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Background <p>Fusariosis is a life-threatening opportunistic fungal infection, especially among immunocompromised individuals, with high mortality rates due to diagnostic delays and antifungal resistance. Despite the increasing global burden, management guidelines for this fatal fungal infection are not much available. This review outlines clinical features, diagnostic approaches, and current treatment options to support effective identification and intervention.</p> Methods <p>This systematic review followed PRISMA guidelines to assess the clinical, microbiological, and antifungal characteristics of fusariosis using global literature. Electronic databases including PubMed, Scopus, and Google Scholar were searched from December 2024 to May 2025 using the MeSH terms. Randomized control trials, cohort, case reports, and surveillance data reporting laboratory-confirmed fusarium infections were included. Two reviewers independently screened and extracted data using a standardized template covering demographics, clinical features, species identification, antifungal susceptibility, and treatment outcomes. Quality assessment was performed using adapted critical appraisal tools for observational studies and case reports.</p> Results <p>Among 139 articles, over 2015 to 2025, 84 (60.4%) reported studies and cases of fungemia. Fusarium fungemia primarily detected among immunocompromised patients, with high associated mortality. Additionally, 47 articles (33.8%) described other fungal infections caused by <i>Fusarium</i> spp. Most infections were superficial, with keratiti<b>s</b> being the predominant presentation, followed by onychomycosis. Eight articles (5.8%) included studies on both fungemia and other fusarium-related infections. <i>F. solani</i> species complex was the most frequently isolated group. Molecular methods enhanced species-level identification. Antifungal susceptibility testing revealed high minimal inhibitory concentration to amphotericin B and azoles, indicating significant resistance patterns. Voriconazole showed variable activity, and echinocandins were ineffective. Emerging therapies such as Rose Bengal PDT demonstrated potential in resistant keratitis cases, offering promising adjunctive treatment options.</p> Conclusion <p>Voriconazole combined with amphotericin B is the most effective treatment for fusariosis, while posaconazole serves as a salvage option. Photodynamic therapy combined with Methylene blue treatment remain as a novel effective therapy. The integration of molecular diagnostics proved essential for accurate species-level identification, which is critical given the variable antifungal susceptibility patterns observed.</p>

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Current Management of Fusariosis: A Systematic Review

  • 期刊论文

  • 发表日期：

    2026年5月8日

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  • Kulasekarage Chulaka Madhuwantha,
  • Adhikari Mudiyanselage Ashani Charuka Adhikari,
  • Harshika Sachini Welgama,
  • Maththe Gama Ralalage Shobha Sanjeewani Gunathilaka,
  • Jayaweera Arachchige Asela Sampath Jayaweera

摘要

Background

Fusariosis is a life-threatening opportunistic fungal infection, especially among immunocompromised individuals, with high mortality rates due to diagnostic delays and antifungal resistance. Despite the increasing global burden, management guidelines for this fatal fungal infection are not much available. This review outlines clinical features, diagnostic approaches, and current treatment options to support effective identification and intervention.

Methods

This systematic review followed PRISMA guidelines to assess the clinical, microbiological, and antifungal characteristics of fusariosis using global literature. Electronic databases including PubMed, Scopus, and Google Scholar were searched from December 2024 to May 2025 using the MeSH terms. Randomized control trials, cohort, case reports, and surveillance data reporting laboratory-confirmed fusarium infections were included. Two reviewers independently screened and extracted data using a standardized template covering demographics, clinical features, species identification, antifungal susceptibility, and treatment outcomes. Quality assessment was performed using adapted critical appraisal tools for observational studies and case reports.

Results

Among 139 articles, over 2015 to 2025, 84 (60.4%) reported studies and cases of fungemia. Fusarium fungemia primarily detected among immunocompromised patients, with high associated mortality. Additionally, 47 articles (33.8%) described other fungal infections caused by Fusarium spp. Most infections were superficial, with keratitis being the predominant presentation, followed by onychomycosis. Eight articles (5.8%) included studies on both fungemia and other fusarium-related infections. F. solani species complex was the most frequently isolated group. Molecular methods enhanced species-level identification. Antifungal susceptibility testing revealed high minimal inhibitory concentration to amphotericin B and azoles, indicating significant resistance patterns. Voriconazole showed variable activity, and echinocandins were ineffective. Emerging therapies such as Rose Bengal PDT demonstrated potential in resistant keratitis cases, offering promising adjunctive treatment options.

Conclusion

Voriconazole combined with amphotericin B is the most effective treatment for fusariosis, while posaconazole serves as a salvage option. Photodynamic therapy combined with Methylene blue treatment remain as a novel effective therapy. The integration of molecular diagnostics proved essential for accurate species-level identification, which is critical given the variable antifungal susceptibility patterns observed.