Treatment of Fusarium Infection of the Central Nervous System: A Review of Past Cases to Guide Therapy for the Ongoing 2023 Outbreak in the United States and Mexico.

Hoenigl, Martin; Jenks, Jeffrey D; Egger, Matthias; Nucci, Marcio; Thompson, George R

Treatment of Fusarium Infection of the Central Nervous System: A Review of Past Cases to Guide Therapy for the Ongoing 2023 Outbreak in the United States and Mexico.

dc.contributor.author	Hoenigl, Martin
dc.contributor.author	Jenks, Jeffrey D
dc.contributor.author	Egger, Matthias
dc.contributor.author	Nucci, Marcio
dc.contributor.author	Thompson, George R
dc.date.accessioned	2023-09-15T17:43:18Z
dc.date.available	2023-09-15T17:43:18Z
dc.date.issued	2023-08
dc.date.updated	2023-09-15T17:43:17Z
dc.description.abstract	Introduction Fusariosis of the central nervous system (CNS) is extremely uncommon. Treatment and outcome data from previously published cases may provide some guidance in light of the ongoing fungal meningitis outbreak in 2023 involving Fusarium spp. in the United States and Mexico. Methods We reviewed the published literature describing cases of invasive fusariosis of the (CNS) that included data on patient demographic characteristics, treatment, and outcome. Results Twenty-six cases met inclusion criteria. The mean age was 36 years, 55% involved females, 60% had underlying hematologic malignancy, and another 16% were on immunosuppressants. The majority of infections were from Fusarium solani species complex. Overall 72% of patients died. The majority received monotherapy with amphotericin B, although some received voriconazole monotherapy or combination therapy with amphotericin B plus voriconazole with or without adjuvant surgery. Among the survivors, 3 received amphotericin B monotherapy, 2 voriconazole monotherapy, 1 combination therapy of both, and one surgery only. Conclusion The overall mortality rate in published cases of fusariosis of the CNS was high, although-unlike during the current outbreak-the preponderance of patients were severely immunocompromised. While historically the majority were treated with amphotericin B monotherapy, some recent patients were treated with voriconazole monotherapy or combination therapy with amphotericin B plus voriconazole. Current guidelines recommend monotherapy with voriconazole or lipid formulations of amphotericin B or combination of both for the treatment of invasive fusariosis, which is in line with the findings from our literature review and should be considered during the ongoing 2023 outbreak.
dc.identifier	10.1007/s11046-023-00790-6
dc.identifier.issn	0301-486X
dc.identifier.issn	1573-0832
dc.identifier.uri	https://hdl.handle.net/10161/29004
dc.language	eng
dc.publisher	Springer Science and Business Media LLC
dc.relation.ispartof	Mycopathologia
dc.relation.isversionof	10.1007/s11046-023-00790-6
dc.subject	Fungal meningitis
dc.subject	Fungal meningitis outbreak
dc.subject	Fusariosis meningitis
dc.subject	Fusarium solani
dc.subject	Fusarium spp.
dc.title	Treatment of Fusarium Infection of the Central Nervous System: A Review of Past Cases to Guide Therapy for the Ongoing 2023 Outbreak in the United States and Mexico.
dc.type	Journal article
duke.contributor.orcid	Jenks, Jeffrey D\|0000-0001-6632-9587
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Medicine
pubs.organisational-group	Medicine, Infectious Diseases
pubs.publication-status	Published