Management of fusariosis in transplant patients

INTRODUCTION: Invasive fusariosis is a rare but devastating mold infection in hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT). Its clinical impact stems from delayed and challenging diagnosis, often made when fungal burden is already high; frequent dissemination with fungemia; and the limited availability of reliably effective antifungal agents. Together with the profound influence of host immune status on outcome, these factors drive persistently high mortality despite advances in antifungal therapy and supportive care, underscoring the urgent need for better diagnostic tools and novel therapeutic strategies. AREAS COVERED: We searched PubMed (1990-2025) for studies reporting the epidemiology, clinical presentation, diagnostic approaches, and management of fusariosis in transplant recipients. Key topics include the trimodal timing of fusariosis after HCT, species distribution across geographic regions, diagnostic challenges with culture and nonspecific biomarkers, and therapeutic outcomes with amphotericin B formulations and voriconazole. Emerging agents such as fosmanogepix and novel molecular platforms are also discussed. EXPERT OPINION: Despite its rarity, fusariosis poses a disproportionate threat to transplant recipients due to diagnostic delays, lack of randomized trials, and few effective antifungal options. Incorporating rapid molecular diagnostics, next-generation antifungals, and immune-directed strategies will be critical to improving real-world outcomes and survival.