Infecciones por Fusarium

AbstractFusarium species are primarily plant pathogens that occasionally cause human disease. Several members of this genus of molds have caused widespread destruction of food crops. Fusarium species are found primarily in soli and on decaying vegetable matter, but also occur in water. Localized infections, such as keratitis, sinusitis, and skin and nail infections, occur in immunocompetent persons. However, invasive sinusitis and pulmonary infection, as well as widespread dissemination, are the rule in markedly immunosuppressed patients, especially those who are profoundly neutropenic. The acute onset of painful skin lesions and the growth of a mold in blood cultures are clues to disseminated fusariosis in immunosuppressed patients. The organism grows readily in the laboratory, but identification to the species level is difficult. Biopsy of infected tissues shows acutely branching septate hyphae that are often indistinguishable from those of Aspergillus species. Localized lesions respond reasonably well to antifungal agents and surgical excision. Invasive pulmonary and disseminated infection respond poorly to antifungal therapy, in part because of the resistance of most species to many antifungal agents, but more importantly, to the absence of an effective host response. Most patients who have disseminated or invasive pulmonary infection are treated with a combination of voriconazole and a lipid formulation of amphotericin B, with the hope that at least one drug may have activity against the organism, and perhaps better killing can be achieved using two drugs. Unfortunately, patients who have disseminated fusariosis and who remain neutropenic rarely survive the infection, regardless of the therapy used