INVASIVE FUSARIUM INFECTIONS - A RETROSPECTIVE SURVEY OF 31 CASES

A retrospective study was conducted in France to investigate Fusarium infections which are now recognized as emerging opportunistic infectio ns. The clinical and mycological findings for 31 cases diagnosed betwe en 1984 and 1993 by members of the French Groupe d'Etudes des Mycoses Opportunistes were analysed. All suffered from haematological disease, most often acute leucaemia (n = 19). Twenty-two had received cytostat ic chemotherapy and ten had undergone bone marrow transplantation. Pro longed aplasia and pancytopenia were present in 18 and 11 patients, re spectively. Skin (61%) and blood (42%) were the sites most frequently involved. Fusarium solani (n = 7), Fusarium oxysporum (n = 7), Fusariu m verticilloides (n = 7) were the species most frequently isolated. Ni ne antifungal treatments were used, associated with colony-stimulating factors in five cases. None was unambiguously superior to all the oth ers. The overall mortality was 51.6% with a specific mortality greater than or equal to 25.8%. The disseminated form of the infection was as sociated with poor prognosis (P < 0.02) whereas improving granulocyte count improved prognosis (P < 0.001). More aggressive cytostatic regim ens used for patients with haematological malignancies have favoured t he emergence of Fusarium infections. As prognosis is closely correlate d with neutrophil recovery, the promising results obtained with the us e of colony-stimulating factors should be further evaluated.