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/μL, and the viral load was 500,000 copies/mL. Cytomegalovirus (CMV) colitis was diagnosed based on positive blood CMV
References
[1]
M. Muhammed, J. J. Coleman, H. A. Carneiro, and E. Mylonakis, “The challenge of managing fusariosis,” Virulence, vol. 2, no. 2, pp. 91–96, 2011.
[2]
J. R. Perfect, “The impact of the host on fungal infections,” American Journal of Medicine, vol. 125, supplement 1, pp. S39–S51, 2012.
[3]
R. Galimberti, A. C. Torre, M. C. Baztan, and F. Rodriguez-Chiappetta, “Emerging systemic fungal infections,” Clinics in Dermatology, vol. 30, no. 6, pp. 633–650, 2012.
[4]
D. P. Short, K. O'Donnell, N. Zhang, J. H. Juba, and D. M. Geiser, “Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains,” Journal of Clinical Microbiology, vol. 49, no. 12, pp. 4264–4272, 2011.
[5]
M. C. Dignani and E. Anaissie, “Human fusariosis,” Clinical Microbiology and Infection, vol. 10, supplement 1, pp. 67–75, 2004.
[6]
M. Nucci and E. Anaissie, “Fusarium infections in immunocompromised patients,” Clinical Microbiology Reviews, vol. 20, no. 4, pp. 695–704, 2007.
[7]
S. M. Leal Jr., C. Vareechon, S. Cowden, et al., “Fungal antioxidant pathways promote survival against neutrophils during infection,” The Journal of Clinical Investigation, vol. 122, no. 7, pp. 2482–2498, 2012.
[8]
M. Campo, R. E. Lewis, and D. P. Kontoyiannis, “Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998–2009,” Journal of Infection, vol. 60, no. 5, pp. 331–337, 2010.
[9]
B. J. Park, P. G. Pappas, K. A. Wannemuehler, et al., “Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001–2006,” Emerging Infectious Diseases, vol. 17, no. 10, pp. 1855–1864, 2011.
[10]
M. Nucci and E. Anaissie, “Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management,” Clinical Infectious Diseases, vol. 35, no. 8, pp. 909–920, 2002.
[11]
J. Eljaschewitsch, J. Sandfort, K. Tintelnot, I. Horbach, and B. Ruf, “Port-a-cath-related Fusarium oxysporum infection in an HIV-infected patient: treatment with liposomal amphotericin B,” Mycoses, vol. 39, no. 3-4, pp. 115–119, 1996.
[12]
J. Guarro, M. Nucci, T. Akiti, and J. Gene, “Mixed infection caused by two species of Fusarium in a human immunodeficiency virus-positive patient,” Journal of Clinical Microbiology, vol. 38, no. 9, pp. 3460–3462, 2000.
[13]
N. Hadad, R. Levy, F. Schlaeffer, and K. Riesenberg, “Direct effect of human immunodeficiency virus protease inhibitors on neutrophil function and apoptosis via calpain inhibition,” Clinical and Vaccine Immunology, vol. 14, no. 11, pp. 1515–1521, 2007.
[14]
S. de Marie, “Diseases and drug-related interventions affecting host defence,” European Journal of Clinical Microbiology & Infectious Diseases, vol. 12, supplement 1, pp. S36–S41, 1993.
[15]
D. Donati, D. Degiannis, L. Homer, L. Gastaldi, J. Raskova, and K. Raska, “Immune deficiency in uremia: interleukin-2 production and responsiveness and interleukin-2 receptor expression and release,” Nephron, vol. 58, no. 3, pp. 268–275, 1991.
[16]
P. M. Grant, L. Komarow, J. Andersen et al., “Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early versus deferred ART during an opportunistic infection,” PloS One, vol. 5, no. 7, Article ID e11416, 2010.
[17]
N. R. Klatt and J. M. Brenchley, “Th17 cell dynamics in HIV infection,” Current Opinion in HIV and AIDS, vol. 5, no. 2, pp. 135–140, 2010.
[18]
D. A. Sutton, A. W. Fothergill, and M. G. Rinaldi, Guide to Clinically Significant Fungi, Williams & Wilkins, Baltimore, Md, USA, 1st edition, 1998.
[19]
D. Y. Ho, J. D. Lee, F. Rosso, and J. G. Montoya, “Treating disseminated fusariosis: amphotericin B, voriconazole or both?” Mycoses, vol. 50, no. 3, pp. 227–231, 2007.
[20]
J. M. Vagace, C. Sanz-Rodriguez, M. S. Casado et al., “Resolution of disseminated fusariosis in a child with acute leukemia treated with combined antifungal therapy: a case report,” BMC Infectious Diseases, vol. 7, article 40, 2007.
