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Mycology, pathogenesis, and epidemiology of Fusarium infection

INTRODUCTION

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 [1]. Fusarium species may also cause allergic diseases, such as sinusitis in immunocompetent individuals [2], and mycotoxicosis following ingestion of food contaminated by toxin-producing Fusarium species [3]. Fusarium species are also important plant pathogens that cause various diseases on cereal grains [3] and occasionally cause infection in animals [4].

The mycology, pathogenesis, and epidemiology of fusariosis will be reviewed here. The clinical manifestations, diagnosis, treatment, and prevention of fusariosis are discussed separately. (See "Clinical manifestations and diagnosis of Fusarium infection" and "Treatment and prevention of Fusarium infection".)

MYCOLOGY

Fusarium species are widely distributed in soil, subterranean and aerial plant parts, plant debris, and other organic matter [3]. They are also present in water worldwide [5].

Growth in vitro — Fusarium species grow rapidly on many media that do not contain cycloheximide, which inhibits its growth. On potato dextrose agar, Fusarium species produce white-, lavender-, pink-, salmon-, or gray-colored colonies with velvety or cottony surfaces [6].

Microscopic appearance — Microscopically, the hyphae of Fusarium in tissue resemble those of Aspergillus species, with septate hyaline hyphae 3 to 8 microns in diameter that typically branch at acute angles (picture 1 and picture 2). Adventitious sporulation, which is the ability to sporulate in tissue and blood, may be present [7]; the identification of hyphal and yeast-like structures in the same specimen is highly suggestive of fusariosis in high-risk patients.

            

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Literature review current through: Nov 2014. | This topic last updated: Feb 6, 2014.
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References
Top
  1. Nucci M, Anaissie E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev 2007; 20:695.
  2. Wickern GM. Fusarium allergic fungal sinusitis. J Allergy Clin Immunol 1993; 92:624.
  3. Nelson PE, Dignani MC, Anaissie EJ. Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev 1994; 7:479.
  4. Evans J, Levesque D, de Lahunta A, Jensen HE. Intracranial fusariosis: a novel cause of fungal meningoencephalitis in a dog. Vet Pathol 2004; 41:510.
  5. Elvers KT, Leeming K, Moore CP, Lappin-Scott HM. Bacterial-fungal biofilms in flowing water photo-processing tanks. J Appl Microbiol 1998; 84:607.
  6. Silveira FP, Queiroz-Telles F, Nucci M. Invasive mold infections. In: Diagnosis of fungal infections, Maertens JA, Marr KA (Eds), Informa Healthcare, 2007. p.171.
  7. Liu K, Howell DN, Perfect JR, Schell WA. Morphologic criteria for the preliminary identification of Fusarium, Paecilomyces, and Acremonium species by histopathology. Am J Clin Pathol 1998; 109:45.
  8. Healy M, Reece K, Walton D, et al. Use of the Diversi Lab System for species and strain differentiation of Fusarium species isolates. J Clin Microbiol 2005; 43:5278.
  9. Fleming, RV, Anaissie, EJ. Hyalohyphomycosis - Infection due to hyaline moulds. In: Diagnosis and Treatment of Human Mycoses, Hospenthal, DR, Rinaldi, MG (Eds), Humana Press, Totowa 2008. p.201.
  10. O'Donnell K, Sutton DA, Rinaldi MG, et al. Internet-accessible DNA sequence database for identifying fusaria from human and animal infections. J Clin Microbiol 2010; 48:3708.
  11. Alastruey-Izquierdo A, Cuenca-Estrella M, Monzón A, et al. Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods. J Antimicrob Chemother 2008; 61:805.
  12. Torres HA, Kontoyiannis DP. Hyalohyphomycoses (Hyaline Moulds). In: Essentials of Clinical Mycology, Second edition, Kauffman C, Pappas PG, Sobel JD (Eds), Springer, New York 2011. p.281.
  13. Dóczi I, Gyetvai T, Kredics L, Nagy E. Involvement of Fusarium spp. in fungal keratitis. Clin Microbiol Infect 2004; 10:773.
  14. Brilhante RS, Cordeiro RA, Medrano DJ, et al. Onychomycosis in Ceará (Northeast Brazil): epidemiological and laboratory aspects. Mem Inst Oswaldo Cruz 2005; 100:131.
  15. Godoy P, Nunes E, Silva V, et al. Onychomycosis caused by Fusarium solani and Fusarium oxysporum in São Paulo, Brazil. Mycopathologia 2004; 157:287.
  16. Ninet B, Jan I, Bontems O, et al. Molecular identification of Fusarium species in onychomycoses. Dermatology 2005; 210:21.
  17. O'Donnell K, Sutton DA, Fothergill A, et al. Molecular phylogenetic diversity, multilocus haplotype nomenclature, and in vitro antifungal resistance within the Fusarium solani species complex. J Clin Microbiol 2008; 46:2477.
  18. Balajee SA, Borman AM, Brandt ME, et al. Sequence-based identification of Aspergillus, fusarium, and mucorales species in the clinical mycology laboratory: where are we and where should we go from here? J Clin Microbiol 2009; 47:877.
  19. Krátká J, Kováciková E. The effect of temperature and age of strains of Fusarium oxysporum on its enzymatic activity. Zentralbl Bakteriol Naturwiss 1979; 134:154.
  20. Mayayo E, Pujol I, Guarro J. Experimental pathogenicity of four opportunist Fusarium species in a murine model. J Med Microbiol 1999; 48:363.
  21. Shoham S, Levitz SM. The immune response to fungal infections. Br J Haematol 2005; 129:569.
  22. Gaviria JM, van Burik JA, Dale DC, et al. Comparison of interferon-gamma, granulocyte colony-stimulating factor, and granulocyte-macrophage colony-stimulating factor for priming leukocyte-mediated hyphal damage of opportunistic fungal pathogens. J Infect Dis 1999; 179:1038.
  23. Winn RM, Gil-Lamaignere C, Roilides E, et al. Effects of interleukin-15 on antifungal responses of human polymorphonuclear leukocytes against Fusarium spp. and Scedosporium spp. Cytokine 2005; 31:1.
  24. Romani L. Immunity to fungal infections. Nat Rev Immunol 2004; 4:1.
  25. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis 2002; 35:909.
  26. Rippon JW, Larson RA, Rosenthal DM, Clayman J. Disseminated cutaneous and peritoneal hyalohyphomycosis caused by Fusarium species: three cases and review of the literature. Mycopathologia 1988; 101:105.
  27. Kerr CM, Perfect JR, Craven PC, et al. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis. Ann Intern Med 1983; 99:334.
  28. Flynn JT, Meislich D, Kaiser BA, et al. Fusarium peritonitis in a child on peritoneal dialysis: case report and review of the literature. Perit Dial Int 1996; 16:52.
  29. Kurien M, Anandi V, Raman R, Brahmadathan KN. Maxillary sinus fusariosis in immunocompetent hosts. J Laryngol Otol 1992; 106:733.
  30. Madhavan M, Ratnakar C, Veliath AJ, et al. Primary disseminated fusarial infection. Postgrad Med J 1992; 68:143.
  31. Sander A, Beyer U, Amberg R. Systemic Fusarium oxysporum infection in an immunocompetent patient with an adult respiratory distress syndrome (ARDS) and extracorporal membrane oxygenation (ECMO). Mycoses 1998; 41:109.
  32. Murray CK, Beckius ML, McAllister K. Fusarium proliferatum superficial suppurative thrombophlebitis. Mil Med 2003; 168:426.
  33. Sturm AW, Grave W, Kwee WS. Disseminated Fusarium oxysporum infection in patient with heatstroke. Lancet 1989; 1:968.
  34. Pflugfelder SC, Flynn HW, Jr., et al. fungal endophthalmitis. Ophthlamology 1988; 95:19.
  35. Gabriele P, Hutchins RK. Fusarium endophthalmitis in an intravenous drug abuser. Am J Ophthalmol 1996; 122:119.
  36. Jakle C, Leek JC, Olson DA, Robbins DL. Septic arthritis due to Fusarium solani. J Rheumatol 1983; 10:151.
  37. Bourguignon RL, Walsh AF, Flynn JC, et al. Fusarium species osteomyelitis. Case report. J Bone Joint Surg Am 1976; 58:722.
  38. Chang DC, Grant GB, O'Donnell K, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006; 296:953.
  39. Khor WB, Aung T, Saw SM, et al. An outbreak of Fusarium keratitis associated with contact lens wear in Singapore. JAMA 2006; 295:2867.
  40. Patel A, Hammersmith K. Contact lens-related microbial keratitis: recent outbreaks. Curr Opin Ophthalmol 2008; 19:302.
  41. Saw SM, Ooi PL, Tan DT, et al. Risk factors for contact lens-related fusarium keratitis: a case-control study in Singapore. Arch Ophthalmol 2007; 125:611.
  42. Bullock JD, Elder BL, Khamis HJ, Warwar RE. Effects of time, temperature, and storage container on the growth of Fusarium species: implications for the worldwide Fusarium keratitis epidemic of 2004-2006. Arch Ophthalmol 2011; 129:133.
  43. Bullock JD, Elder BL, Warwar RE, et al. Mechanism of drug failure in fusarium keratitis, 2004-2006. N Engl J Med 2014; 370:88.
  44. Yildiz EH, Abdalla YF, Elsahn AF, et al. Update on fungal keratitis from 1999 to 2008. Cornea 2010; 29:1406.
  45. Tanure MA, Cohen EJ, Sudesh S, et al. Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea 2000; 19:307.
  46. Rosa RH Jr, Miller D, Alfonso EC. The changing spectrum of fungal keratitis in south Florida. Ophthalmology 1994; 101:1005.
  47. Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TI. Fusarium spp. as agents of onychomycosis in immunocompetent hosts. Int J Dermatol 2007; 46:822.
  48. Hilmioğlu-Polat S, Metin DY, Inci R, et al. Non-dermatophytic molds as agents of onychomycosis in Izmir, Turkey - a prospective study. Mycopathologia 2005; 160:125.
  49. Romano C, Papini M, Ghilardi A, Gianni C. Onychomycosis in children: a survey of 46 cases. Mycoses 2005; 48:430.
  50. Anaissie EJ, Kuchar RT, Rex JH, et al. Fusariosis associated with pathogenic fusarium species colonization of a hospital water system: a new paradigm for the epidemiology of opportunistic mold infections. Clin Infect Dis 2001; 33:1871.
  51. Nucci M, Varon AG, Garnica M, et al. Increased incidence of invasive fusariosis with cutaneous portal of entry, Brazil. Emerg Infect Dis 2013; 19:1567.
  52. Varon AG, Nouer SA, Barreiros G, et al. Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive fusariosis. J Infect 2014; 68:85.
  53. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years' experience at a cancer center and implications for management. Blood 1997; 90:999.
  54. Nucci M, Anaissie EJ, Queiroz-Telles F, et al. Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection. Cancer 2003; 98:315.
  55. Nucci M, Marr KA, Queiroz-Telles F, et al. Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis 2004; 38:1237.
  56. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 2010; 50:1091.
  57. Pagano L, Caira M, Nosari A, et al. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis 2007; 45:1161.
  58. Pagano L, Caira M, Candoni A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91:1068.
  59. Nucci M, Garnica M, Gloria AB, et al. Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil. Clin Microbiol Infect 2013; 19:745.
  60. Sampathkumar P, Paya CV. Fusarium infection after solid-organ transplantation. Clin Infect Dis 2001; 32:1237.