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      Intracranial Fusarium Fungal Abscess in an Immunocompetent Patient: Case Report and Review of the Literature

      case-report

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          Abstract

          Introduction  Fusarium spp is an omnipresent fungal species that may lead to fatal infections in immunocompromised populations. Spontaneous intracranial infection by Fusarium spp in immunocompetent individuals is exceedingly rare.

          Case Report An immunocompetent 33-year-old Hispanic woman presented with persistent headaches and was found to have a contrast-enhancing mass in the left petrous apex and prepontine cistern. She underwent a subsequent craniotomy for biopsy and partial resection that revealed a Fusarium abscess. She had a left transient partial oculomotor palsy following the operation that resolved over the next few weeks. She was treated with long-term intravenous antifungal therapy and remained at her neurologic baseline 18 months following the intervention.

          Discussion To our knowledge, this is the first reported case of Fusarium spp brain abscess in an immunocompetent patient. Treatment options include surgical intervention and various antifungal medications.

          Conclusion This case demonstrates the rare potential of intracranial Fusarium infection in the immunocompetent host, as well as its successful treatment with surgical aspiration and antifungal therapy.

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          Taxonomy, biology, and clinical aspects of Fusarium species.

          P Nelson, M Dignani, E. J. Anaissie (1994)
          There are several taxonomic systems available for identifying Fusarium species. The philosophy used in each taxonomic system is discussed as well as problems encountered in working with Fusarium species in culture. Fusarium species are toxigenic, and the mycotoxins produced by these organisms are often associated with animal and human diseases. The implications for the association of the carcinogens, fumonisins, produced by Fusarium moniliforme and other Fusarium species with human diseases are discussed. Foreign-body-associated fusarial infection such as keratitis in contact lens wearers, onychomycosis, skin infections, and disseminated multiorgan infections are discussed. Disseminated fusarial hyalohyphomycosis has emerged as a significant, usually fatal infection in the immunocompromised host. Successful outcome is determined by the degree of immunosuppression, the extent of the infection, and the presence of a removable focus such as an indwelling central venous catheter. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy, probably with one of the newer antifungal agents. Perhaps the use of such agents or the use of colony-stimulating factors may improve the outcome of this devastating infection. However, until new approaches for treatment develop, effective preventive measures are urgently needed.
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            Internet-accessible DNA sequence database for identifying fusaria from human and animal infections.

            Richard C. Summerbell, Jongsun Park, Brice A J Sarver … (2010)
            Because less than one-third of clinically relevant fusaria can be accurately identified to species level using phenotypic data (i.e., morphological species recognition), we constructed a three-locus DNA sequence database to facilitate molecular identification of the 69 Fusarium species associated with human or animal mycoses encountered in clinical microbiology laboratories. The database comprises partial sequences from three nuclear genes: translation elongation factor 1α (EF-1α), the largest subunit of RNA polymerase (RPB1), and the second largest subunit of RNA polymerase (RPB2). These three gene fragments can be amplified by PCR and sequenced using primers that are conserved across the phylogenetic breadth of Fusarium. Phylogenetic analyses of the combined data set reveal that, with the exception of two monotypic lineages, all clinically relevant fusaria are nested in one of eight variously sized and strongly supported species complexes. The monophyletic lineages have been named informally to facilitate communication of an isolate's clade membership and genetic diversity. To identify isolates to the species included within the database, partial DNA sequence data from one or more of the three genes can be used as a BLAST query against the database which is Web accessible at FUSARIUM-ID (http://isolate.fusariumdb.org) and the Centraalbureau voor Schimmelcultures (CBS-KNAW) Fungal Biodiversity Center (http://www.cbs.knaw.nl/fusarium). Alternatively, isolates can be identified via phylogenetic analysis by adding sequences of unknowns to the DNA sequence alignment, which can be downloaded from the two aforementioned websites. The utility of this database should increase significantly as members of the clinical microbiology community deposit in internationally accessible culture collections (e.g., CBS-KNAW or the Fusarium Research Center) cultures of novel mycosis-associated fusaria, along with associated, corrected sequence chromatograms and data, so that the sequence results can be verified and isolates are made available for future study.
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              Infections due to emerging and uncommon medically important fungal pathogens.

              J Hiemenz, A Groll, H. R. FLEMING … (2004)
              The emergence of less common but medically important fungal pathogens contributes to the rate of morbidity and mortality, especially in the increasingly expanding population of immunocompromised patients. These pathogens include septate filamentous fungi (e.g., Fusarium spp., Scedosporium spp., Trichoderma spp.), nonseptate Zygomycetes, the endemic dimorphic pathogen Penicillium marneffei, and non-Cryptococcus, non-Candida pathogenic yeast (e.g., Trichosporon spp.). The medical community is thus called upon to acquire an understanding of the microbiology, epidemiology and pathogenesis of these previously uncommon pathogens in order to become familiar with the options for prevention and treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Neurol Surg Rep
                Journal ID (iso-abbrev): J Neurol Surg Rep
                Journal ID (doi): 10.1055/s-00000182
                Title: Journal of Neurological Surgery Reports
                Publisher: Georg Thieme Verlag KG (Stuttgart · New York )
                ISSN (Print): 2193-6358
                ISSN (Electronic): 2193-6366
                Publication date (Electronic): 12 November 2014
                Publication date (Print): December 2014
                Volume: 75
                Issue: 2
                Pages: e241-e245
                Affiliations
                [1 ]Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
                [2 ]Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
                [3 ]Department of Infectious Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
                Author notes
                Address for correspondence Asa Peterson, MS LAC + USC Medical Center, 1200 North State Street Suite 3300, Los Angeles, CA 90033United States asa.z.peterson@ 123456gmail.com
                Article
                Publisher ID: 130060
                DOI: 10.1055/s-0034-1387182
                PMC ID: 4242827
                PubMed ID: 25485222
                SO-VID: 190ca276-7393-406c-b549-e8a8d0aac8f5
                Copyright © © Thieme Medical Publishers
                History
                Date received : 29 November 2013
                Date accepted : 25 May 2014
                Categories
                Subject: Article

                Keywords: intracranial abscess,fusarium,fungal infection
                Data availability:
                Keywords: intracranial abscess, fusarium, fungal infection

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