TABLE 1.
Clinical Features of 6 Cases of Fusarium Infection in Lung Transplant Patients at Massachusetts General Hospital
| Patient (Age in yr/Sex) | Reason for Lung Transplant |
Positive Culture Specimen |
Immunosuppression at Diagnosis |
Signs and Symptoms |
Fusarium Treatment |
Outcome | Reason for Death | Acute Rejection 6 mo Before Infection |
Antifungal Prophylaxis or Previous Therapy |
1Y3 B-D Glucan | Galactomannan Antigen |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (20/F) | Cystic fibrosis | BAL | Tacrolimus, prednisone | SOB, fever, abdominal distention, PE, postural hypotension, crackles in left chest (WBC 19.2, %PMN 89, ANC 17,100) | Liposomal amphotericin B, caspofungin | Died | Invasive aspergillosis | Yes | No | ND | ND |
| 2 (55/M) | Alpha-1 antitrypsin deficiency | BAL | Cyclosporine, azathioprine, antithymocyte globulin (ATG), prednisone | SOB, fever (97.9-F), pneumonia, hemoptysis, fine crackles on auscultation, diminished BS at base (WBC 7.1, %PMN 75, ANC 6270) | None | Died | Sepsis, ARF, scedosporium infection | No | No | ND | ND |
| 3 (59/F) | Interstitial pulmonary fibrosis | Blood, BAL | Tacrolimus, prednisone | SOB, fever, nonproductive cough, ARF, intubated, hypoxia, fine crackles (WBC 3.9, %PMN 94, ANC 3660) | Liposomal amphotericin B, voriconazole | Died | Sepsis, Fusarium infection, CMV pneumonitis | No | Voriconazole, caspofungin | 53 | 0.09 |
| 4 (66/F) | Chronic obstructive airways disease | BAL | Antithymocyte globulin (ATG), prednisone | Fever (98.1-F), hypoxia, dimished BS, otherwise asymptomatic (WBC 14.5, %PMN ND, ANC ND) | Amphotericin B, voriconazole | Survived | — | No | Fluconazole | ND | ND |
| 5 (19/F) | Cystic fibrosis | BAL | Cyclosporine, prednisone | SOB, fever (100.3-F), hypoxia, diminished BS on affected side, no cervical lymphadenopathy, fatigue, headache, dry heaves (WBC 4.9, %PMN 78, ANC 3850) | Voriconazole | Died | Unknown | Yes | No | 31 | 0.206 |
| 6 (36/F) | Interstitial pulmonary fibrosis | Sputum | Cyclosporine, prednisone | SOB, fever (99.5-F), chills, hypoxia, nonproductive cough, headache, coarse crackles on affected side, expiratory wheezing (WBC 8, %PMN 86, ANC 7610) | Liposomal amphotericin B, voriconazole | Died | Respiratory distress, sepsis | No | Itraconazole | ND | 0.59 |
Abbrevations: ANC = absolute neutrophil count, ARF = acute respiratory failure, BS = breath sounds, CMV = cytomegalovirus, ND = no data, PE = pulmonary embolism, PMN = polymorphonuclear cells (granulocytes), SOB = shortness of breath, WBC = white blood cell count, 106cells/mL.