A rare Fusarium equiseti infection in a 53-year-old male with burn injury: A case report

Document Type : Case report

Authors

1 Department of Otorhinolaryngology, Nghe An Obstetrics and Pediatrics Hospital, Vinh, Vietnam

2 Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Hanoi, Vietnam

3 Department of Parasitology, Vietnam Military Medical University, Hanoi, Vietnam

4 Department of Pathology, Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam

5 Department of Parasitology, Hue University of Medicine and Pharmacy, Hue, Vietnam

10.18502/cmm.7.1.6245

Abstract

Background and Purpose: Burn injuries are prone to infection caused by bacteria, fungi, or other pathogens. Fungal wound infection usually has non-specific clinical symptoms.Nevertheless, in some cases, the fungal burden is so substantial that can easily be seen by the naked eyes, but this phenomenon has rarely been reported with Fusarium.
Case report: A 53-year-old patient with severe burn injury was admitted to the intensive care unit of the National Hospital of Burn, Ha Noi, Vietnam. His wound was dressed with a traditional herbal product before the hospital admission. On the 5th day after the admission, some white patches suspected of fungal colonies appeared on burn lesions where the herbal medicine was placed. Histological examination (Periodic acidSchiff) and culture of biopsy samples taken from those lesions revealed fungus that was identified as Fusarium equiseti after analysis of the internal transcribed spacer and D1/D2 region of the large subunit of the 28S rDNA. The isolated strain showed susceptibility to voriconazole but resistance to fluconazole, itraconazole, caspofungin,and amphotericin B in vitro. The patient received aggressive treatment, including IV voriconazole (400 mg daily from day five); however, he could not recover.
Conclusion: Fusarium should be suspected in burn patients with white patches on lesions. Antifungal susceptibility testing is important since multidrug resistance is common among Fusarium strains.
 

Keywords


1. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn
wound infections. Clin Microbiol Rev. 2006; 19(2):403-34.
2. Mousa H, Al-Bader S, Hassan D. Correlation between fungi
isolated from burn wound and burn care units. Burns. 1999;
25(2):145-7.
3. Akelma H, Tarikci Kılıç E, Karahan ZA. Rare burn cases treated
traditionally: folk medicine: review of eight cases. J Burn Care
Res. 2019; 40(4):520-6.
4. Resch TR, Main S, Price LA, Milner SM. A fungal burn
infection. Eplasty. 2014; 14(14):ic5.
5. Moon P, Jithendran N. Invasive fungal infection with absidia
corymbifera in immunocompetent patient with electrical scalp
burn. World J Plast Surg. 2018; 7(2):249-52.
6. Atiyeh B, Masellis A, Conte C. Optimizing burn treatment in
developing low- and middle-income countries with limited
health care resources (Part 1). Ann Burn Fire Disasters. 2009;
22(3):121-5.
7. Nguyen LT, Kaptchuk TJ, Davis RB, Nguyen G, Pham V,
Tringale SM, et al. The use of traditional vietnamese medicine
among vietnamese immigrants attending an urban community
health center in the United States. J Altern Complement Med.
2016; 22(2):145-53.
8. de Sousa Lima CM, Fujishima MA, de Paula Lima B,
Mastroianni PC, de Sousa FFO, da Silva JO. Microbial
contamination in herbal medicines: a serious health hazard to
elderly consumers. BMC Complement Med Ther. 2020;
20(1):17.
9. Espinel-Ingroff A, Arthington-Skaggs B, Iqbal N, Ellis D,
Pfaller MA, Messer S, et al. Multicenter evaluation of a new
disk agar diffusion method for susceptibility testing of
filamentous fungi with voriconazole, posaconazole, itraconazole,
amphotericin B, and caspofungin. J Clin Microbiol. 2007;
45(6):1811-20.
10. Guarro J. Fusariosis, a complex infection caused by a high
diversity of fungal species refractory to treatment. Eur J Clin
Microbiol Infect Dis. 2013; 32(12):1491–500.
11. Teresa M, Brizuela M, Villasboas M, Guarracino F, Alvarez V,
Santos P, et al.
Fusarium spp infections in a pediatric burn unit:
nine years of experience. Braz J Infect Dis. 2016; 20(4):389-92.
12. Nucci M, Anaissie E.
Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007; 20(4):695-704.
13. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE,
Calandra T, et al. 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.
2008; 46(12):1813-21.
14. Kwiatkowski N, Babiker W, Merz W, Carroll KC, Zhang SX.
Evaluation of nucleic acid sequencing of the D1/D2 region of
the large subunit of the 28S rDNA and the internal transcribed
spacer region using SmartGene IDNS [corrected] software for
identification of filamentous fungi in a clinical laboratory. J Mol
Diagn. 2012; 14(4):393–401.
15. Muhammed M, Coleman J, Carneiro H, Mylonakis E. The
challenge of managing fusariosis. Virulence. 2011; 2(2):91–6.
16. Taj-Aldeen SJ, Salah H, Al-Hatmi AM, Hamed M, Theelen B,
van Diepeningen AD, et al. In vitro resistance of clinical
Fusarium species to amphotericin B and voriconazole using the
EUCAST antifungal susceptibility method. Diagn Microbiol
Infect Dis. 2016; 85(4):438-43.
17. Nucci M, Marr KA, Vehreschild MJ, de Souza CA, Velasco E,
Cappellano P, et al. Improvement in the outcome of invasive
fusariosis in the last decade. Clin Microbiol Infect. 2014;
20(6):580-5.
18. Wright J, Lam K, Hansen D, Burrell R. Efficacy of topical silver
against fungal burn wound pathogens. Am J Infect Control.
1999; 27(4):344–50.
19. Adorisio S, Fierabracci A, Rossetto A, Muscari I, Nardicchi
V, Liberati AM, et al. Integration of traditional and western
medicine in vietnamese populations: a review of health
perceptions and therapies. Nat Prod Commun. 2016;
11(9):1409-16.
20. World Health Organization. WHO guidelines for assessing
quality of herbal medicines with reference to contaminants and
residues. Geneva: World Health Organization; 2007.
 
Volume 7, Issue 1
March 2021
Pages 59-62
  • Receive Date: 31 December 2020
  • Revise Date: 08 May 2021
  • Accept Date: 10 May 2021
  • Publish Date: 01 March 2021