Clinical manifestations and diagnosis of Fusarium infection
- Elias Anaissie, MD
Elias Anaissie, MD
- Staff physician
- FirstMark Hematology and Myeloma Center
- Marcio Nucci, MD
Marcio Nucci, MD
- Associate Professor, Department of Internal Medicine Federal University of Rio de Janeiro
- Head, Mycology Laboratory
- Hospital Universitario Clementino Fraga Filho
Fusarium species cause a broad spectrum of infections in humans, including superficial infections such as keratitis and onychomycosis, as well as locally invasive and disseminated infections . Invasive and disseminated infections occur almost exclusively in severely immunocompromised patients, particularly among those with prolonged and profound neutropenia and/or severe T cell immunodeficiency. Among patients with hematologic malignancy, the infection predominates during periods of neutropenia, typically among patients with leukemia receiving induction chemotherapy.
Fusarium species may also cause allergic diseases such as sinusitis in immunocompetent individuals  and mycotoxicosis following ingestion of food contaminated by toxin-producing Fusarium species . Fusarium species are also important plant pathogens that cause various diseases of cereal grains  and occasionally cause infection in animals .
The clinical manifestations and diagnosis of fusariosis will be reviewed here. The mycology, pathogenesis, epidemiology, treatment, and prevention of fusariosis are discussed separately. (See "Mycology, pathogenesis, and epidemiology of Fusarium infection" and "Treatment and prevention of Fusarium infection".)
Immunocompetent patients — Keratitis and onychomycosis are the most common manifestations of fusariosis among immunocompetent hosts.
Keratitis — Keratitis is inflammation of the cornea and can be caused by a variety of infectious and noninfectious causes  (see 'Keratitis' below). Fusarium spp are a common cause of fungal keratitis and were responsible for an outbreak among contact lens users between 2004 and 2006, which was linked to a specific brand of contact lens solution, ReNu with MoistureLoc. (See "Mycology, pathogenesis, and epidemiology of Fusarium infection", section on 'Keratitis'.)
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- CLINICAL MANIFESTATIONS
- Immunocompetent patients
- - Keratitis
- - Onychomycosis and superficial skin infections
- - Deep cutaneous infections
- - Other infections
- Immunocompromised patients
- - Sinusitis
- - Pneumonia
- - Cutaneous lesions
- - Fungemia
- - Disseminated disease
- DIFFERENTIAL DIAGNOSIS
- Invasive disease
- Approach to diagnosis
- Blood cultures
- Growth of cultures
- Beta-D-glucan and galactomannan antigen
- Other techniques
- SUMMARY AND RECOMMENDATIONS