651. A Single-Center Ten Year Retrospective Analysis of Fusarium Infection in Patients with Malignancy
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

The incidence of fusariosis has increased significantly, especially in patients with hematologic malignancies. Risk factors (RF) for invasive fusariosis include prolonged neutropenia (NP), macrophage dysfunction, graft-versus-host disease (GVHD), chronic steroid use and HLA-mismatched or unrelated donor hematopoietic stem cell transplantation (HSCT).  An epidemiological study was done to examine the characteristics of cancer patients diagnosed with Fusarium infection from 1999-2009 at Moffitt Cancer Center (MCC) in Tampa, FL.

Methods:

A retrospective chart review was performed for infection characteristics stratified by types of malignancy, RFs, clinical presentation, diagnostic patterns and predictors of outcome.  45 cases of diagnosed Fusarium infections were reviewed for interpretation.

Results:

64% of these cases had acute leukemia, whereas 29% and 7% had other hematologic and non-hematologic malignancies, respectively.  The most prevalent RF at 80% was NP, of which 53% were prolonged, followed by HSCT (33%), chronic steroid use (29%), and GVHD (22%). Unexpectedly, the more common HSCTs were autologous (33%), matched unrelated (27%), and matched related (20%). 67% presented with disseminated disease and mostly involved sino-pulmonary (77%) and skin (57%) manifestations. Diagnosis was made by cultures of skin lesions (40%), toe nail (38%), nasal turbinates/ sinuses (16%) and lower respiratory tract (20%). Of those with lung involvement (53%), 88% had pulmonary nodules via CT imaging.  The fusarium related mortality rate was 31%. The most common outcome predictors for mortality were acute leukemia (58%) and prolonged NP (37%).

Conclusion:

At MCC, the majority of patients presented with disseminated disease (67%) and mortality rates were high (31%). Decreasing the duration of NP and steroid use as well as other preventative methods are key to reducing incidence and improving outcome of invasive fusariosis.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Moise L. Carrington, MD , Infectious Disease, University of South Florida College of Medicine, Tampa, FL
Aliyah Baluch, MD , University of South Florida, Tampa, FL
Ana Velez, MD , University of South Florida College of Medicine, Tampa, FL
John Greene, MD , Infectious Disease, Moffitt Cancer Center, Tampa, FL

Disclosures:

M. L. Carrington, None

A. Baluch, None

A. Velez, None

J. Greene, None

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