Pseudomonas dışı ektima gangrenosum: fusarium enfeksiyonu olgusu

Abstract

Fusarium tipleri, bağışıklığı baskılanmış kişilerde giderek artış gösteren ciddi etkenlerdir ve derin nötropenik hastalarda geliştiğinde genellikle ölümcüldür. Uzun süreli ciddi nötropeni(˂500/ mm3), kortikosteroidler, geniş spektrumlu antibiyotikler, intravenöz kateter varlığı yaygın Fusarium enfeksiyonu gelişimi için önemli risk faktörleridir. Olgumuz; nüks Akut Myeloid Lösemi tanılı 52 yaşında, erkek olup kurtarma amaçlı etoposid+ mitoksantron+ sitarabin kemoterapisi verildi. Hastamızda posakonazol profilaksisi altında ciltte ektima gangrenosum benzeri döküntülerle kendini gösteren Fusarium enfeksiyonu gelişti ve vorikonazol ile başarılı şekilde tedavi edildi. Yaygın hastalığın kötü seyirli oluşu lokalize enfeksiyonun erken tanı ve tedavisine dikkat çekmektedir. Bilinen risk faktörleri olan ve fuzariyal enfeksiyondan şüphelenilen hastalarda vakit kaybedilmeden yüksek doz lipozomal amfoterisin tedavisine başlanması önerilmektedir. Fusarium tedavisinde etkin olabilen itrakonazol, vorikonazol ve posakonazol gibi daha yeni triazol grubu antifungal ajanlar mevcuttur. Nadir görülen fakat bağışıklığı baskılanmış hastalarda sıklığı giderek artış gösteren, erken tanındığında ve hemen tedaviye başlandığında başarılı sonuçlar alınabilen Fusarium enfeksiyonuna dikkat çekmek istedikDeveloping drug resistance requires the rational use of antibiotics. In this study; it is aimed to assess the affectivity of the oral treatment and monotherapy in febrile neutropenia. In this study, 64 febrile neutropenia attacks that have observed in 44 patients were evaluated retrospectively. In the low risk group, when a starch has provided; imipenem, a starch has been providing three days imipenem+five days oral cefixime, in the high risk group; a starch was provided as cefixime+amicasin, other starch was provided as imipenem. None of the patients who were involved in the study lost their lives. The empiric treatment success without any modification in entire group was 78%. The same success was 53,8% in low risk imipenem brachion, the same success was 92,3% in three days imipenem+five days cefixime brachion (p=0,037), it was 81,3% in high risk cefixime+amicasin brachion and in the imienem brachion, it was 81,8% (p=0,641). Due to the fact that our number of patient is restricted, in the empiric treatment, the oral treatment could be more effective in the oral treatment however, in high risky patients, monotherapy is accepted as betterness because each brachion has same success.

Fusarium species are increasingly recognised as serious pathogens in the immunocompromised patients. The outcome in severe neutropenia has been almost fatal. Prolonged severe neutropenia (˂500/ mm3), corticosteroids, broad spectrum antibiotics, and indwelling intravenous catheters are all important risk factors for the development of disseminated fusariosis. Our case is 52 year old male who was diagnosed relapse acute myeloid leukemia and given etoposide+ mitoxantrone+ cytarabine combination as a salvage chemotherapy. In our patient, Fusarium infection, which presented eruptions like ectima gangrenosum during prophylactic posaconazole was occured and succesfully treated with voriconazole. The poor prognosis of disseminated disease highlights the importance of early recognition and treatment of localised disease. High dose liposomal amphotericin should be started without delay if fusarial infection is suspected in a patient with known risk factors. Newer antifungal triazole agents that may have good activity against fusarium species such as itraconazole, voriconazole, and posaconazole are available. Here, we want to notice Fusarium infections are rare but tend to increase in the immuncomprised and early recognition and treatment could yield succesful results if provided.