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LETTER TO EDITOR
Year : 2011  |  Volume : 48  |  Issue : 1  |  Page : 116-117
 

Fusarial skin lesion in immunocompromised


1 Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore 560 029, India
2 Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore 560 029, India

Date of Web Publication10-Feb-2011

Correspondence Address:
S B Gurusidappa
Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore 560 029
India
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DOI: 10.4103/0019-509X.76633

PMID: 21330756

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How to cite this article:
Gurusidappa S B, Mamatha H S. Fusarial skin lesion in immunocompromised. Indian J Cancer 2011;48:116-7

How to cite this URL:
Gurusidappa S B, Mamatha H S. Fusarial skin lesion in immunocompromised. Indian J Cancer [serial online] 2011 [cited 2014 Aug 30];48:116-7. Available from: http://www.indianjcancer.com/text.asp?2011/48/1/116/76633


Sir,

Fungi, previously considered to be harmless colonizers, are now emerging as a significant pathogen in immunocompromised patients, in particular reference is the Fusarium species. [1]

A 6-year-old male child diagnosed as acute lymphocytic leukemia (ALL) was admitted with history of high grade, intermittent fever, and history of left knee injury since 2 months. On examination, the patient was febrileand pale with left cervical lymphadenopathy. A hematoma (4 cm × 4 cm) was present over left knee joint.

X-ray of left knee showed evidence of swelling with collection of fluid within the joint. Diagnosis was acute arthritis, probably traumatic arthritis. Patient was put on parenteral cefuroxime and tobramycin. Slough excision and debridement of wound was done under general anesthesia. Conventional culture of the excised wound on McConkey and to blood agar plates grew pinkish-white and white colonies, respectively, after 24 h.

Sabouraud's dextrose agar plates showed pinkishwhite, cottony growth. Lacto phenol cotton blue preparation showed septate branching hyphae with clusters of sickle-shaped microconidia. The above morpholological features w reconfirmed by slide culture technique. Consecutive three samples yielded same growth. The pathogen was confirmed as Fusarium oxysporum [Figure 1] I.V. amphoptercin-B was changed to ketoconazole (an azole group of antifungal agent) after which there was marked improvement in healing of the lesion [Figure 2]
Figure 1: Culture of Fusarium oxysporum of the patient

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Figure 2: Healed skin lesion

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A high index of suspicion especially for skin lesions will help in early diagnoses before systemic and visceral dissemination can occur. Excision of the initial focus of infection and antifungal therapy aided by speedy neutrophil recovery are likely to protect patients threatened with these fatal infections. [2]

Fungal infections have emerged as one of the most importantsignificant complications of antineoplastic therapy and marrow transplantation in children. Recent trends indicate that the incidence and spectrum of fungal infections are increasing, partly because of the successful management of bacterial and viral infections.[3]

Aggressive cytostatic regimens used for patients with hematological malignancies have favored the emergence of fusarium infections. [4]

Most fusarial infections are refractory to amphotericin B-lipid complex but respond successfully to voriconazole.

A comprehensive review of skin lesions in a hematological malignancy, with a propensity for invasive fungal infections (IFI) should be borne in mind, particularly in reference to suspicious fungal infections of skin.


  Acknowledgments Top


Department of Mycology, Post Graduate Institute of Medical Sciences, Chandigarh.

 
  References Top

1.Anaisie E, Kantarajan H, Ro J, Hopfer R, Rolston K, Fainstein V, et al. The emerging role of fusarium infections in patients with cancer. Medicine 1988;67:77-83.  Back to cited text no. 1
    
2.Girmenia C, Pagano L, Corvatta L, Mele L, Del A, Favero, et al. The Epidemiology Of Fusarioses In Patients With Haematological Diseases. Br J Haematol 2000;111:272-6.  Back to cited text no. 2
    
3.Musa MO, Al Eisa A, Halim M, Sahovic E, Gyger M, Chaudhri N, et al. The spectrum of fusarium infection in immunocompromised patients with haematological malignancies and in non-immunocompromised patients; A single institution experience over 10 years. Br J Haematol 2000;108:544-8.  Back to cited text no. 3
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4.Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with haematological malignancies: Ten years experience at a cancer centre and implications for management. Blood 1997;90:999-1008.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]

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