Öz
Enfeksiyonlar, immünkompromize hastalarda önemli bir mortalite nedeni olmaya devam etmektedir. İnvaziv fusariozis, nadir görülen, kötü prognostik fırsatçı bir mantar enfeksiyonudur. Akut miyeloid lösemi (M4) nedeniyle allojenik hematopoietik kök hücre nakli uygulanan ve daha sonra dissemine deri lezyonları gelişen 46 yaşındaki erkek hastaya ait nadir ve zorlu bir olguyu sunuyoruz. Bu olgu, immünkompromize hastalarda, özellikle amfoterisin B’ye karşı yüksek minimum inhibitör konsantrasyon değerleri göstermesi nedeniyle ampirik tedavinin zor olduğu durumlarda, invaziv fusariozis için klinik şüphe duyulmasının önemini vurgulamaktadır. Erken mikrobiyolojik tanı ve antifungal tedavi çok önemlidir. İnvaziv fusariozis için önleme ve tedavi stratejileri konusunda daha fazla araştırma yapılması gerekmektedir.
Anahtar Kelimeler:
Allojenik hematopoietik kök hücre nakli, antifungal duyarlılık, fungal enfeksiyon, fırsatçı enfeksiyonlar
Kaynaklar
1
Guarro J. Fusariosis, a complex infection caused by a high diversity of fungal species refractory to treatment. Eur J Clin Microbiol Infect Dis. 2013;32(12):1491-500.
2
Little JS, Weiss ZF, Hammond SP. Invasive fungal infections and targeted therapies in hematological malignancies. J Fungi (Basel). 2021;7(12):1058.
3
Samborska M, Wziątek A, Młynarczyk Ł, Dey S, Varghese N, Derwich K. Fusarium oxysporum disseminated infection in a teenage patient with a relapse of acute lymphoblastic leukemia - case report and review of the literature. J Infect Chemother. 2024;30(3):258-62.
4
Nucci M, Barreiros G, Akiti T, Anaissie E, Nouér SA. Invasive fusariosis in patients with hematologic diseases. J Fungi (Basel). 2021;7(10):815.
5
Yin X, Hu X, Tong H, You L. Trends in mortality from infection among patients with hematologic malignancies: differences according to hematologic malignancy subtype. Ther Adv Chronic Dis. 2023;14:20406223231173891.
6
Batista BG, Chaves MA, Reginatto P, Saraiva OJ, Fuentefria AM. Human fusariosis: an emerging infection that is difficult to treat. Rev Soc Bras Med Trop. 2020;53:e20200013.
7
Furaijat G, Bettac L, Kächele M, Grüner B, Skrabal C, Barth TFE, Parlak M, Hagemann JB, Peters L, Walther G, Kersten J. An unusual presentation of invasive Fusarium aortitis in a patient who is immunocompromised: a case report. Int J Infect Dis. 2023;134:102-5.
8
Kao AS, Cramer-Bour C, Kupsky W, Soubani AO. Endophthalmitis as the initial manifestation of invasive fusariosis in an allogeneic stem cell transplant patient: a case report. Med Mycol Case Rep. 2023;40:5-7.
9
Marino A, Calvo M, Trovato L, Scalia G, Gussio M, Consoli U, Ceccarelli M, Nunnari G, Cacopardo B. Mucorales/ Fusarium mixed infection in hematologic patient with COVID-19 complications: an unfortunate combination. Pathogens. 2023;12(2):304.
10
Hannemann M, Wilmes D, Dombrowski F, Löffler J, Kaminski A, Hummel A, Ulm L, Bohnert J, Rickerts V, Springer J, Lode HN, Ehlert K. Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: a case report. Front Pediatr. 2022;10:1060663.
11
Zhong L, Song Y, Hu J, Yao X, Li T, Li H. Successful treatment of disseminated amphotericin-resistant fusariosis in a paediatric patient with acute lymphoblastic leukaemia: a case report and literature review. Eur J Dermatol. 2022;32(5):623-8.
12
Fei H, Liu X, Sun L, Shi X, Wang W, Zhao H, Zhao C. Disseminated Fusarium infection after allogeneic hematopoietic stem cell transplantation after CART: a case report. Medicine (Baltimore). 2022;101(45):e31594.
13
De la Espriella A, Restrepo A, Trujillo M, Arango K. Disseminated fusariosis in children: report of two cases in girls with leukemia. Curr Med Mycol. 2022;8(1):39-43.
14
Brent G, Abdul-Wahab A, Borman AM, Ferguson L, Ferreras-Antolin L, Ho B, Johnson EM, Mashhoudi Y, van Rijswijk E, Wijesuriya N, Mansoor N. Disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia. Pediatr Dermatol. 2023;40(3):503-6.
15
Asiimwe DD, Ravi M, Isache C. Fusariosis: an invasive fungal disease in a neutropenic patient with acute myeloid leukemia. Cureus. 2022;14(9):e29303.
16
Al-Farsi F, Balkhair A, Al-Siyabi T, Qureshi A. Fusarium solani necrotizing fasciitis complicating leukemia treatment: a case report. Cureus. 2022;14(6):e25847.
17
Risum M, Overgaard UM, Rubek N, Haastrup EK, Hare RK, Helweg-Larsen J. Disseminated fusariosis with cerebral involvement in a patient with acute myeloid leukemia: successful outcome with intrathecal -and systemic antifungal treatment. J Infect Chemother. 2022;28(9):1324-8.
18
Park H, Bae S, Kim MJ, Chong YP, Kim SH, Choi SH, Lee SO, Kim YS, Jung J. Clinical characteristics and outcomes of invasive and non-invasive fusariosis in South Korea. Mycoses. 2023;66(3):211-8.
19
Zhao B, He D, Wang L. Advances in Fusarium drug resistance research. J Glob Antimicrob Resist. 2021;24:215-9.
20
Al-Hatmi AM, van Diepeningen AD, Curfs-Breuker I, de Hoog GS, Meis JF. Specific antifungal susceptibility profiles of opportunists in the Fusarium fujikuroi complex. J Antimicrob Chemother. 2015;70(4):1068-71.
