FUSARIUM INFECTIONS IN IMMUNOCOMPROMISED PATIENTS - CASE-REPORTS AND LITERATURE-REVIEW

Five cases are reported of Fusarium infection in patients with aplasia following chemotherapy of leukemia. The clinical signs, diagnosis and course of the infection during treatment are outlined and discussed i n conjunction with the characteristics of other cases already reported in the literature. Sixty-three cases of Fusarium infection have been reported in immunocompromised patients, 44 cases since 1985. These inc luded patients with hematological malignancies (58 cases), especially acute leukemia (43 cases). The main sites of infection were the skin ( 46 cases), blood (28 cases) and lungs (13 cases). The infection was mo stly diagnosed by means of skin biopsy but also by means of positive b lood cultures. Forty-three strains were identified, 19 of which were F usarium solani. Amphotericin B treatment was given in 55 cases, often combined with other antifungal agents, leukocyte transfusions or granu locyte-macrophage-colony stimulating factor. The outcome was fatal in 36 of the 63 cases reported, often due to resistance of the strain to antifungal agents, particularly amphotericin B (20 of 33 strains teste d). The most important risk factor seems to be profound and prolonged aplasia. Deep mycoses due to Fusarium species thus pose an important p roblem and are occurring in increasing numbers in immunocompromised pa tients. Treatment of these infections is difficult and the prognosis i s poor.