%0 Journal Article
%T Fatal Disseminated Fusarium Infection in a Human Immunodeficiency Virus Positive Patient
%A Ashwini K. Esnakula
%A Irorere Summers
%A Tammey J. Naab
%J Case Reports in Infectious Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/379320
%X Systemic mycotic infections have been increasing in incidence in immunocompromised patients. Although yeasts are most often isolated, opportunistic fungal infections may also be caused by filamentous fungi, including Aspergillus and Fusarium. Like Aspergillus, Fusarium is angioinvasive with an ability to disseminate widely. Disseminated fusariosis is most commonly linked to prolonged neutropenia. Disseminated infections due to Fusarium are rare in Human Immunodeficiency Virus (HIV) positive patients but have been reported in HIV positive patients with neutropenia and lymphoma. We describe an HIV positive patient without neutropenia, skin lesions, or concomitant malignancy, who developed fatal disseminated infection with possible endocarditis due to Fusarium solani. Early identification of Fusarium is important because of its high level of resistance to several antifungal drugs, with response often requiring combination therapy. 1. Introduction Systemic mycoses are most often caused by yeasts in immunocompromised hosts. Candida and Cryptococcus are the most frequent isolates. Recently, filamentous fungi (molds) have been increasingly identified in disseminated and sometimes fatal opportunistic infections in Human Immunodeficiency Virus (HIV) positive patients with AIDS, patients with hematologic malignancies, and hematopoietic stem cell transplant recipients. This increase in filamentous fungal infections has been attributed to antifungal prophylaxes used to prevent yeast infections [1]. The most commonly isolated mold is Aspergillus. Fusarium, Scedosporium, and Penicillium and the aseptate Zygomycetes have also been increasing in incidence. Neutropenia, T-cell deficiency, and high dose corticosteroid therapy are important risk factors for developing mold infections [2]. For unknown reasons, Fusarium infections are rare in HIV positive patients [3]. We describe an AIDS patient without neutropenia developing fatal disseminated disease with possible infective endocarditis due to Fusarium solani. This is the first case report of fatal disseminated Fusarium infection in an AIDS patient without neutropenia. 2. Case Description A 44-year-old African-American HIV positive male with a past medical history of AIDS, dialysis-dependent end-stage renal disease due to HIV associated nephropathy, chronic hepatitis C, and seizure disorder was admitted with chief complaint of intractable diarrhea of one month¡¯s duration. The CD4 T-lymphocyte count was 64/¦̀L, and the viral load was 500,000 copies/mL. Cytomegalovirus (CMV) colitis was diagnosed based on positive blood CMV
%U http://www.hindawi.com/journals/criid/2013/379320/