The Fusarium are phytopathogenic found in the soil; some species are responsible for opportunistic infections in immunocompromised patients but also onyxis. Fusarium equiseti has never been described as responsible for human infection; We report the first case occurred in a military victim of a poly screening in Afghanistan.
Our patient aged 34 was hospitalized in intensive care following a polytrauma explosive suicide-bomber in Kapisa. The initial management was conducted in Kabul for roar and polycriblage upper limb open fracture of the left femur, cervical polycriblage, hemopneumothorax left, lesions of the spine. The initial infectious pulmonary complications are quickly progressing to ARDS with isolation of Klebsiella pneumoniae with ESBLs and aAspergillus flavus also found in large quantities on several catheters and necrotic tissue. An initial antifungal therapy is initiated by Vfend quickly substituted Ambisome following the isolation of a Rhizomucor variabilis in biopsies performed on multiple lesions of the left arm. In the absence of improvement in skin biopsies of new lesions are carried out with isolation of a large number of colonies of Fusarium sp. Appearing only sensitive to Vfend, which is introduced in addition to the first antifungal. Lesions of the left arm and quickly amend the specific treatment is stopped after one week. Skin grafts are performed on the member without fungal complication. The diagnosis of this case will be provided by molecular biology. Fusarium equiseti is known as phytopatogène many plants (Fusarium wilt of potato) but also as a protective vis-à-vis other against bacteria or fungi by producing of certain mycotoxins.
This observation illustrates the opportunistic role of certain non deemed pathogenic molds; the nature and severity of the initial injury, the antibiotic pressure, the prescription of a non effective antifungal may have favored the appearance of this fusarium. The use of molecular techniques is essential to the accuracy of the species.
Full conference title:
- RICAI 32nd (2012)