Bisifusarium Delphinoides, an Emerging Opportunistic Pathogen in a Burn Patient with Diabetes Mellitus

Fusariosis in burn patients: A systematic review of case reports

Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.

Two new species of Sordariomycetes (Chaetomiaceae and Nectriaceae) from China

Rich and diverse fungal species occur in different habitats on the earth. Many new taxa are being reported and described in increasing numbers with the advent of molecular phylogenetics. However, there are still a number of unknown fungi that have not yet been discovered and described. During a survey of fungal diversity in different habitats in China, we identified and proposed two new species, based on the morphology and multi-gene phylogenetic analyses. Herein, we report the descriptions, illustrations and molecular phylogeny of the two new species, Bisifusariumkeratinophilumsp. nov. and Ovatosporasinensissp. nov.

Disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia

Fusarium is a polyphyletic genus of plant pathogens, members of which can cause opportunistic human infections with varying superficial and systemic presentations, including disseminated infections which typically occur in immunocompromised patients and have a poor prognosis. Treatment is challenging due to intrinsic resistance to many antifungal agents, and antifungal susceptibility testing is therefore essential. Early suspicion, isolation of the organism, and prompt initiation of management are crucial to improving survival. We present a case of disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia, successfully treated with liposomal amphotericin B, voriconazole, flucytosine, and terbinafine.

Effect of abiotic factors and culture media on the growth of cheese-associated Nectriaceae species

Nectriaceae species have been described in various natural environments or as plant or human pathogens. Within this family, the Bisifusarium domesticum species is of particular interest for food mycologists as it is used for technological functions in various cheese productions. Moreover, it has only been isolated from the cheese environment so far and, until recently, was the only Nectriaceae species described in this food product. Recently, four novel cheese-associated Nectriaceae species have been described, including two associated to the Bisifusarium genus and two to a new genus, Longinectria gen. nov.. These observations raise questions concerning the potential adaptation of these species to the cheese environment. In this context, this study first focused on determining the impact of abiotic factors on the growth of isolates belonging to the five cheese-associated species (i.e. B. allantoides sp. nov., B. domesticum, B. penicilloides sp. nov., L. lagenoides gen. nov. sp. nov. and L. verticilliforme gen. nov. sp. nov.) but also included phylogenetically close species. To do so, fungal growth kinetics in liquid medium (Potato Dextrose Broth) were determined by laser nephelometry at different temperatures, pH and water activities using NaCl as a depressor. Growth modeling was then performed to estimate cardinal values for each abiotic factor. Secondly, fungal growth was also evaluated on Potato Dextrose Agar (synthetic medium), cheese agar (cheese-mimicking medium) and Raclette de Savoie cheese (actual cheese). Our results clearly highlighted physiological differences in growth characteristics between the studied cheese-associated Nectriaceae spp. and the "non-cheese" species which could suggest, for the former, an adaptation to this food matrix. Indeed, regarding the impact of the tested abiotic factors, statistical analyses confirmed this dichotomy, with for example the lowest optimal temperatures estimated for the cheese-associated species (T_opt 19.1-23.1 °C) while the other Bisifusarium species exhibited the highest optimal temperatures (T_opt 26.1-36.2 °C). As for the impact of growth media, radial growth measurements highlighted that B. domesticum was the least affected species for growth on Raclette de Savoie and even grew faster on cheese agar than on synthetic medium confirming its strong adaptation to the cheese environment.

Fungal Infection in Burn Patents: A Review of 36 Case Reports

OBJECTIVES

The aims of this study were to review recent fungal infection case reports published, evaluate the treatment regimens and clinical outcomes, and provide recommendations for future management.

METHODS

A review of case reports published over the last decade was conducted. PubMed was searched to collect the relevant citations using a combination of the key words ("burn," "burned," "burns," "fungal," "fungi," and "fungus") in title or abstract. Case series, reviews, guidelines, and experimental and non-English studies were excluded. Statistical analyses were performed using Microsoft Excel 2019.

RESULTS

A total of 36 case reports encompassing a total of 44 burn patients with fungal infection were included in the final analysis. Ablative surgeries, including surgical excision, debridement, skin graft, vitrectomy, teeth extraction, valve replacement, or amputation, were performed in 38 cases after the suspicion or identification of fungal infection. Twenty-nine of them were eventually discharged, yielding a survival rate of 76.3%. In the remaining 6 cases, ablative surgery was not mentioned and 3 of them eventually died, yielding a survival rate of 50%. The total mortality was 27.27%. Among the 12 death cases, 1 was infected with Candida albicans, 1 with non-albicans Candida, 2 with Aspergillus spp, 2 with Fusarium spp, 4 with Zygomycetes, and 2 with other fungal species.

CONCLUSIONS

The overall mortality of fungal wound infection is still high in burn patients around the world, especially those infected with non-Candida species. Early diagnosis of fungal infection, early initiation of appropriate antifungal therapy, and effective surgical intervention are key measures to improve the treatment effect and reduce the mortality of fungal infection in burn patients.