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Fusariosis: Taxonomy and treatment - 05/06/15

Doi : 10.1016/j.mycmed.2015.02.002 
Guarro Josep
 Unitat de Microbiologia, Departament de Ciències Mèdiques Bàsiques, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Carrer Sant Llorenç 21, 43201 Reus, Tarragona, Spain 

Resumen

Fusarium is a very common saprophyte fungus able to cause important diseases of economic relevance in plants and, although relatively rarely, animal infections. In humans they can produce very severe infections refractory to treatment. Until recently the species associated to fusariosis were relatively small, mainly F. solani, F. oxysporum and F. verticillioides (F. moniliforme), but with the advent of molecular techniques and the use of MLST and GCPSR methods its number, mainly of cryptic species, has increased considerably. Currently 72 species, mostly unnamed, grouped into 8 species complexes, have been linked to human infections; however, most of the cases have been attributed to only four species, i.e. F. keratoplasticum, F. petroliphilum, and two unnamed species of the F. oxysporum SC and F. dimerum SC, respectively. In recent years, there have been a large number of articles published about Fusarium and important progress has been achieved in many fields, although in the management of fusariosis this has only been modest. A lack of correlation seems to be evident between the in vitro studies of antifungal susceptibility and the clinical results of the different therapies. Voriconazole shows a very poor activity in vitro and seems not to work in experimental studies but it is recommended by the recent ESCMID and ECMM guidelines. Amphotericin B is more active in vitro but did not work so well in clinical studies. There is very little experience in the use of posaconazole, combined drugs or the use of cytokines as adjunctive therapy. Therefore, considering that the development of new, and more effective, antifungals against fusariosis is far away, it seems reasonable to follow the recommendations proposed, such as reversing the immunosuppression whenever possible, carefully evaluating and treating skin lesions, particularly onychomycosis (in a recent study the portal of entry of invasive fusariosis was cutaneous in 70% of the cases), and trying to avoid nosocomial acquired airborne and waterborne infections.

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© 2015  Publicado por Elsevier Masson SAS.
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Vol 25 - N° 2

P. e95 - juin 2015 Regresar al número
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