Antifungal Agents/therapeutic use* ; Child ; Fusariosis/drug therapy* ; Humans ; Leukemia, Myeloid, Acute/drug therapy*

Aims: Piper nigrum L. (black pepper) is an economically important commodity plant in Malaysia, which generated RM 200.95 million from pepper export in the year of 2018. However, the increase in pepper production is restricted by diseases. Fusarium wilt is one of the major diseases of P. nigrum L. The objectives for this study were to isolate Fusarium spp. associated with Fusarium wilt of P. nigrum L. from selected pepper farms in the northwestern region of Sarawak and to characterize the Fusarium spp. isolated morphologically and molecularly. Methodology and results: Fusarium spp. were isolated from diseased root samples. The pathogen was grown on potato dextrose agar (PDA) under dark condition at circa (ca.) 25 °C for morphological characterisation. Molecular characterisation was done by using internal transcribed spacer (ITS). Phylogenetic tree was constructed to study the genetic relationship of the isolates. Fusarium solani, F. oxysporum, F. proliferatum were the three Fusarium species identified. There were variations in morphological characters observed between and among the species, including the colony form, margin, elevation, surface appearance and pigmentation. No distinctive morphological characteristic was specific to a location. In addition, growth rate, macroconidia sporulation rate, and microconidia sporulation rate of the isolates were not correlated. In molecular phylogeny, the three Fusarium species were separated into three distinct clades representing the three identified species. The genetic relatedness between isolates within each species was depicted in the tree. Conclusion, significance and impact of study Variations were observed among isolates in this study based on morphological and molecular characterization. This study would contribute information on the variations of Fusarium spp. associated with Fusarium wilt of P. nigrum L. from the northwestern region of Sarawak.
Fusarium ; Fusariosis ; Piper nigrum

No abstract available.
Fusariosis* ; Hand* ; Snake Bites* ; Wounds and Injuries*

A healthy 27-year-old woman with a corneal ulcer underwent fibrin gluing with a bandage contact lens twice, due to an impending perforation. The ulcer lesion slowly progressed, unresponsive to topical antibiotics and amphotericin B. We removed the gluing patch and performed a corneal or scraping or biopsy with multiple amniotic membrane grafts to seal the thinned or perforated cornea. Three days after the surgery, the corneal cultures grew Fusarium, as well as Enterococcus faecalis. Three weeks after surgery, the outermost layer of amniotic membranes, serving as a temporary patch, was removed. The anterior chamber was clear without cells. The signs of infection clinically and symptomatically cleared up four weeks later. Two months after surgery, the lesion became enhanced by amniotic membranes. The use of fibrin glue in infectious keratitis should be avoided, because it not only masks the underlying lesion, but it also interferes with drug penetration into the underlying lesion.
Adult ; Corneal Perforation/*drug therapy ; Corneal Ulcer/*drug therapy/*microbiology ; Eye Infections, Fungal/*microbiology ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Fusariosis/*microbiology ; Fusarium/*isolation & purification ; Humans

Recently, we experienced a case of disseminated fusarial blood stream infection with varicelloid skin eruptions, who had suffered from persistent neutropenic fever after salvage chemotherapy for relapsed acute lymphocytic leukemia (ALL). Neutropenia continued in spite of G-CSF and granulocyte transfusion, and he failed to respond to conventional amphotericin B initially, and then liposomal amphotericin B and voriconazole combination therapy. Disseminated fusariosis can be diagnosed by blood cultures in 50% of patients and present skin lesions in more than 80% of patients. So, typical skin lesions are important clue to diagnose of the disseminated fusariosis. However, many skin lesions in immunocompromised hosts are due to various infectious and non-infectious causes. So, this case shows that it is important to obtain biopsy specimens of skin lesions for histopathologic examination, culture and staining. Here, we present our case with the review of the literatures reported in our country, so far.
Amphotericin B ; Biopsy ; Chickenpox* ; Drug Therapy ; Fever ; Fusariosis* ; Fusarium* ; Granulocyte Colony-Stimulating Factor ; Granulocytes ; Humans ; Immunocompromised Host ; Leukemia* ; Neutropenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Rivers ; Skin*

Recently, we experienced a case of disseminated fusarial blood stream infection with varicelloid skin eruptions, who had suffered from persistent neutropenic fever after salvage chemotherapy for relapsed acute lymphocytic leukemia (ALL). Neutropenia continued in spite of G-CSF and granulocyte transfusion, and he failed to respond to conventional amphotericin B initially, and then liposomal amphotericin B and voriconazole combination therapy. Disseminated fusariosis can be diagnosed by blood cultures in 50% of patients and present skin lesions in more than 80% of patients. So, typical skin lesions are important clue to diagnose of the disseminated fusariosis. However, many skin lesions in immunocompromised hosts are due to various infectious and non-infectious causes. So, this case shows that it is important to obtain biopsy specimens of skin lesions for histopathologic examination, culture and staining. Here, we present our case with the review of the literatures reported in our country, so far.
Amphotericin B ; Biopsy ; Chickenpox* ; Drug Therapy ; Fever ; Fusariosis* ; Fusarium* ; Granulocyte Colony-Stimulating Factor ; Granulocytes ; Humans ; Immunocompromised Host ; Leukemia* ; Neutropenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Rivers ; Skin*

Fusarium species are common soil saprophytes and plant pathogens. In humans, several species have been recognized as agents of superficial infections. Disseminated Fusariosis have been increasingly described in immunocompromised patients, especially in neutropenic patients. The prognosis is very poor despites antifungal therapy. This is the report of Fusarium oxysporum infection in a 6-year-old patient with relapsed acute leukemia and prolonged neutropenia. The patient presented with persistent fever and multiple erythematous papules with central necrosis or vesicle. Fuasrium oxysporum was isolated and cultured from a skin biopsy specimen. Initially, the patient failed to respond to conventional amphotericin B but recovered after treatment was switched to liposomal amphotericin B and voriconazole.
Amphotericin B* ; Biopsy ; Child* ; Drug Therapy* ; Fever ; Fusariosis* ; Fusarium ; Humans ; Immunocompromised Host ; Leukemia ; Necrosis ; Neutropenia ; Plants ; Prognosis ; Skin ; Soil

Fusariosis is a rare infectious disease caused by species of the genus Fusarium that has been increasingly documented as an emerging agent of opportunistic infections in immunocompromised patients and, occasionally, immunocompetent hosts. We describe an 18-year-old Korean male, previously diagnosed as acute lymphocytic leukemia, presented with 2~4 cm-sized erythematous to necrotic papulonodules on the trunk and extremities for a week. White blood cell count was 200 cells/L and biopsy specimen showed structures resembling fungal elements in the dermis and subcutaneous fat. Cultures from a biopsy sample growing whitish cottony colonies contained fusoid multiseptated macroconidia. He was diagnosed as fusariosis and treated with intravenous amphotericin B. But white blood cell count and clinical symptoms didn't improve and he was expired after 6 days of treatment.
Adolescent ; Amphotericin B ; Biopsy ; Communicable Diseases ; Dermis ; Extremities ; Fusariosis ; Fusarium* ; Humans ; Immunocompromised Host ; Leukocyte Count ; Male ; Opportunistic Infections ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Subcutaneous Fat

Voriconazole is a second-generation triazole that has an enhanced antifungal spectrum, compared with older triazoles. It will likely become the drug of choice for treatment of invasive aspergillosis and many Scedosporium/Pseudallescheria and Fusarium infections. Voriconazole should not replace fluconazole or other antifungal agents for treatment of most Candida infections. The drug has more side effects and drug interactions than fluconazole. The oral formulation, with its excellent bioavailability, is available it is especially beneficial in patients with renal failure, who should not be exposed to the cyclodextrin vehicle used for the intravenous formulation. Caspofungin, the first inhibitor of fungal beta -1, 3 glucan synthesis, is effective for the treatment of mucosal and invasive candidiasis and invasive aspergillosis. It is also active in vitro and in animal models against a number of other filamentous and dimorphic endemic fungi and in animal models of Pneumocystis carinii infection. Caspofungin has an excellent safety profile. Caspofungin may prove to be useful in empirical therapy for suspected invasive fungal infections. Additional clinical trial data that expand our knowledge of the usefulness of caspofungin for these and other mycoses is anticipated. The broad spectrum antifungal itraconazole is an effective and well tolerated agent for the prophylaxis and treatment of systemic fungal infections. The recent development of an itraconazole oral solution and an intravenous itraconazole solution has increased the options for the use of this drug. Intravenous itraconazole solution is at least as effective as intravenous amphotericin B in the empirical treatment of neutropenic patients with systemic fungal infections, and drug-related adverse events are more frequent in patients treated with amphotericin B. A large proportion of patients with confirmed aspergillosis also respond to the treatment with intravenous itraconazole followed by oral itraconazole. Liposomal nystatin is another promising antifungal agent that might be effective for treatment of invasive candidiasis and invasive aspergillosis. More clinical data, however, is needed for clinical application.
Amphotericin B ; Antifungal Agents* ; Aspergillosis ; Biological Availability ; Candida ; Candidiasis, Invasive ; Drug Interactions ; Fluconazole ; Fungi ; Fusariosis ; Humans ; Itraconazole ; Models, Animal ; Mycoses ; Nystatin ; Pneumocystis Infections ; Renal Insufficiency ; Triazoles

Fusarium spp., basically a superficial pathogen, is a newly emerging fungal pathogen of opportunistic infections in immunocompromised patients. At present, although Fusarium spp. are relatively resistant to amphotericin B, the combination of amphotericin B and surgical debridement appear to be optimal treatment for disseminated infection. Recently we experienced a 32-year-old neutropenic patient after induction chemotherapy for acute myelocytic leukemia presented with skin lesions and infiltrations in both lungs. We diagnosed with disseminated fusariosis by skin culture and successfully treated the patient with liposomal amphotericin B. We emphasize a high index of suspicion for skin lesions especially in immunocopromised patients.
Adult ; Amphotericin B* ; Debridement ; Fusariosis* ; Fusarium* ; Humans ; Immunocompromised Host ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; Lung ; Opportunistic Infections ; Skin