September 2009 - Wadsworth Center

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M-3 Fusarium sp.Source: BloodScoring:No. LaboratoriesReferee Laboratories with correct ID: 10Laboratories with correct ID: 73Laboratories with incorrect ID: 1(Acremonium sp. ) (1)Clinical Significance: A frequent casual agent of keratitis, endophthalmitis, and onychomycosis inhealthy individuals. It has been reported from peritonitis and disseminated infection inimmunocompromised patients. Most common etiologic agents of human infections are F. oxysporumspecies complex (FOSC) and F. solani species complex (FSSC).Ecology: Cosmopolitan in soil and plants. Some species of Fusarium are major plant pathogens.Laboratory Diagnosis:1. Culture – Fusarium grew fast on Sabouraud’s dextrose agar. After 5 days, colony was white, pinkish,to purplish in color, wooly with orange, to red–violet reverse (Figure 5).2. Microscopic morphology – Lactophenol cotton blue or Calcofluor mounts showed septate hyphae,with short or long phialides. Microconidia were ovoid, and macroconidia were septate and curvedboat/banana-shaped(Figure 6). Chlamydospores were seen.3. Differentiation from other molds – Fusarium species produce curved, septate macroconidia along withsingle-cell microconidia, which distinguish them from other hyphomycetes, especially Acremoniumspecies.4. In vitro susceptibility testing – Most clinical isolates are susceptible to amphotericin B. Some isolatesare variably susceptible to azoles.5. Molecular tests – PCR method for rapid detection and identification of Fusarium species from cultureand clinical samples was described. Pan-fungal PCR, followed by nested PCR with species–specificprimers was reported for rapid detection of Fusarium DNA in ocular samples.Comments: One participating laboratory reported this specimen as Acremonium sp. possibly becausemacroconidia of Fusarium were not observed.Further Reading:1. Calado, N.B., Sousa, F. Jr, Gomes, N.O., Cardoso, F.R., Zaror, L.C., and Milan, E.P. 2006. Fusariumnail and skin infection: a report of eight cases from Natal, Brazil. Mycopathologia. 161: 27-31.2. Klont, R.R., Eggink, C.A., Rijs, A.J., Wesseling, P., and Verweij, P.E. 2005. Successful treatment ofFusarium keratitis with cornea transplantation and topical and systemic voriconazole. Clin Infect Dis.40: e110-112.3. Hay, R.J. 2007. Fusarium infections of the skin. Curr Opin Infect Dis. 20: 115-117.4. Ho, D.Y., Lee, J.D., Rosso, F., and Montoya, J.G. 2007. Treating disseminated fusariosis:amphotericin B, voriconazole or both? Mycoses. 50: 227-231.5. Lin, H.C., Chu, P.H., Kuo, Y.H., and Shen, S.C. 2005. Clinical experience in managing Fusariumsolani keratitis. Int J Clin Pract. 59: 549-554.6. O'Donnell, K., Sutton, D.A., Fothergill, A., McCarthy, D., Rinaldi, M.G., Brandt, M.E., Zhang, N.,and Geiser, D.M. 2008. Molecular phylogenetic diversity, multilocus haplotype nomenclature, and in16
vitro antifungal resistance within the Fusarium solani species complex. J Clin Microbiol. 46: 2477-2490.7. Qiu, W.Y., Yao, Y.F., Zhu, Y.F., Zhang, Y.M., Zhou, P., Jin, Y.Q., and Zhang, B. 2005. Fungalspectrum identified by a new slide culture and in vitro drug susceptibility using Etest in fungalkeratitis. Curr Eye Res. 30: 1113-1120.8. Ranawaka, R.R., de Silva, N., and Ragunathan, R.W. 2008. Onychomycosis caused by Fusarium sp inSri Lanka: prevalence, clinical features and response to itraconazole pulse therapy in six cases. JDermatolog Treat. 19: 308-12.9. Sagnelli, C., Fumagalli, L., Prigitano, A., Baccari, P., Magnani, P., and Lazzarin, A. 2006. Successfulvoriconazole therapy of disseminated Fusarium verticillioides infection in an immunocompromisedpatient receiving chemotherapy. J Antimicrob Chemother. 57: 796-798.10. Testerman GM, Steagald MK, Colquitt LA, Maki A. 2008. Disseminated Fusarium infection in amultiple trauma patient. South Med J. 101: 320-323.11. Thomas, P.A., and Geraldine, P. 2007. Infectious keratitis. Curr Opin Infect Dis. 20: 129-141.12. Weinstein, W.L., Moore, P.A., Sanchez, S., Dietrich, U.M., Wooley, R.E., Ritchie, B.W. 2006. Invitro efficacy of a buffered chelating solution as an antimicrobial potentiator for antifungal drugsagainst fungal pathogens obtained from horses with mycotic keratitis. Am J Vet Res. 67: 562-568.13. Woodward, L. 2005. Skin infection with Fusarium. Dermatol Nurs. 17: 455.17
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September 2009 - Wadsworth Center

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