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Fusarium Infection

Fusariosis

Fungal species of the genus Fusarium are opportunistic pathogens and may cause fusariosis. Immunocompromised patients are particularly prone to Fusarium infection and in these individuals, hematogenous spread of pathogens may lead to disseminated, life-threatening disease.

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Presentation

Patients suffering from fusariosis usually have a medical history of immunosuppression and/or hospitalization, i.e., they belong to any of the aforementioned risk groups. Long-term use of corticosteroids as well as neutropenia or lymphopenia may indicate an immunosuppression in people not previously diagnosed with disorders of the immune system. In contrast, immunocompetent individuals may not report recently sustained minor traumas that may have facilitated Fusarium infection unless inquired about.

Most frequent initial manifestations of fusariosis are dermatitis, onychomycosis, and keratitis. In immunocompetent individuals, an exacerbation of symptoms is unlikely since pathogens don't typically spread from the primary site of entry. In immunocompromised patients, dermatitis may turn into ecthyma, cellulitis, panniculitis and soft-tissue necrosis. The appearance of multiple subcutaneous nodules indicates the hematogenous spread of pathogens. Furthermore, patients may develop sinusitis and pneumonia. Less commonly, fusariosis may trigger septic arthritis [7] and osteomyelitis [8]. Dissemination is common in those patients who suffer from Fusarium-induced thrombophlebitis or peritonitis. Infiltration of neighboring tissues as well as systemic spread are generally associated with constitutive symptoms like malaise and fever.

Fever
  • Disseminated Fusarium infection should be suspected in immunocompromised patients with fever and neutropenia who have generalized, eroded, violaceous papules, vesicles, and pustules, particularly with associated myalgias.[ncbi.nlm.nih.gov]
  • In the immunocompromised, disseminated fusariosis is more common and it manifests with refractory fever, skin lesions (ecthyma-like, target, and multiple subcutaneous nodules), severe myalgias and sino-pulmonary infections.[orpha.net]
  • During the neutropenic period after intensive chemotherapy, vomiting, diarrhea, fever, subcutaneous nodes, and coughing appeared. Pneumonia was diagnosed, and Fusarium moniliforme was isolated from blood culture.[ncbi.nlm.nih.gov]
  • The patient, a 22-year-old man with acute lymphoblastic leukaemia (ALL), developed fever and diffuse cutaneous maculopapular necrotising nodules during post-chemotherapy neutropenia.[ncbi.nlm.nih.gov]
  • Patients presented with dyspnea, fever, nonproductive cough, hemoptysis, and headache. Blood tests showed elevated white blood cell counts with granulocytosis and elevated inflammatory markers.[ncbi.nlm.nih.gov]
Pain
  • The patient had fever and neutropenia, and scattered violaceous papules and vesicles with central erosions that rapidly progressed to generalized, painful, violaceous, papulovesicular lesions with central necrosis. Severe myalgias were associated.[ncbi.nlm.nih.gov]
  • All patients experienced a unilateral stabbing pain of the affected eye after removal of the contact lens.[ncbi.nlm.nih.gov]
  • This is a painful condition referred to as onycholysis. Tips for Avoiding Fusarium Fungal Infections of the Nails It’s much better to prevent fusarium fungal infections of the nails than it is to try to treat them.[hubpages.com]
  • […] disseminated infection in rare and is only seen with any frequency in severely immunocompromised patients. that being said, superficial or localized infection does have the potential to spread and therefore if your mother starts to develop fevers, joint/muscle pain[zocdoc.com]
  • Published online: October 07, 2009 Number of Print Pages: 3 Number of Figures: 0 Number of Tables: 0 ISSN: 1018-8665 (Print) eISSN: 1421-9832 (Online) For additional information: Abstract A 27-year-old woman with acute lymphocytic leukemia developed red painful[karger.com]
Weakness
  • Cerebral aneurysm caused by infections differ from congenital brain aneurysm, which often occur the junctions where these arteries come together and form weak spots.[bloodjournal.org]
  • A fusarium fungal infection is much more likely in those with weak immune systems. These patients lack the “fighter” cells to defend the body against the fusarium fungus.[hubpages.com]
  • If the infected seedlings emerge, they may be stunted and weak with chlorotic cotyledons.[wiki.bugwood.org]
  • In the medical field, the species cause opportunistic infections of human eyes, skin or nails and may also cause systemic infections in individuals with weak immune system.[moldbacteria.com]
  • Those most at risk are individuals with weak or compromised immune systems.[sciencedaily.com]
Malaise
  • Infiltration of neighboring tissues as well as systemic spread are generally associated with constitutive symptoms like malaise and fever.[symptoma.com]
  • […] secondary relapse despite achieving complete leukaemic remission. fusarium disseminated neutropenia remission Statistics from Altmetric.com fusarium disseminated neutropenia remission A 67 year old man presented with a three to four week history of general malaise[jcp.bmj.com]
Chills
  • The patient had a history of low-grade fever (without chills and rigors) for 9 months and 4 months ago, following a persistent headache she was diagnosed to have TBM on the basis of cerebrospinal fluid (CSF) examination.[jnaccjournal.org]
Pneumonia
  • Pneumonia was diagnosed, and Fusarium moniliforme was isolated from blood culture. A central venous catheter was removed.[ncbi.nlm.nih.gov]
  • PATIENT AND METHODS: Woman with pulmonary sarcoidosis necessitating bilateral lung transplants 4 months prior to her demise who was soon readmitted with viral pneumonia.[ncbi.nlm.nih.gov]
  • The patient had profound neutropenia and developed skin nodules and pneumonia in spite of posaconazole prophylaxis. F. solani was isolated from blood and skin biopsy, being identified from its morphology and by molecular methods.[ncbi.nlm.nih.gov]
  • Furthermore, patients may develop sinusitis and pneumonia. Less commonly, fusariosis may trigger septic arthritis and osteomyelitis. Dissemination is common in those patients who suffer from Fusarium-induced thrombophlebitis or peritonitis.[symptoma.com]
  • Airborne fusariosis is acquired by the inhalation of airborne fusarial conidia as suggested by the occurrence of sinusitis and or pneumonia in the absence of dissemination.[indianjnephrol.org]
Cough
  • During the neutropenic period after intensive chemotherapy, vomiting, diarrhea, fever, subcutaneous nodes, and coughing appeared. Pneumonia was diagnosed, and Fusarium moniliforme was isolated from blood culture.[ncbi.nlm.nih.gov]
  • Patients presented with dyspnea, fever, nonproductive cough, hemoptysis, and headache. Blood tests showed elevated white blood cell counts with granulocytosis and elevated inflammatory markers.[ncbi.nlm.nih.gov]
  • She had a 3-year history of respiratory symptoms that involved productive cough. Physical examination revealed skin lesions (as described above) and a coarse crackle at left lung apex; there were no other abnormal clinical findings.[academic.oup.com]
Dyspnea
  • Patients presented with dyspnea, fever, nonproductive cough, hemoptysis, and headache. Blood tests showed elevated white blood cell counts with granulocytosis and elevated inflammatory markers.[ncbi.nlm.nih.gov]
  • In October 2012, during a routine medical consultation, she complained of palpitation and dyspnea starting 10 days before. The patient presented with hypercalcemia and had to be admitted for the treatment of this condition.[springerplus.springeropen.com]
Rhinitis
  • Abstract Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now "rhinosinusitis".[ncbi.nlm.nih.gov]
Hemoptysis
  • Patients presented with dyspnea, fever, nonproductive cough, hemoptysis, and headache. Blood tests showed elevated white blood cell counts with granulocytosis and elevated inflammatory markers.[ncbi.nlm.nih.gov]
Abdominal Pain
  • The initial symptoms of the infection included fever, abdominal pain, vomiting, and diarrhea. Within days, the victims suffered from bloody diarrhea, bloody urine, vaginal bleeding, tarry stools, and ulcers of the larynx and stomach.[hubpages.com]
Food Poisoning
  • Ingestion of contaminated products may thus lead to different forms of food poisoning. For instance, mycotoxin T2 exposure has been associated with Kashin-Beck disease.[symptoma.com]
Myalgia
  • Disseminated Fusarium infection should be suspected in immunocompromised patients with fever and neutropenia who have generalized, eroded, violaceous papules, vesicles, and pustules, particularly with associated myalgias.[ncbi.nlm.nih.gov]
  • In the immunocompromised, disseminated fusariosis is more common and it manifests with refractory fever, skin lesions (ecthyma-like, target, and multiple subcutaneous nodules), severe myalgias and sino-pulmonary infections.[orpha.net]
  • Lesions at different stages of evolution (papules, nodules and necrotic lesions) may be present in a third of patients and concomitant myalgia (suggesting muscle involvement) was described in 15%.[indianjnephrol.org]
  • He started with neutropenia in the D 1 post-transplant, and presented fever in the D 3 post-transplant, followed by intense myalgia and papular skin lesion with rapid dissemination.[scielo.br]
Eye Pain
  • Symptoms of fungal keratitis include: Eye pain Eye redness Blurred vision Sensitivity to light Excessive tearing Eye discharge If you experience any of these symptoms, remove your contact lenses (if you wear them) and call your eye doctor right away.[cdc.gov]
Excessive Tearing
  • Symptoms of fungal keratitis include: Eye pain Eye redness Blurred vision Sensitivity to light Excessive tearing Eye discharge If you experience any of these symptoms, remove your contact lenses (if you wear them) and call your eye doctor right away.[cdc.gov]
Subcutaneous Nodule
  • Skin lesions associated with disseminated infection included red or gray macules, papules (some with central necrosis or eschar), pustules, and subcutaneous nodules. Most patients had a variety of lesions simultaneously.[ncbi.nlm.nih.gov]
  • In the immunocompromised, disseminated fusariosis is more common and it manifests with refractory fever, skin lesions (ecthyma-like, target, and multiple subcutaneous nodules), severe myalgias and sino-pulmonary infections.[orpha.net]
  • Abstract A 61-year-old male with leukemia manifested multiple cutaneous nodules on his whole body surface, subcutaneous nodules on his arms and a tongue tumor.[ncbi.nlm.nih.gov]
  • The appearance of multiple subcutaneous nodules indicates the hematogenous spread of pathogens. Furthermore, patients may develop sinusitis and pneumonia. Less commonly, fusariosis may trigger septic arthritis and osteomyelitis.[symptoma.com]
Ecthyma
  • In the immunocompromised, disseminated fusariosis is more common and it manifests with refractory fever, skin lesions (ecthyma-like, target, and multiple subcutaneous nodules), severe myalgias and sino-pulmonary infections.[orpha.net]
  • In immunocompromised patients, dermatitis may turn into ecthyma, cellulitis, panniculitis and soft-tissue necrosis. The appearance of multiple subcutaneous nodules indicates the hematogenous spread of pathogens.[symptoma.com]
  • […] patients), local trauma (3 patients), or an insect bite (2 patients) was reported. [5] Patients with disseminated disease typically have multiple erythematous papular or nodular and painful lesions, frequently with central necrosis giving the lesions an ecthyma[indianjnephrol.org]
  • Successful treatment of Fusarium solani ecthyma gangrenosum in a patient affected by leukocyte adhesion deficiency type 1 with granulocytes transfusions. BMC Dermatol. 2010;10:10. [ Links ] Cherif H, Axdorph U, Kalin M, Bjorkholm M.[scielo.br]
Intertrigo
  • Fusarium spp. can also infect the nails, causing melanonychia and onychomycosis (1, 17) and rarely causes interdigital intertrigo, abscesses and mycetoma (2, 18).[medicaljournals.se]
  • A strong association between invasive Fusarium infection and a superficial skin lesion, especially onychomycosis or intertrigo, has been demonstrated in recent studies. 6 , 7 Moreover, the presence of a Fusarium skin lesion at admission was associated[scielo.br]
Dermatitis
  • Usually, affected people suffer from dermatitis or cellulitis, onychomycosis, keratitis, and respiratory infection, possibly accompanied by constitutive symptoms like malaise and fever.[symptoma.com]
Plantar Hyperkeratosis
  • Plantar hyperkeratosis due to Fusarium verticilloides in a patient with malignancy. Clin Exp Dermatol 1999; 24: 175–178. 6. Chade ME, Mereles BE, Medvedeff MG, Vedoya MC. Micosis subcutánea postraumática por Fusarium solani.[medicaljournals.se]

Workup

Although fusariosis is generally considered a rare disease, Fusarium spp. are among the most common fungal pathogens isolated from immunodeficient patients. Thus, characteristic skin lesions or keratitis in immunocompromised individuals should prompt a strong suspicion of Fusarium infection. Histopathological examination of tissue samples is strongly recommended to confirm this suspicion, although in vivo confocal microscopy and anterior segment optical coherence tomography may be utilized to diagnose ocular fungal infections [9]. Fusarium spp. grow in form of hyaline, septate hyphae that measure up to 8 μm in diameter and largely resemble Aspergillus filaments. Hyphae branch at right or acute angles. Canoe- or banana-shaped macroconidia may be observed and are characteristic of the genus; the precise appearance of microconidia is of importance to distinguish species [10]. If histopathological analyses don't allow for a reliable diagnosis, fungi have to be cultured. Of note, Fusarium spp. spread hematogenously, and blood cultures do yield positive results in about half of patients. Nevertheless, negative results don't rule out fusariosis or fungal infections triggered by pathogens of other genera. For a long time, isolation of Fusarium spp. from infected sites has been the diagnostic measure of choice, but more recently, the identification of fungal pathogens by means of molecular biological techniques has been gaining importance [11]. Antimicrobial susceptibility testing is recommended to assure an optimum response to therapy and to avoid further dissemination of the disease.

Although diagnostic imaging is not required to confirm Fusarium infection, plain radiography or computed tomography scans of the thoracic cavity often reveal poorly demarcated, angioinvasive masses in the lungs of patients presenting with respiratory infection. The latter technique is more sensitive than the former, but both lack specificity to diagnose fusariosis [12].

Fusarium
  • The discussion of Fusarium-related mycotoxicosis is beyond the scope of this article, though. Fusarium infection or fusariosis refers to an infection with fungal species of the genus Fusarium.[symptoma.com]
  • Abstract Fusarium is a newly emerging fungal pathogen associated with significant morbidity and mortality in the immunocompromised host. We have reviewed our hospital's experience with Fusarium between 1985 and 1995.[ncbi.nlm.nih.gov]
  • The Fusarium infection did not recur, but after transplantation, leukemia relapsed.[ncbi.nlm.nih.gov]
  • Abstract We report here a case of localized oral Fusarium infection in an AIDS patient who developed an ulceration in the soft palate. Fusarium solani was identified by histopathology and culture.[ncbi.nlm.nih.gov]
  • Pathologic diagnosis of Fusarium is difficult because the septate hyphae of Fusarium are difficult to distinguish from Aspergillus, which has a more favorable outcome.[ncbi.nlm.nih.gov]

Treatment

Antimycotic treatment is the mainstay of fusariosis therapy, but isolates may vary largely with regards to their susceptibility to determined compounds [4]. Clinical trials have not yet been conducted and according to empiric evidence, amphotericin B deoxycholate, lipid-based amphotericin B formulations, voriconazole and posaconazole are most indicated to this end. Amphotericin B deoxycholate is more likely to provoke side effects than lipid-based formulations; posaconazole should be reserved for patients suffering from severe fusariosis and those infected with multi-resistant strains [11]. Furthermore, ketoconazole and nystatin as well as combined regimens have occasionally been applied with success. In contrast, fluconazole and itraconazole have repeatedly been proven ineffective. Fusarium spp. commonly show multiple resistance and thus, the selection of an effective antimycotic drug should be based on the results of susceptibility testing. An early initiation of treatment is of particular importance in immunocompromised individuals and may avoid systemic spread. Here, systemic administration of the aforementioned antifungal drugs should be complemented with surgical debridement of infected tissues. Whenever possible, the underlying immunosuppression should be remedied.

Evidence regarding the efficacy of an adjuvant therapy with granulocyte colony-stimulating factor or granulocyte–macrophage colony-stimulating factor is scarce. At this moment, such an approach can thus not be recommended.

Prognosis

Immunocompetent patients diagnosed with localized fusariosis generally respond well to antimycotic therapy and have an excellent prognosis. In contrast, disseminated fusariosis is often refractory to antimicrobial therapy and Fusarium infection of immunocompromised individuals is related to mortality rates of 50 to 80%. Intractable immunosuppression accompanied by persistent neutropenia, graft-versus-host disease and continued immunosuppressive therapy are unfavorable prognostic factors to this end [2] [6]. Moreover, these conditions are associated with a high risk of recurrence in survivors.

Etiology

Fusariosis may be caused by a wide variety of fungi of the genus Fusarium. The respective species are widely distributed in soil, air and plants, and may be encountered in virtually all geographic regions, including deserts and polar regions [3]. Accordingly, large parts of the population are exposed to Fusarium spp. and indeed, these fungi have been proven to colonize mucous membranes of healthy individuals. More than a dozen species have been related to fusariosis, with the following species being isolated most commonly [4]:

  • F. solani (accounts for about 50% of all cases)
  • F. oxysporum (isolated from about 20% of affected individuals)
  • F. verticillioides (formerly F. moniliforme; triggers approximately 10% of all cases)

Species occasionally causing Fusarium infection are [1]:

  • F. anthophilum
  • F. chlamydosporum
  • F. dimerum
  • F. equiseti
  • F. falciforme
  • F. fujikuroi
  • F. lichenicola
  • F. napiforme
  • F. proliferatum
  • F. sacchari
  • F. semitecum
  • F. subglutinans

Fusarium spp. differ in their propensity for cutaneous, ocular and respiratory infection. Morover, minimal inhibitory concentrations of distinct antimycotics against Fusarium isolates may vary considerably [4]. These facts emphasize the need for a reliable identification of the causative agent.

Immunosuppression is the most important risk factor for Fusarium infection and subsequent systemic spread. In this context, patients suffering from hematological malignancies or neutropenia, and those in need of solid organ or stem cell transplants and adjuvant immunosuppressive therapy constitute major risk groups. Use of catheters and peritoneal dialysis may be associated with Fusarium-induced thrombophlebitis, fungemia and peritonitis. On the other hand, skin-penetrating trauma and burns as well as use of contact lenses predispose immunocompetent individuals for fusariosis.

Epidemiology

Although Fusarium infection is generally considered a rare disease, Fusarium spp. are second only to Aspergillus spp. as causative agents of life-threatening fungal infections in immunodeficient patients. As has been indicated above, Fusarium infection is a major complication of hematological malignancies and neutropenia. In this context, incidence rates of up to 4.5 per 1,000 patient-years have been observed [5]. According to a retrospective study on fusariosis after hematopoietic stem cell transplantation, this fungal infection is to be expected in 0.5 and 2% of patients who receive transplants from matched, related and unmatched donors, respectively [6]. Epidemiological data regarding racial and gender predilection as well as the patients' age at symptom onset are largely influenced by the underlying disease. Patient cohorts considered in the aforementioned studies consisted of approximately equal parts of men and women, and their reported age at diagnosis ranged from 2 to 77 years.

Sex distribution
Age distribution

Pathophysiology

Fungal pathogens are present in distinct environments and rigorous measures have to be undertaken to reduce a patient's exposure to Fusarium spp. Accordingly, the vast majority of the population is constantly exposed to these opportunistic agents. In healthy individuals, an infection is prevented by the mechanical barrier posed by the skin, by antimicrobial compounds in tears and the integrity of the cornea, and by immune cells that act upon inhalation of Fusarium spp. or in case fungi overcome the aforementioned barriers. The latter happens rather frequently, e.g., in case of cutaneous lesions, micro-lesions of the cornea provoked by the use of contact lenses, or skin-penetrating medical procedures. Thus, immune cells like neutrophil granulocytes play the key role in avoiding Fusarium infection. In healthy individuals, an inoculation of pathogens does usually not even result in a localized infection with clinical symptoms. In contrast, neutropenic patients are most susceptible to fusariosis.

Prevention

No specific measures can be recommended to prevent Fusarium infection in immunocompetent individuals. However, adequate measures should be undertaken to minimize the exposure of immunodeficient patients to fungal pathogens, and to avoid systemic dissemination of etiological agents in case of a suspected infection:

  • Severely immunocompromised patients should be hospitalized in positive-pressure rooms equipped with HEPA filters, and these individuals should not consume tap water.
  • Sinks, showers, other wet areas and people suffering from onychomycosis may also serve as sources of infection and every possible effort should be made to keep those free from Fusarium spp. [13] and to avoid contact with infected personnel and visitors.
  • Cutaneous as well as corneal lesions should be avoided whenever possible, and patients presenting with wounds should be provided appropriate wound care.

Due to wide-spread resistances among Fusarium spp., prophylactic administration of antimycotics is not generally recommended.

Summary

Fusarium infection or fusariosis refers to an infection with fungal species of the genus Fusarium. Fusarium spp. are opportunistic pathogens and while there are case reports regarding fusariosis triggered by many distinct species, F. solani, F. oxysporum and F. verticillioides are most commonly isolated from men [1]. Immunosuppression is the single most important risk factor for Fusarium infection and also increases the individual risk of hematogenous spread and systemic disease. However, immunocompetent patients may present with fusariosis if an infection is facilitated by the breakdown of mechanical and functional barriers or the presence of foreign bodies. Usually, affected people suffer from dermatitis or cellulitis, onychomycosis, keratitis, and respiratory infection, possibly accompanied by constitutive symptoms like malaise and fever.

Treatment should comprise antimycotic medication and therapy of the underlying immunosuppression. With regards to the former, both polyene and azole antimycotics have been used. Unfortunately, most patients presenting with fusariosis suffer from non-curable primary diseases like hematological malignancies, or require prolonged immunosuppressive therapy to prevent organ transplant rejection. These conditions are unfavorable prognostic factors and therefore, mortality rates in immunocompromised patients by far exceed 50% [2].

Of note, Fusarium spp. may release mycotoxins, mainly trichothecenes and fumonisins. Ingestion of contaminated products may thus lead to different forms of food poisoning. For instance, mycotoxin T2 exposure has been associated with Kashin-Beck disease. The discussion of Fusarium-related mycotoxicosis is beyond the scope of this article, though.

Patient Information

Fusarium infection or fusariosis refers to an infection with fungal species of the genus Fusarium. These fungi may release mycotoxins and are more commonly known for poisoning of livestock and men, since otherwise healthy individuals rarely contract an infection with live pathogens. Occasionally, dermatitis, onychomycosis, and keratitis may be triggered by Fusarium species. In this context, skin-penetrating traumas and use of contact lenses are important predisposing factors. Such fungal infections are curable and patients have an excellent prognosis.

In contrast, fusariosis is a life-threatening disease in immunodeficient individuals. Patients suffering from hematological malignancies, neutropenia, and those in need of solid organ or stem cell transplants and adjuvant immunosuppressive therapy are at rather high risks of Fusarium infection. Initially, the disease manifests as described for immunocompetent patients, but fungi tend to spread via blood vessels throughout the whole body. Systemic fusariosis is typically accompanied by malaise and fever, and the majority of affected individuals respond poorly to antifungal medication. Disseminated Fusarium infection is associated with mortality rates of more than 50% and thus, every possible effort should be undertaken to avoid an infection in the first place. At home, preventive measures consist in avoiding cutaneous as well as corneal lesions whenever possible. Medical attention should be sought to receive proper wound care when necessary. In hospitals, severely immunodeficient patients are generally placed in special rooms equipped with air filters.

References

Article

  1. Alastruey-Izquierdo A, Cuenca-Estrella M, Monzon A, Mellado E, Rodriguez-Tudela JL. Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods. J Antimicrob Chemother. 2008; 61(4):805-809.
  2. Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect. 2004; 10 Suppl 1:67-75.
  3. Nelson PE, Dignani MC, Anaissie EJ. Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev. 1994; 7(4):479-504.
  4. Tortorano AM, Prigitano A, Dho G, et al. Species distribution and in vitro antifungal susceptibility patterns of 75 clinical isolates of Fusarium spp. from northern Italy. Antimicrob Agents Chemother. 2008; 52(7):2683-2685.
  5. Campo M, Lewis RE, Kontoyiannis DP. Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998-2009. J Infect. 2010; 60(5):331-337.
  6. Nucci M, Marr KA, Queiroz-Telles F, et al. Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2004; 38(9):1237-1242.
  7. Stempel JM, Hammond SP, Sutton DA, Weiser LM, Marty FM. Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience. Open Forum Infect Dis. 2015; 2(3):ofv099.
  8. Walls G, Noonan L, Wilson E, Holland D, Briggs S. Successful use of locally applied polyhexamethylene biguanide as an adjunct to the treatment of fungal osteomyelitis. Can J Infect Dis Med Microbiol. 2013; 24(2):109-112.
  9. Thomas PA, Kaliamurthy J. Mycotic keratitis: epidemiology, diagnosis and management. Clin Microbiol Infect. 2013; 19(3):210-220.
  10. Nakamura A, Osonoi T, Terauchi Y. Relationship between urinary sodium excretion and pioglitazone-induced edema. J Diabetes Investig. 2010; 1(5):208-211.
  11. Tortorano AM, Richardson M, Roilides E, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect. 2014; 20 Suppl 3:27-46.
  12. Marom EM, Holmes AM, Bruzzi JF, Truong MT, O'Sullivan PJ, Kontoyiannis DP. Imaging of pulmonary fusariosis in patients with hematologic malignancies. AJR Am J Roentgenol. 2008; 190(6):1605-1609.
  13. Litvinov N, da Silva MT, van der Heijden IM, et al. An outbreak of invasive fusariosis in a children's cancer hospital. Clin Microbiol Infect. 2015; 21(3):268.e261-267.

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Last updated: 2018-06-22 05:50