Fusarium species represent an opportunistic fungal pathogen in patients with an unrelated disease. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico. The diagnosis of proven fusariosis was made according to European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. Forty-nine cases were identified in our series. Most patients had burn injuries (49%) and 37% had hematological malignancy. Most patients had fire injuries (40%), followed by electric injury (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 48%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, eyes). Most patients received voriconazole as a single drug therapy (30%), followed by a lipidic formulation of amphotericin B (20%) or conventional amphotericin B (16%). The most common combination therapy was triazole plus a lipidic formulation of amphotericin B (30%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico. This study describes the epidemiological characteristics of patients with fusariosis from a multicenter cohort in Mexico. This findings provide information from this invasive fungal disease that threats different countries in Latin America.

In 2012, the US Centers for Disease Control and Prevention reported a fungal meningitis outbreak due to Exserohilum rostratum, caused by methylprednisolone administration. Twelve years later, an iatrogenic outbreak of Fusarium meningitis was documented in Mexico after epidural anesthesia. Due to the infrequency of its occurrence, fusariosis was historically an infectious disease of low interest in Mexico. When it did occur, cutaneous and ophthalmologic presentations were commonly reported. However, fusariosis became a health priority when an iatrogenic outbreak caused fungal meningitis. In this perspective, I present the valuable lessons learned by attending to this epidemiologic problem in Mexico, based on publications about the outbreak. Likewise, I discuss the latest publication regarding invasive fusariosis in Mexico, unrelated to the outbreak.

Breakthrough invasive fungal infections (bIFIs) are a challenging serious complication in high-risk hematologic patients and allogeneic hematopoietic stem cell transplantation recipients that may negatively impact their outcome. Despite advances in antifungal prophylaxis, diagnostics, and supportive care, bIFI occurrence reflects a complex interaction between host immunosuppression, emergence of resistant pathogens and pharmacological variables, including subtherapeutic drug exposure. Candida spp. have shifted towards non-albicans yeasts, whereas breakthrough mold infections more frequently involve non-fumigatus Aspergillus, Mucorales, Fusarium spp., and Scedosporium/Lomentospora spp. Early clinical recognition, rapid therapy escalation, aggressive diagnostic investigation, a switch to liposomal amphotericin B-based regimens in patients on azole prophylaxis, and therapeutic drug monitoring are essential to improve outcomes. Reducing the growing global burden of bIFIs will also require improved access to high-quality diagnostics and strengthened educational and stewardship efforts that prioritize antifungal resistance as an urgent health concern.

In Mexico, the Hospital Epidemiological Surveillance Network previously the COVID-19 pandemic, reported a total of 61,969 health care associated infections with an incidence rate of 4.7 per 100 discharges, 20.7% of which were categorized as ventilator associated pneumonia. Biofire Filmarray pneumonia panel has been accepted as a tool for early and rapid diagnostic of pneumonia with recognition of several hospital acquired pathogens including resistant genes. However, there are some mismatch in the multiplex PCR detection and the culture isolation. An observational, comparative, retrospective, non-randomized, cross-sectional, open study was performed using files from patients diagnosed with ventilator associated pneumonia who underwent diagnostic testing on culture and PCR multiplex FilmArray pneumonia panel to determine diagnostic accuracy. Intensive care unit files from August 2021 to February 2022 with ventilator associated pneumonia with airway samples for Filmarray pneumonia panel and cultures. Evaluation of the used diagnostic tests was carried out using: sensitivity, specificity, positive predictive value and negative predictive value. 55 patients were included, each of them with both test. 72% of the study population were males, with a mean age of 61 years. 76% of the population had severe COVID-19. E.Coli had 100% sentitivity and 96% specificity , P. aeruginosa 100% sentitivity and 88% specificity, E.Cloacae 100% sentitivity and 91% specificity, and S. aureus had 100% sentitivity and 89% specificity on Biofire Filmarray pneumonia panel. While K. pneumoniae had 50% sensitivity and 89% specificity. NPV was 98% for K. pneumoniae, and 100% for E. coli, P. aeruginosa, E. cloacae, and S. aureus. S.maltophilia was isolated in 3 culture samples and the Filmarray pneumonia panel was reported negative because lacking of testing this microorganism, as well as 1 A. fumigatus isolation. The different samples that were included from 55 patients in this study correlated with pneumonia panel and conventional cultures. Each of the microorganism that had correlation between Filmarray pneumonia panel compared with conventional cultures Biofire Filmarray pneumonia panel provides early and accurate information on pathogens causing ventilator associated pneumonia. However it cannot replace conventional culture because of lacking of some microorganism detection. It provides a useful tool for early decision-making in treatment. All Authors: No reported disclosures