Skip to main content

Advertisement

SpringerLink
Log in

European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

In order to better understand the epidemiology of fusariosis in Europe, a survey collecting information on the clinical characteristics of the patients infected by Fusarium as well as on the infecting isolates was launched. A total of 76 cases of invasive fusariosis occurring from January 2007 to June 2012 were collected and Fusarium isolates were identified by sequencing the translation elongation factor 1α (TEF) gene. Also, antifungal susceptibility was tested by broth microdilution according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Etest. Disseminated disease was considered proven in 46 cases and probable in 17 cases. Localised infection was seen in 13 cases. Gibberella fujikuroi species complex (SC), including Fusarium verticillioides and F. proliferatum, and F. solani SC were the most frequent aetiology of disseminated and localised infections, respectively. The crude mortality rate was 46 %, the highest associated with F. solani SC (67 %) and F. proliferatum (62.5 %). A wide range of antifungal susceptibilities was observed. Amphotericin B was the most potent antifungal in vitro, and itraconazole the least effective. The azoles exhibited lower minimum inhibitory concentrations (MICs) against F. verticillioides strains, with posaconazole having a slightly better performance, while F. solani SC isolates were resistant to all three azoles tested. The essential agreement between the Etest and the EUCAST method was 100 % for itraconazole and voriconazole, and 96 % for amphotericin B and posaconazole. In conclusion, we confirm that fusariosis is a rare but severe event in Europe, that G. fujikuroi SC is the predominant cause of deep infections and that different species have different antifungal in vitro susceptibility patterns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nucci M, Anaissie E (2007) Fusarium infections in immunocompromised patients. Clin Microbiol Rev 20:695–704. doi:10.1128/CMR.00014-07

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Campo M, Lewis RE, Kontoyiannis DP (2010) Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998–2009. J Infect 60:331–337. doi:10.1016/j.jinf.2010.01.010

    Article  PubMed  Google Scholar 

  3. Guarro J (2013) Fusariosis, a complex infection caused by a high diversity of fungal species refractory to treatment. Eur J Clin Microbiol Infect Dis 32:1491–1500. doi:10.1007/s10096-013-1924-7

    Article  CAS  PubMed  Google Scholar 

  4. O’Donnell K, Sutton DA, Rinaldi MG, Sarver BA, Balajee SA, Schroers HJ et al (2010) Internet-accessible DNA sequence database for identifying fusaria from human and animal infections. J Clin Microbiol 48:3708–3718. doi:10.1128/JCM.00989-10

    Article  PubMed Central  PubMed  Google Scholar 

  5. Seifert KA, Aoki T, Baayen RP, Brayford D, Burgess LW, Chulze S et al (2003) The name Fusarium moniliforme should no longer be used. Mycol Res 107:643–644. doi:10.1017/S095375620323820X

    Article  Google Scholar 

  6. Tortorano AM, Prigitano A, Dho G, Esposto MC, Gianni C, Grancini A et al (2008) Species distribution and in vitro antifungal susceptibility patterns of 75 clinical isolates of Fusarium spp. from northern Italy. Antimicrob Agents Chemother 52:2683–2685. doi:10.1128/AAC.00272-08

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. 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

    CAS  PubMed Central  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Azor M, Gené J, Cano J, Guarro J (2007) Universal in vitro antifungal resistance of genetic clades of the Fusarium solani species complex. Antimicrob Agents Chemother 51:1500–1503. doi:10.1128/AAC.01618-06

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Iqbal NJ, Boey A, Park BJ, Brandt ME (2008) Determination of in vitro susceptibility of ocular Fusarium spp. isolates from keratitis cases and comparison of Clinical and Laboratory Standards Institute M38-A2 and E test methods. Diagn Microbiol Infect Dis 62:348–350. doi:10.1016/j.diagmicrobio.2008.07.003

    Article  CAS  PubMed  Google Scholar 

  11. Alastruey-Izquierdo A, Cuenca-Estrella M, Monzón A, Mellado E, Rodríguez-Tudela JL (2008) Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods. J Antimicrob Chemother 61:805–809. doi:10.1093/jac/dkn022

    Article  CAS  PubMed  Google Scholar 

  12. Lortholary O, Obenga G, Biswas P, Caillot D, Chachaty E, Bienvenu AL et al (2010) International retrospective analysis of 73 cases of invasive fusariosis treated with voriconazole. Antimicrob Agents Chemother 54:4446–4450

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T et al (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46:1813–1821. doi:10.1086/588660

    Article  PubMed Central  PubMed  Google Scholar 

  14. Geiser DM, del Mar Jiménez-Gasco M, Kang S, Makalowska I, Veeraraghavan N, Ward TJ et al (2004) FUSARIUM-ID v. 1.0: a DNA sequence database for identifying Fusarium. Eur J Plant Pathol 110:473–479

    CAS  Google Scholar 

  15. O’Donnell K, Kistler HC, Cigelnik E, Ploetz RC (1998) Multiple evolutionary origins of the fungus causing Panama disease of banana: concordant evidence from nuclear and mitochondrial gene genealogies. Proc Natl Acad Sci U S A 95:2044–2049

    Article  PubMed Central  PubMed  Google Scholar 

  16. O’Donnell K, Sutton DA, Fothergill A, McCarthy D, Rinaldi MG, Brandt ME et al (2008) Molecular phylogenetic diversity, multilocus haplotype nomenclature, and in vitro antifungal resistance within the Fusarium solani species complex. J Clin Microbiol 46:2477–2490. doi:10.1128/JCM.02371-07

    Article  PubMed Central  PubMed  Google Scholar 

  17. Rodriguez-Tudela JL, Arendrup MC, Arikan S, Barchiesi F, Bille J, Chryssanthou E, et al (2008) EUCAST DEFINITIVE DOCUMENT E.DEF 9.1: Method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia forming moulds. EUCAST E.DEF 9.1.:1–13

  18. Guarner J, Brandt ME (2011) Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 24:247–280. doi:10.1128/CMR.00053-10

    Article  PubMed Central  PubMed  Google Scholar 

  19. Thomas PA, Jesudasan CA, Geraldine P, Kaliamurthy J (2011) Adventitious sporulation in Fusarium keratitis. Graefes Arch Clin Exp Ophthalmol 249:1429–1431

    Article  PubMed  Google Scholar 

  20. Nucci M, Anaissie E, Queiroz-Telles F, Martins CA, Trabasso P, Solza C et al (2003) Outcome predictor of 84 patients with hematologic malignancies and Fusarium infection. Cancer 98:315–319. doi:10.1002/cncr.11510

    Article  PubMed  Google Scholar 

  21. Nucci M, Marr KA, Queiroz-Telles F, Martins CA, Trabasso P, Costa S et al (2004) Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis 38:1237–1242. doi:10.1086/383319

    Article  PubMed  Google Scholar 

  22. Geiser DM, Aoki T, Bacon CW, Baker SE, Bhattacharyya MK, Brandt ME et al (2013) One Fungus, one name: defining the genus Fusarium in a scientifically robust way that preserves longstanding use. Phytopathology 103:400–408. doi:10.1094/PHYTO-07-12-0150-LE

    Article  PubMed  Google Scholar 

  23. Lionakis MS, Kontoyiannis DP (2004) Fusarium infections in critically ill patients. Semin Respir Crit Care Med 25:159–169

    PubMed  Google Scholar 

  24. Nucci M, Anaissie EJ (2009) Hyalohyphomycosis. In: Anaissie EJ, McGinnis MR, Pfaller MA (eds) Clinical mycology, 2nd edn. Churchill Livingstone, St. Louis, MO, USA, pp 309–327

    Chapter  Google Scholar 

  25. Debourgogne A, de Hoog S, Lozniewski A, Machouart M (2012) Amphotericin B and voriconazole susceptibility profiles for the Fusarium solani species complex: comparison between the E-test and CLSI M38-A2 microdilution methodology. Eur J Clin Microbiol Infect Dis 31:615–618. doi:10.1007/s10096-011-1323-x

    Article  CAS  PubMed  Google Scholar 

  26. Tortorano AM, Richardson M, Roilides E, van Diepeningen A, Caira M, Munoz P et al (2014) ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect 20(Suppl 3):27–46. doi:10.1111/1469-0691.12465

    Article  CAS  PubMed  Google Scholar 

  27. Nucci M, Marr KA, Vehreschild MJ, de Souza CA, Velasco E, Cappellano P et al (2013) Improvement in the outcome of invasive fusariosis in the last decade. Clin Microbiol Infect. doi:10.1111/1469-0691.12409

    Google Scholar 

  28. Raad II, Hachem RY, Herbrecht R, Graybill JR, Hare R, Corcoran G et al (2006) Posaconazole as salvage treatment for invasive fusariosis in patients with underlying hematologic malignancy and other conditions. Clin Infect Dis 42:1398–1403

    Article  CAS  PubMed  Google Scholar 

  29. de Hoog GS, Haase G, Chaturvedi V, Walsh TJ, Meyer W, Lackner M (2013) Taxonomy of medically important fungi in the molecular era. Lancet Infect Dis 13:385–386. doi:10.1016/S1473-3099(13)70058-6

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

The manuscript does not contain clinical studies.

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy

    A. M. Tortorano, A. Prigitano & M. C. Esposto

  2. Institut za Mikrobiologiju i Imunologiju, Univerziteta u Beogradu, Beograd, Serbia

    V. Arsic Arsenijevic

  3. Department of Hematology/Oncology, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Republic of Serbia

    J. Kolarovic

  4. Mycology Laboratory, Institute of Public Health of Serbia, Beograd, Serbia

    D. Ivanovic

  5. Institute of Oncology and Radiology, Beograd, Serbia

    L. Paripovic

  6. National and Karolinska University Hospital, Stockholm, Sweden

    L. Klingspor

  7. Institute of Microbiology, Rikshospitalet, Oslo, Norway

    I. Nordøy

  8. Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

    P. Hamal

  9. Hacettepe University Medical School, Ankara, Turkey

    S. Arikan Akdagli

  10. Laboraf, Diagnostica e Ricerca San Raffaele, Milano, Italy

    C. Ossi

  11. Laboratorio di Microbiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milano, Italy

    A. Grancini

  12. Laboratorio di Microbiologia, IRCCS Policlinico S. Matteo, Pavia, Italy

    C. Cavanna

  13. Servizio di Microbiologia, Azienda Ospedaliera di Verona, Verona, Italy

    G. Lo Cascio

  14. Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy

    C. Scarparo & A. Candoni

  15. Università Cattolica del S. Cuore, Roma, Italy

    M. Caira

  16. National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece

    M. Drogari Apiranthitou

Authors
  1. A. M. Tortorano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Prigitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. C. Esposto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Arsic Arsenijevic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Kolarovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Ivanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Paripovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Klingspor
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. Nordøy
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Hamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Arikan Akdagli
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C. Ossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. A. Grancini
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. Cavanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. G. Lo Cascio
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. C. Scarparo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. A. Candoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. M. Caira
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. M. Drogari Apiranthitou
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On the behalf of the ECMM Working Group

Corresponding author

Correspondence to A. M. Tortorano.

Additional information

The ECMM Working Group

Czech Republic-Slovak Republic: E. Faber (Olomouc), A. Streharova (Trnava)

Greece: A. Argynopoulou, J. Baltadakis, M. Christofidou, E. Giamarellos-Bourboulis, N. Harahalakis, M. Marango, J. Meletiadis, K. Pananikolaou, M. Pirounaki, M. Stamouli (Athens)

Italy: M. Passera (Bergamo); S. Oliveri (Catania); C. Bonetti (Crema); S. Grandesso (Mestre); R. Milani, F. Ciceri, C. Verona, S. Malato, R. Chiesa, A. Puglisi, P. Manunta, E. Pajetta, F. Giglio, C.M. Rossi, A. Assanelli, B. Valeri, C. Boschetti, P. Tarsia, C. Annaloro, G. Viola (Milano); I. Casaroli (Monza); M. Sanguinetti (Roma); A. Sartor (Udine)

Turkey: O. Uzun, S. Alp (Ankara)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tortorano, A.M., Prigitano, A., Esposto, M.C. et al. European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe. Eur J Clin Microbiol Infect Dis 33, 1623–1630 (2014). https://doi.org/10.1007/s10096-014-2111-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-014-2111-1

Keywords

Search

Navigation