Fusarium oxysporum pneumonia in an immunocompetent host: Epidemiology and treatment

Gorman S 1, Magiorakos A 2, Zimmerman S 1, Craven D 1

Author address: 

1 Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, USA, 2 Tufts-New England Medical Center, Tufts University School of Medicine, Boston, USA

Abstract: 

Introduction: Isolated pulmonary fusariosis has not been previously reported in immunocompetent individuals, and data on successful therapy with voriconazole are limited.1-6 Case Presentation: A 69 year-old woman presented with 3 weeks of productive cough, fevers, night sweats, and weight loss of 5 pounds. She was an ex-smoker with moderate chronic obstructive pulmonary disease (COPD) and a previous infection with Mycobacterium avium complex (MAC). The patient denied any travel outside New England, enjoyed gardening, and frequently cleaned bird droppings from her boathouse in Maine. Computed tomography (CT) scan of the thorax showed right apical nodules, lingular and right middle lobe consolidation, and mediastinal lymphadenopathy. Bronchoscopy showed purulent secretions in the airways. Septate hyphae and budding yeast cells were seen on direct examination of bronchial washings. The culture grew some H. influenzae and was overgrown by F. oxysporum. The patient was treated with levofloxacin 500 mg for 7 days and voriconazole 200 mg orally twice daily for four months. Her symptoms subsequently improved over the next 2 weeks. At the end of treatment, she was asymptomatic, and the CT scan returned to normal. Discussion: Although pulmonary Fusarium infection has been reported in various types of immunocompromised patients, this is the first documented case of primary pulmonary infection due to F. oxysporum in an apparently immunocompetent individual.1-6 This patient, who had COPD and prior pulmonary infection with MAC, probably acquired F. oxysporum through airborne infection. She had an excellent clinical response to therapy with oral voriconazole for 16 weeks. Conclusions: Fusarium is an emerging opportunistic pathogen and should be considered in patients with moderate-severe COPD and suspected opportunistic infections. Outpatient therapy with oral voriconazole was effective treatment. References: 1. Lionakis MS, Kontoyiannis DP. Fusarium infections in critically ill patients. Semin Respir Crit Care Med 2004;25(2):159- 169. 2. Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004;10 (Suppl. 1):48-66. 3. Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect 2004;10 (Suppl. 1): 67-75. 4. Rodriguez CA, Lují¡n-Zilbermann J, Woodard P, et al. Successful treatment of disseminated fusariosis (correspondence). Bone Marrow Transplant 2003;31:411-412. 5. Consigny S, Dhedin N, Datry A, et al. Successful voriconazole treatment of disseminated fusarium infection in an immunocompromised patient. Clin Infect Dis 2003;37:311-313. 6. Perfect JR, Marr KA, Walsh TJ, et al. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis 2003;36:1122-1131
2005

abstract No: 

19

Full conference title: 

15th Annual Focus on Fungal Infections
    • FFI 15th (2005)