections. Criteria for the identification of the responsible species

The incidence of human infections by Fusarium is increasing in contemporary medicine. Since the recognition of the species involved in such processes is generally difficult for non-specialists, we include here the main criteria that should be used in the identification of the responsible species. The most frequent species are F. verticillioides, F. oxysporum and F. solani, which are illustrated. The differences between Fusarium and Acremonium and Cylindrocarpon, two close genera, are discussed. The latter two are also illustrated. The main morphological characteristics of Fusarium such as sporodochium, conidiophore, conidiogenous cell, phialide, locus, macroconidia, mesoconidia, microconidia and chlamydospores are defined and illustrated. A key to the identification of Fusarium species isolated from human lesions is also included.