Fusariosis: an update on therapeutic options for management

ABSTRACT

Introduction

Disseminated fusariosis is a serious fungal infection with a high mortality rate among immunocompromised hosts. Management of fusariosis is challenging due to intrinsic resistance to most available antifungal agents. The novel antifungals that are in the pipeline may help to enhance favorable outcome of fusariosis. Clinical trials and animal model studies are required to achieve optimal management of fusariosis.

Areas covered

This review highlights the available and novel antifungal agents for management of human fusariosis. It also highlights the importance of surgical debridement and reversal of immunosuppression in patients with invasive fusariosis We examine the following databases: Medline, PubMed, and Google Scholar for the following key terms ‘fusariosis', ‘disseminated fusariosis,’ ‘invasive fusariosis,’ and ‘Fusarium.’

Expert opinion

Currently, voriconazole or liposomal amphotericin B is the recommended approach for treating invasive fusariosis. Posaconazole is used for salvage therapy. Combination therapy may be used in refractory or severe cases as empiric therapy awaiting results of susceptibility testing. Granulocyte colony stimulating factor is usually used in patients with profound and prolonged neutropenia. Immunosuppressive agents should be reduced when possible. Primary triazole prophylaxis may be considered for high-risk patients, while secondary prophylaxis is recommended in patients with  a history of invasive fusariosis requiring immunosuppression.

KEYWORDS:

• Fusariosis
• invasive infection
• disseminated infection
• voriconazole
• amphotericin b
• resistance
• neutropenia
• immunosuppression

Article highlights

• Reviews the available and novel antifungal agents used for management of human fusariosis

• Discuss the importance of surgical debridement

• Reversal of immunosuppression in patients with invasive fusariosis.

• Novel therapies are being studied and may provide alternative treatment options.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.