Invasive fusariosis in two transplanted children

Here we report on two children with leukaemia and Fusarium infection. The first patient was a boy with ALL in whom signs of fungal infection appeared during induction therapy and after 13 days of profound neutropenia (Fig. 1). Cultures were positive for Fusarium solani. The patient was treated with liposomal amphotericin B and gradually the fungal lesions resolved. Allogenic BMT was performed 11 months after the initial ALL diagnosis and 6 months after the last positive culture of Fusarium solani (Table 1). The patient engrafted, but developed acute and chronic graft-versus-host disease (GVHD). About 2 months before the patient died, both pharyngeal and faecal cultures were again transiently positive for Fusarium solani without any attributable symptoms. Liposomal amphotericin B was continued throughout the transplant course. Despite the aggressive therapy, the patient succumbed 6 months post-transplant. The parents refused an autopsy. The second patient was a boy who was transplanted 4 months after an AML relapse. Two months post-transplant after developing acute GVHD and following prolonged febrile neutropenia, empiric liposomal amphotericin B was initiated and thereafter given continuously. Five months after the first BMT he received a second graft from another donor for delayed rejection (Table 1). Six months after the first BMT and 1 month after the second one, small pustules were noticed on his skin. Ten days before his death, faecal surveillance cultures were positive for Fusarium. He died 6.5 months after the first BMT.