Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive fusariosis Andrea G. Varon, Simone A. Nouer **, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalh ~ aes, Tiyomi Akiti, Marcia Garnica, Marcio Nucci* University Hospital, Federal University of Rio de Janeiro, Brazil Accepted 20 August 2013 Available online 28 August 2013 KEYWORDS Fusariosis; Onychomycosis; Invasive fungal disease; Risk factor; Hematologic disease Summary Objectives: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive fu- sariosis. Methods: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. Results: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing le- sions of onychomycosis, intertrigo or both. Invasive fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the sub- sequent development of invasive fusariosis (p Z 0.04). Conclusions: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive fusariosis. The use of anti-mould prophy- laxis in this setting should be explored in future studies. ª 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Hospital Universit ario Clementino Fraga Filho, UFRJ, Rua Prof. Rodolpho Paulo Rocco 255, 21941-913 Rio de Janeiro, Brazil. Tel./fax: þ55 21 25622460. ** Corresponding author. Hospital Universit ario Clementino Fraga Filho, UFRJ, Rua Prof. Rodolpho Paulo Rocco 255, 21941-913 Rio de Janeiro, Brazil. Tel.: þ55 21 25622693. E-mail addresses: snouer@hucff.ufrj.br (S.A. Nouer), mnucci@hucff.ufrj.br , mar.nucci@gmail.com (M. Nucci). 0163-4453/$36 ª 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jinf.2013.08.011 www.elsevierhealth.com/journals/jinf Journal of Infection (2014) 68, 85e89