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Invasive fusariosis mortality high, combination antifungal treatment improves survival
Although invasive fusariosis continues to be associated with high mortality rates, treatment with a combination of antifungal agents may improve survival, according to recent data.
Researchers retrospectively examined 15 cases of invasive fusariosis treated at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston between January 2002 and December 2014. Along with reviewing patient medical records, microbiology results and pathology results, they documented baseline demographic and clinical characteristics. The 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Invasive Mycoses Study Group (EORTC/MSG) Consensus Group criteria for invasive fungal disease was used to classify all cases. Risk factors for invasive fungal disease and survival 6 and 12 weeks after diagnosis were considered, and each patient’s fungal species and susceptibilities to antifungal drugs were identified.
The researchers found that of the 15 cases, 80% were classified as proven invasive fusariosis and 20% were probable invasive fusariosis. The mean patient age was 60 years (range, 26-78), and the patient population consisted of five females and 10 males.
The most common underlying condition was hematological malignancy in 13 patients. The other two patients had juvenile idiopathic arthritis and third-degree burns. Five patients had undergone hematopoietic stem cell transplantation before invasive fusariosis diagnosis. Sis patients had received systemic glucocorticoids, and 11 patients had prolonged neutropenia and recent chemotherapy at the time of diagnosis. Identified clinical presentations included skin or soft tissue infection (53%), neutropenia with fever (27%), respiratory tract infection (13%) and septic arthritis (one case, 7%).
Voriconazole was administered to 12 patients, of which six received voriconazole monotherapy, four received voriconazole and terbinafine, and two received voriconazole, terbinafine and amphotericin. Terbinafine alone was given to one patient, and another patient received micafungin alone. Surgical debridement was performed on four patients.
In nine isolates, susceptibility testing revealed that eight cases exhibited voriconazole minimum inhibitory concentrations greater than or equal to 4 μg/ml. At 6 weeks post-diagnosis, the cumulative probability of survival was 66.7%, and at 12 weeks the probability was 53.3%.
The researchers noted that although these survival rates were higher than those reported in previous studies, they are not conclusive regarding the benefits of combination antifungal therapy for invasive fusariosis.
“The small number of cases in this single-center study, and the significant competing risk of death related to underlying [hematologic malignancies] in many cases in the cohort, limit our ability to draw conclusions about the impact of combination antifungal therapy for [invasive fusariosis],” the researchers wrote. “The use of terbinafine, either alone or combined with another agent, should be studied systematically for the treatment of fusariosis, including refractory [invasive fusariosis] and fusarial arthritis.”
Disclosure: Stempel reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.