TABLE 5.
Approach to the diagnosis and management of invasive fusariosis in high-risk hematologic patientsa
| Action |
|---|
| Identify patients at elevated risk |
| Acute leukemia receiving induction chemotherapy for newly diagnosed or relapsed disease with profound (<100/mm3) neutropenia; active smoking |
| Allogeneic HCT recipient Pre-engraftment period: profound (<100/mm3) neutropenia, cord blood HCT, ATG in the conditioning regimen Post-engraftment period: receipt of corticosteroids or other immunosuppressive agents for the treatment of severe GVHD, CMV reactivation |
| The presence of skin breakdowns at sites of onychomycosis and/or interdigital intertrigo should increase the alertness |
| Consider the diagnosis of invasive fusariosis if |
| Skin lesions or unexplained myalgia |
| New pulmonary infiltrates |
| Sinusitis |
| Endophthalmitis |
| Positive blood culture for mold |
| Diagnostic workup |
| Prompt biopsy of a skin lesion, with direct examination, culture, and histopathology |
| Treat immediately if |
| Presence of hyaline hyphae on the direct exam of a fragment of skin biopsy |
| Positive blood culture for a mold |
a
HCT = hematopoietic cell transplantation; ATG = anti-thymocyte globulin; GVDH = graft versus host disease; CMV = cytomegalovirus.