Journal Article

Disseminated Amphotericin-Resistant Fusariosis in Acute Leukemia Patients: Report of Two Cases

Pereira, Graziella Hanna, Brasil, Roosecelis Araujo, de Angelis, Derlene Attili, de Souza Carvalho Melhem, Marcia, dos Anjos Martins, Marilena, Szeszs, Maria Walderez, de Matos Castro e Silva, Dulcilena

2013

Overview

Disseminated fusariosis has emerged as a significant, usually fatal infection in immunocompromised hosts despite antifungal treatment. We describe here two patients with acute leukemia who developed disseminated amphotericin-resistant fusariosis, and review of six studies of cases series in the literature. Two Fusarium solani strains were isolated from blood and skin cultures of one patient, and one strain from the blood culture of the second patient. Both patients died despite antifungal treatment. Strains were identified by sequencing of ITS1 and ITS4 regions. Random amplified polymorphic DNA analysis of the three F. solani isolates showed a low degree of similarity. Screening for Fusarium spp. contaminants within our facility was negative. Using the CLSI M-38-A2 broth dilution method and E tests ® , we found that the MICs were low for voriconazole (0.12 and 0.5 mg/L, respectively), unexpectedly high for amphotericin B (≥8 and ≥32 μg/mL, respectively) and itraconazole (≥16 mg/ml). Patients with leukemia or persistent neutropenia should be assessed for disseminated fungal infections, including biopsy and skin cultures. Antifungal susceptibility tests are important due to the possibility of the strains being amphotericin resistant. Treatments must be aggressive, with high doses of antifungals or combined therapy.

• Publisher: Springer Netherlands,Springer,Springer Nature B.V
• Subject: Acute leukemia / Aged / Amphotericin B / Amphotericin B - pharmacology / Analysis / Antifungal Agents - pharmacology / Antiparasitic agents / Biomedical and Life Sciences / Biopsy / Blood / Care and treatment / Chemotherapy / DNA / DNA, Fungal - chemistry / DNA, Fungal - genetics / DNA, Ribosomal Spacer - chemistry / DNA, Ribosomal Spacer - genetics / Drug Resistance, Fungal / Eukaryotic Microbiology / Fatal Outcome / Fusariosis - diagnosis / Fusariosis - microbiology / Fusariosis - pathology / Fusarium - drug effects / Fusarium - isolation & purification / Fusarium solani / Health aspects / Humans / Infections / Itraconazole / Leukemia / Leukemia, Biphenotypic, Acute - complications / Life Sciences / Male / Medical examination / Medical Microbiology / Microbial Ecology / Microbial Sensitivity Tests / Microbiology / Mortality / Mycoses / Neutropenia / Patients / Plant Sciences / Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications / Sequence Analysis, DNA / Skin