A report of the species Fusarium proliferatum causing systemic
infection in a child with
acute lymphoblastic leukemia is presented, with a review of the clinical and laboratory features relating to outcome in disseminated fusarial
infections. Thirteen cases of disseminated
infection due to Fusarium species have been reported, all but one of which were fatal.
Hematologic malignancy is the commonest underlying illness. The frequent occurrence of multiple skin lesions, orbitofacial involvement, and
fungemia is in contrast to the otherwise similar disseminated
aspergillosis or
mucormycosis.
Fungemia in
disseminated fusariosis may reflect a capacity for invasion of intravascular
catheters by Fusarium species. Fusarium isolates from disseminated
infections are variably sensitive to
amphotericin B,
ketoconazole, and
miconazole and uniformly resistant to
5-fluorocytosine. The correlation between antifungal susceptibility status and clinical outcome is poor, reflecting problems in susceptibility testing, marginally effective
chemotherapy, and serious impairment of host defenses. Attention to early diagnosis and the care of indwelling prosthetic devices may enhance survival until more effective
chemotherapy is available.