Survey of Infections due to Fusarium species in Europe

Fusarium species cause a variety of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical presentation largely depends on the immune status of the host and the fungal portal of entry.(1)
Superficial infections, such as keratitis and onychomycosis, are usually observed in immunocompetent individuals, whereas invasive and disseminated infections occur in immunocompromised patients and are mainly associated with prolonged and profound neutropenia or severe T-cell immunodeficiency.(2)
Among the more than 50 Fusarium species identified, twelve have been described as causes of human infection. F. solani is the most frequently reported Fusarium species and is the cause of approximately 50% of the Fusarium infections; the next most prevalent species, in order, are F. oxysporum (20%), F. verticillioides (10%), and F. moniliforme (now classified as F. verticillioides, 10%).(1,3) In contrast with data from the literature, in Italy F. verticillioides resulted the most prevalent species (41%) followed by F. solani (25%). In particular, F. verticililoides was the most frequent species (57%) in deep-seated infections and F. solani is more common in superficial infections (46%).(4)
Fusarium species are relatively resistant to most antifungal agents. Careful analysis, however, shows that different species have different patterns of susceptibility.(1) The majority of F. solani isolates exhibited reduced susceptibility to azoles.(1,4-8)
The prognosis of fusariosis in immunocompromised host is poor and also the treatment of skin and nail infections is frustrating and failure of systemic and local treatment is common.
The main purpose of this study is to understand the epidemiology of fusariosis in Europe, collecting information on the patients infected by Fusarium (risk factors, localization/extent of infection, diagnosis, antifungal treatment and outcome) and on the infecting isolates (identification by molecular methods, in vitro susceptibility to antifungal agents).

Study design
Cases of fusariosis, deep seated as well as superficial infections, for which the infecting isolate is available, will be recorded on a questionnaire and the isolate collected and characterized. The form and the corresponding isolates will be collected in the national coordinator laboratory and strains studied.
The prospective study is planned to last two years, from January 2009 to December 2010. Two years (2007 and 2008) retrospective data will be also collected.
Investigators interested in participating to this study as national coordinator for their country are welcome.

Anna Maria Tortorano
Convenor of the Working Group

Country

Co-ordinator

Austria

Cornelia Lass Floerl

Belgium

Katrien Lagrou

Czech Republic

Petr Hamal

Denmark

Maiken Cavling Arendrup

France

Christophe Hennequin

Germany

Kathrin Tintelnot

Greece

Olga Paniara

Ireland

Tom Rogers

Italy

Anna Maria Tortorano

Norway

Ingvild Nordoy

Portugal

Cristina Verissimo

Spain

Ferran Sanchez Reus

Sweeden

Lena Klingspor

Turkey

Sevtap Arikan

REFERENCES
1. Nucci M, Anaissie E. 2007. Fusarium infections in immunocompromised patients. Clin. Microbiol. Rev. 20:695-704.
2. Nucci M, Anaissie E. 2002. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin. Infect. Dis. 35:909-920.
3. Seifert KA, Aoki T, Baayen RP, et al. 2003. The name Fusarium moniliforme should no longer be used. Mycol. Res. 107: 643-644.
4. Tortorano AM, Prigitano A, Dho G, Esposto MC, Gianni C, Grancini A, Ossi C, Viviani MA. 2008. Species distribution and in vitro antifungal susceptibility patterns of 75 clinical isolates of Fusarium from Northern Italy. Antimicrob. Agents Chemother. 52:2683-2685
5. Arikan S, Lozano-Chiu M, Paetznick V, Nangia S, Rex JH. 1999. Microdilution susceptibility testing of amphotericin B, itraconazole, and voriconazole against clinical isolates of Aspergillus and Fusarium species. J. Clin. Microbiol. 37:3946-3951.
6. Azor M, Gené J, Cano J, Guardo J. 2007. Universal in vitro antifungal resistance of genetic clades of the Fusarium solani species complex. Antimicrob. Agents Chemother. 51:1500-1503.
7. Paphitou NI, Ostrosky-Zeichner L, Paetznick VL, Rodriguez JR, Chen E, Rex JH. 2002. In vitro activities of investigational triazoles against Fusarium species: effects of inoculum size and incubation time on broth microdilution susceptibility test results. Antimicrob. Agents Chemother. 46:3298-3300.
8. Alastruey-Izquierdo A, Cuenca-Estrella M, Monzon A, Mellado E, Rodriguez-Tudela JL. 2008. Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods. J. Antimicrob. Chemother. 61:805-809.