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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fusariosis is an opportunistic&#44; cosmopolitan disease caused by filamentous&#44; hyaline fungi of the <span class="elsevierStyleItalic">Fusarium</span> genus&#44; widely distributed in nature as soil and plant saprobes&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It rarely affects immunocompetent individuals&#59; when it does&#44; the infection usually remains superficial&#44; causing onychomycosis and keratitis&#44; related to direct inoculation&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In immunocompromised patients&#44; especially those with hematological cancer&#44; in particular acute myeloid leukemia&#44; and after bone marrow transplantation&#44; invasive fungal infections are associated with 70&#37; mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In disseminated infections&#44; 80&#37; of patients develop skin lesions&#44; which may be the only early manifestation of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In its disseminated form&#44; fusariosis is a rare infection&#44; with an incidence of 0&#46;06&#37; to 0&#46;2&#37; in the United States and Europe&#59; in hematological patients&#44; however&#44; it is associated with high morbimortality&#44; due to the increased incidence and the low effectiveness of treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This report describes a case of disseminated fusariosis with cutaneous involvement in an immunocompromised patient due to bone marrow aplasia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">Female patient&#44; 29 years old&#44; previously healthy&#44; admitted to a tertiary hospital due to the sudden onset of petechiae in the lower limbs two months before&#44; associated with fever of recent onset&#46; On admission&#44; she was diagnosed with pancytopenia and severe febrile neutropenia &#40;neutrophils below 100 cells&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; and broad-spectrum antibiotic therapy &#40;meropenem and vancomycin&#41; was initiated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the investigation&#44; a bone marrow biopsy was performed&#59; the histopathology showed bone marrow hypoplasia of the three hematopoietic cell lines&#44; with only 5&#37; of cells&#46; In addition&#44; all serologies &#40;including parvovirus B19&#41; were requested&#44; and all infectious hypotheses were discarded&#59; therefore&#44; the diagnosis of idiopathic bone marrow aplasia was reached&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient had persistent fever despite antibiotic therapy&#44; but without bacterial growth in blood cultures&#46; Due to hemodynamic instability&#44; the patient was taken to the intensive care unit&#44; and amphotericin B was indicated at a dose of 5&#8239;mg&#47;kg&#47;day&#44; due to febrile neutropenia unresponsive to antibiotic therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">After the seventh day of hospitalization&#44; the patient presented a painful&#44; erythematous-violet macula in the left upper limb&#44; which after one week evolved with central necrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A lesion biopsy was performed&#59; the histopathology was compatible with leukocytoclastic vasculitis and numerous hyphae were seen on the vessel wall &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Direct examination of material from the skin lesion revealed filamentous fungi&#46; Culture in Sabouraud&#8217;s medium with chloramphenicol from the skin fragment and subsequent microculture of the colony evidenced the growth of <span class="elsevierStyleItalic">Fusarium</span> spp&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs 3 and 4</a>&#41;&#46; After the results of these tests&#44; amphotericin B was associated with voriconazole&#44; and the patient initially benefited from this association&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The dermatological examination also showed paronychia in the second and third left fingers and exuberant livedo reticularis in all lower limbs&#44; extending to the abdomen &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The image examination of the sinuses revealed extensive shadowing of the maxillary&#44; frontal&#44; sphenoid&#44; and ethmoid sinuses&#44; which was attributed to invasive sinusitis &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The otorhinolaryngology team performed a biopsy of the sinuses and a direct examination of the nasal cavity&#46; Surgical treatment through debridement was not possible due to persistent thrombocytopenia and lesion angioinvasion&#46; Histopathology and direct examination were similar to the findings of the skin lesion&#46; She also had extensive bilateral diffuse pulmonary infiltrate consistent with invasive pneumonia&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Throughout the period of neutropenia&#44; the patient received transfusions and stimulating factor for granulocytic colonies&#44; but did not present any bone morrow response&#46; After four weeks&#44; she developed refractory septic shock and&#44; despite supportive measures&#44; died 54 days after hospitalization&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fusariosis is the second most frequent invasive fungal infection in patients with hematological neoplasms&#59; <span class="elsevierStyleItalic">Fusarium solani</span> is the most common&#44; virulent&#44; and resistant species&#44; presenting the highest mortality&#44; confirmed in the case presented&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The infection starts by inhaling conidia or by direct contact with materials contaminated by spores&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Studies indicate that disseminated cases are usually acquired by inhalation with subsequent dissemination to other organs such as the kidneys&#44; liver&#44; eyes&#44; spleen&#44; and brain&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;8</span></a> In the reported case&#44; skin lesions preceded sinusitis and pneumonia&#44; suggesting hematogenous spread of cutaneous focus&#46; The infection is classified as disseminated when two or more organs are involved&#44; as seen in the case reported&#44; in which the patient presented sinusitis and pneumonia&#44; confirmed by image examination and the presence of skin lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The most common presentation is persistent fever unresponsive to broad-spectrum antibiotic therapy in a neutropenic patient&#44; such as the patient studied&#46; Typical skin involvement shows painful erythematous-violet macules or papules&#44; the center of which evolves to necrosis&#44; usually on the extremities&#59; all these findings were observed in the present case&#46; The dermatological examination also showed livedo reticularis in the entire lower limb reaching the abdomen&#44; which probably occurred due to intravascular proliferation of the fungus leading to occlusion and necrosis of the microvasculature&#44; although the authors have not found any reports of this phenomenon in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis requires the isolation of <span class="elsevierStyleItalic">Fusarium</span> spp&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present case&#44; hyphae were observed in the histopathology of the skin and sinuses&#44; confirmed by the growth of fungi in the culture of samples collected at these sites&#46; In histopathological examination&#44; fungi characteristically present angiolymphatic invasion by septate&#44; hyaline&#44; and branched hyphae&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Culture identification is important to help differentiate fusariosis from other hyalohyphomycoses&#46; The <span class="elsevierStyleItalic">Fusarium</span> genus is identified in the culture by multiple canoe-shaped hyaline macroconidia&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> However&#44; species identification requires molecular methods&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Invasive and generalized infections respond poorly to antifungal therapy&#44; partly due to drug resistance&#44; but mainly due to the lack of an effective response from the host&#44; which led to our patient&#39;s unfavorable outcome&#44; who remained with persistent neutropenia&#46; Therefore&#44; treatment is based on systemic antifungals and reversal of immunosuppression&#46; The ideal treatment should be guided by the antifungal sensitivity test&#44; which is available in only a few centers&#59; therefore&#44; most authors recommend combined therapy for severe cases&#44; with voriconazole and amphotericin B&#44; the scheme used in the present patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The patient had severe neutropenia related to bone marrow aplasia&#44; and the authors found in the literature three cases of disseminated fusariosis associated with this hematological disease&#44; all of which also had a fatal outcome&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Danielle Ferreira Chagas&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Lucia Martins Diniz&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Elton Almeida Lucas&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Paulo Sergio Emerich Nogueira&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fusariosis is a superficial or systemic infection&#44; which occurs mainly in immunocompromised hosts&#44; especially in patients with hematological neoplasia&#59; 70&#37;&#8211;75&#37; of the cases present cutaneous manifestations&#46; The disseminated form is rare and difficult to diagnose&#59; even with specific treatment&#44; the evolution is usually fatal&#46; Currently&#44; it is considered an emerging disease&#59; in some centers&#44; it is the second most common cause of invasive mycosis&#44; after aspergillosis&#46; The authors describe a case of a female patient with idiopathic bone marrow aplasia and disseminated fusariosis&#44; who initially appeared to benefit from voriconazole and amphotericin B&#59; however&#44; due to persistent neutropenia&#44; her clinical condition deteriorated with fatal evolution&#46;</p></span>"
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Case Report
Disseminated fusariosis in a patient with bone marrow aplasia
Danielle Ferreira Chagas
Corresponding author
daaani__@hotmail.com

Corresponding author.
, Lucia Martins Diniz, Elton Almeida Lucas, Paulo Sergio Emerich Nogueira
Dermatology Service, Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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in particular acute myeloid leukemia&#44; and after bone marrow transplantation&#44; invasive fungal infections are associated with 70&#37; mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In disseminated infections&#44; 80&#37; of patients develop skin lesions&#44; which may be the only early manifestation of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In its disseminated form&#44; fusariosis is a rare infection&#44; with an incidence of 0&#46;06&#37; to 0&#46;2&#37; in the United States and Europe&#59; in hematological patients&#44; however&#44; it is associated with high morbimortality&#44; due to the increased incidence and the low effectiveness of treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This report describes a case of disseminated fusariosis with cutaneous involvement in an immunocompromised patient due to bone marrow aplasia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">Female patient&#44; 29 years old&#44; previously healthy&#44; admitted to a tertiary hospital due to the sudden onset of petechiae in the lower limbs two months before&#44; associated with fever of recent onset&#46; On admission&#44; she was diagnosed with pancytopenia and severe febrile neutropenia &#40;neutrophils below 100 cells&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; and broad-spectrum antibiotic therapy &#40;meropenem and vancomycin&#41; was initiated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the investigation&#44; a bone marrow biopsy was performed&#59; the histopathology showed bone marrow hypoplasia of the three hematopoietic cell lines&#44; with only 5&#37; of cells&#46; In addition&#44; all serologies &#40;including parvovirus B19&#41; were requested&#44; and all infectious hypotheses were discarded&#59; therefore&#44; the diagnosis of idiopathic bone marrow aplasia was reached&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient had persistent fever despite antibiotic therapy&#44; but without bacterial growth in blood cultures&#46; Due to hemodynamic instability&#44; the patient was taken to the intensive care unit&#44; and amphotericin B was indicated at a dose of 5&#8239;mg&#47;kg&#47;day&#44; due to febrile neutropenia unresponsive to antibiotic therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">After the seventh day of hospitalization&#44; the patient presented a painful&#44; erythematous-violet macula in the left upper limb&#44; which after one week evolved with central necrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A lesion biopsy was performed&#59; the histopathology was compatible with leukocytoclastic vasculitis and numerous hyphae were seen on the vessel wall &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Direct examination of material from the skin lesion revealed filamentous fungi&#46; Culture in Sabouraud&#8217;s medium with chloramphenicol from the skin fragment and subsequent microculture of the colony evidenced the growth of <span class="elsevierStyleItalic">Fusarium</span> spp&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs 3 and 4</a>&#41;&#46; After the results of these tests&#44; amphotericin B was associated with voriconazole&#44; and the patient initially benefited from this association&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The dermatological examination also showed paronychia in the second and third left fingers and exuberant livedo reticularis in all lower limbs&#44; extending to the abdomen &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The image examination of the sinuses revealed extensive shadowing of the maxillary&#44; frontal&#44; sphenoid&#44; and ethmoid sinuses&#44; which was attributed to invasive sinusitis &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The otorhinolaryngology team performed a biopsy of the sinuses and a direct examination of the nasal cavity&#46; Surgical treatment through debridement was not possible due to persistent thrombocytopenia and lesion angioinvasion&#46; Histopathology and direct examination were similar to the findings of the skin lesion&#46; She also had extensive bilateral diffuse pulmonary infiltrate consistent with invasive pneumonia&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Throughout the period of neutropenia&#44; the patient received transfusions and stimulating factor for granulocytic colonies&#44; but did not present any bone morrow response&#46; After four weeks&#44; she developed refractory septic shock and&#44; despite supportive measures&#44; died 54 days after hospitalization&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fusariosis is the second most frequent invasive fungal infection in patients with hematological neoplasms&#59; <span class="elsevierStyleItalic">Fusarium solani</span> is the most common&#44; virulent&#44; and resistant species&#44; presenting the highest mortality&#44; confirmed in the case presented&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The infection starts by inhaling conidia or by direct contact with materials contaminated by spores&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Studies indicate that disseminated cases are usually acquired by inhalation with subsequent dissemination to other organs such as the kidneys&#44; liver&#44; eyes&#44; spleen&#44; and brain&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;8</span></a> In the reported case&#44; skin lesions preceded sinusitis and pneumonia&#44; suggesting hematogenous spread of cutaneous focus&#46; The infection is classified as disseminated when two or more organs are involved&#44; as seen in the case reported&#44; in which the patient presented sinusitis and pneumonia&#44; confirmed by image examination and the presence of skin lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The most common presentation is persistent fever unresponsive to broad-spectrum antibiotic therapy in a neutropenic patient&#44; such as the patient studied&#46; Typical skin involvement shows painful erythematous-violet macules or papules&#44; the center of which evolves to necrosis&#44; usually on the extremities&#59; all these findings were observed in the present case&#46; The dermatological examination also showed livedo reticularis in the entire lower limb reaching the abdomen&#44; which probably occurred due to intravascular proliferation of the fungus leading to occlusion and necrosis of the microvasculature&#44; although the authors have not found any reports of this phenomenon in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis requires the isolation of <span class="elsevierStyleItalic">Fusarium</span> spp&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present case&#44; hyphae were observed in the histopathology of the skin and sinuses&#44; confirmed by the growth of fungi in the culture of samples collected at these sites&#46; In histopathological examination&#44; fungi characteristically present angiolymphatic invasion by septate&#44; hyaline&#44; and branched hyphae&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Culture identification is important to help differentiate fusariosis from other hyalohyphomycoses&#46; The <span class="elsevierStyleItalic">Fusarium</span> genus is identified in the culture by multiple canoe-shaped hyaline macroconidia&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> However&#44; species identification requires molecular methods&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Invasive and generalized infections respond poorly to antifungal therapy&#44; partly due to drug resistance&#44; but mainly due to the lack of an effective response from the host&#44; which led to our patient&#39;s unfavorable outcome&#44; who remained with persistent neutropenia&#46; Therefore&#44; treatment is based on systemic antifungals and reversal of immunosuppression&#46; The ideal treatment should be guided by the antifungal sensitivity test&#44; which is available in only a few centers&#59; therefore&#44; most authors recommend combined therapy for severe cases&#44; with voriconazole and amphotericin B&#44; the scheme used in the present patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The patient had severe neutropenia related to bone marrow aplasia&#44; and the authors found in the literature three cases of disseminated fusariosis associated with this hematological disease&#44; all of which also had a fatal outcome&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Danielle Ferreira Chagas&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Lucia Martins Diniz&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Elton Almeida Lucas&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Paulo Sergio Emerich Nogueira&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fusariosis is a superficial or systemic infection&#44; which occurs mainly in immunocompromised hosts&#44; especially in patients with hematological neoplasia&#59; 70&#37;&#8211;75&#37; of the cases present cutaneous manifestations&#46; The disseminated form is rare and difficult to diagnose&#59; even with specific treatment&#44; the evolution is usually fatal&#46; Currently&#44; it is considered an emerging disease&#59; in some centers&#44; it is the second most common cause of invasive mycosis&#44; after aspergillosis&#46; The authors describe a case of a female patient with idiopathic bone marrow aplasia and disseminated fusariosis&#44; who initially appeared to benefit from voriconazole and amphotericin B&#59; however&#44; due to persistent neutropenia&#44; her clinical condition deteriorated with fatal evolution&#46;</p></span>"
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ISSN: 03650596
Original language: English
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