Submitted to: Journal of Clinical Microbiology
Publication Type: Peer reviewed journal
Publication Acceptance Date: 3/18/2011
Publication Date: 6/20/2011
Citation: Edupuganti, S., Rouphael, N., Mehta, A., Eaton, M., Heller, J., Bressler, A., Brandt, M., O Donnell, K. 2011. Fusarium falciforme vertebral abscess and osteomyelitis: case report and molecular classification. Journal of Clinical Microbiology. 49(6):2350-2353. Interpretive Summary: This report describes the application of novel DNA sequence-based typing technologies to identify the filamentous fungus responsible for a spinal infection in an immunocompromised patient with steroid-induced diabetes. After the patient presented to the Emory University School of Medicine complaining of progressive lower back pain, radiological examination revealed an abnormal growth on the spine. The abscessed soft tissue and bone was removed surgically and a portion was evaluated by pathology and microbiology. Pathological analysis revealed fungal growth within the bone and abscess. In addition, a Fusarium species was cultured microbiologically from a portion of the biopsy. DNA sequence-based typing of the fungus, using recently published multigene assays (O’Donnell et al., J. Clin. Microbiology 46:2477-2490 and J. Clin. Microbiology 48:3708-3718 revealed that the infection was caused by a novel genetic type of Fusarium falciforme designated FSSC 3+4qqq. Given that various Fusarium species have been reported to have different susceptibilities to antifungal drugs, accurate identification of fungal pathogens is integral to selecting appropriate antibiotic therapies. The patient is currently being treated with an antifungal drug called amphotericin B. This study will be of interest to clinicians treating patients with fungal infections and microbiologists studying filamentous fungi, for whom accurate identification of fusaria to the species level is important.
Technical Abstract: Fusarium is a ubiquitous filamentous mold that rarely causes disease in immunocompetent humans but can be fatal in immunocompromised hosts. We report an unusual case of vertebral abscess and osteomyelitis in a patient with an autoimmune disorder who was on long term glucocorticoids. Multilocus DNA sequence-based typing revealed that the infection was caused by a novel three-locus haplotype of Fusarium falciforme designated FSSC 3+4qqq.