Disseminated Amphotericin-Resistant Fusariosis in Acute Leukemia Patients: Report of Two Cases

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dc.contributor.authorPereira, Graziella Hanna
dc.contributor.authorde Angelis, Derlene Attili [UNESP]
dc.contributor.authorBrasil, Roosecelis Araujo
dc.contributor.authordos Anjos Martins, Marilena
dc.contributor.authorde Matos Castro e Silva, Dulcilena
dc.contributor.authorSzeszs, Maria Walderez
dc.contributor.authorde Souza Carvalho Melhem, Marcia
dc.contributor.institutionBrigadeiro Hospital
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionInstituto Adolfo Lutz (IAL)
dc.date.accessioned2014-05-27T11:27:27Z
dc.date.available2014-05-27T11:27:27Z
dc.date.issued2013-01-01
dc.description.abstractDisseminated fusariosis has emerged as a significant, usually fatal infection in immunocompromised hosts despite antifungal treatment. We describe here two patients with acute leukemia who developed disseminated amphotericin-resistant fusariosis, and review of six studies of cases series in the literature. Two Fusarium solani strains were isolated from blood and skin cultures of one patient, and one strain from the blood culture of the second patient. Both patients died despite antifungal treatment. Strains were identified by sequencing of ITS1 and ITS4 regions. Random amplified polymorphic DNA analysis of the three F. solani isolates showed a low degree of similarity. Screening for Fusarium spp. contaminants within our facility was negative. Using the CLSI M-38-A2 broth dilution method and E tests®, we found that the MICs were low for voriconazole (0. 12 and 0. 5 mg/L, respectively), unexpectedly high for amphotericin B (≥8 and ≥32 μg/mL, respectively) and itraconazole (≥16 mg/ml). Patients with leukemia or persistent neutropenia should be assessed for disseminated fungal infections, including biopsy and skin cultures. Antifungal susceptibility tests are important due to the possibility of the strains being amphotericin resistant. Treatments must be aggressive, with high doses of antifungals or combined therapy. © 2012 Springer Science+Business Media Dordrecht.en
dc.description.affiliationDepartment of Infection Diseases Brigadeiro Hospital, Av. Jandira, 79/231, São Paulo, SP, 04080-000
dc.description.affiliationDepartment of Biochemistry and Microbiology UNESP-São Paulo State University, São Paulo
dc.description.affiliationDepartment of Pathology Adolfo Lutz Institute, São Paulo
dc.description.affiliationDepartment of Mycology Adolfo Lutz Institute, São Paulo
dc.description.affiliationUnespDepartment of Biochemistry and Microbiology UNESP-São Paulo State University, São Paulo
dc.format.extent107-114
dc.identifierhttp://dx.doi.org/10.1007/s11046-012-9585-0
dc.identifier.citationMycopathologia, v. 175, n. 1-2, p. 107-114, 2013.
dc.identifier.doi10.1007/s11046-012-9585-0
dc.identifier.issn0301-486X
dc.identifier.scopus2-s2.0-84872784493
dc.identifier.urihttp://hdl.handle.net/11449/74142
dc.identifier.wosWOS:000313968100012
dc.language.isoeng
dc.relation.ispartofMycopathologia
dc.relation.ispartofjcr1.476
dc.rights.accessRightsAcesso restrito
dc.sourceScopus
dc.subjectAmphotericin resistant
dc.subjectAntifungal
dc.subjectFusariosis
dc.subjectFusarium solani
dc.subjectLeukemia
dc.subjectamphotericin B
dc.subjectantifungal agent
dc.subjectfungal DNA
dc.subjectribosomal spacer DNA
dc.subjectacute biphenotypic leukemia
dc.subjectacute lymphoblastic leukemia
dc.subjectaged
dc.subjectantifungal resistance
dc.subjectcase report
dc.subjectchemistry
dc.subjectDNA sequence
dc.subjectdrug effect
dc.subjectfatality
dc.subjectfusariosis
dc.subjectFusarium
dc.subjectgenetics
dc.subjecthuman
dc.subjectisolation and purification
dc.subjectmale
dc.subjectmicrobial sensitivity test
dc.subjectmicrobiology
dc.subjectpathology
dc.subjectAged
dc.subjectAmphotericin B
dc.subjectAntifungal Agents
dc.subjectDNA, Fungal
dc.subjectDNA, Ribosomal Spacer
dc.subjectDrug Resistance, Fungal
dc.subjectFatal Outcome
dc.subjectHumans
dc.subjectLeukemia, Biphenotypic, Acute
dc.subjectMale
dc.subjectMicrobial Sensitivity Tests
dc.subjectPrecursor Cell Lymphoblastic Leukemia-Lymphoma
dc.subjectSequence Analysis, DNA
dc.titleDisseminated Amphotericin-Resistant Fusariosis in Acute Leukemia Patients: Report of Two Casesen
dc.typeArtigo
dcterms.licensehttp://www.springer.com/open+access/authors+rights
unesp.campusUniversidade Estadual Paulista (Unesp), Instituto de Biociências, Rio Claropt

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