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Prevention of healthcare-associated invasive aspergillosis during hospital construction/renovation works. J Hosp Infect 2019; 103:1-12. [DOI: 10.1016/j.jhin.2018.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 01/10/2023]
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A Polyphasic Approach Aids Early Detection of Potentially Toxigenic Aspergilli in Soil. Microorganisms 2019; 7:microorganisms7090300. [PMID: 31470555 PMCID: PMC6781248 DOI: 10.3390/microorganisms7090300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022] Open
Abstract
Key chili and maize growing areas of Pakistan were selected for a focused baseline study of the levels of Aspergillus spp. Investigations were undertaken using a combination of molecular and culture-based techniques. Samples investigated included soil samples, one-year-old corn cobs, and fresh chili from selected locations. Aspergillus strains obtained from corn cobs were screened using coconut milk agar, resulting in one strain that was positive for aflatoxin production. Whole genome sequencing (WGS) with low coverage techniques were employed to screen the isolates for differences in the ribosomal RNA gene cluster and mitochondrial genome, with the aflatoxigenic strain proving to have a distinctive profile. Finally, strains were subjected to matrix-assisted laser-desorption and ionization time-of-flight mass spectrometry (MALDI-ToF-MS) in order to obtain a proteomic ‘fingerprint’ which was used to distinguish the aflatoxigenic strain from the other isolates. The next generation sequencing (NGS) study was broadened to incorporate metabarcoding with ITS rRNA for determining the microbial biodiversity of the soil samples and presumptive screening for the presence of aflatoxigenic strains. Using information gleaned from the WGS results, a putative aflatoxigenic operational taxonomic unit (OTU) was observed in four of the 15 soil samples screened by metabarcoding. This method may have beneficial applications in early detection and surveillance programs in agricultural soils and commodities.
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Durga CS, Gupta N, Soneja M, Bhatt M, Xess I, Jorwal P, Singh G, Ray A, Nischal N, Ranjan P, Biswas A, Wig N. Invasive fungal infections in critically ill patients: A prospective study from a tertiary care hospital in India. Drug Discov Ther 2019; 12:363-367. [PMID: 30674771 DOI: 10.5582/ddt.2018.01068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Invasive fungal infections (IFI) are commonly seen in immunosuppressed individuals but their epidemiology in critically ill patients has not been well described. The aim of this study was to determine the frequency, risk factors and outcome of invasive fungal infections in a medical intensive care unit. A prospective observational study was carried out between August 2016 and March 2018 in the medical intensive care unit. Patients above the age of 14 years with endotracheal intubation and/or central venous catheter for at-least three days and sepsis (not responding to 48 hours of intravenous antibiotic therapy) were included in the study. Suitable samples were collected and were subjected to fungal diagnostics. Invasive fungal disease was defined according to standard guidelines. Of the 100 recruited patients, a total of 11 patients had invasive aspergillosis, three patients had invasive candidiasis and one patient had both invasive aspergillosis and mucormycosis. IFI was more commonly seen in patients with auto-immune diseases (p = 0.002, odds ratio-10.13 (95% CI: 2.3-44)). A mortality of 73% was observed in patients with IFI. In conclusion, IFI, especially aspergillosis is grossly under-reported in critical settings. Early suspicion, thorough investigation and timely diagnosis may alleviate patients of significant mortality and morbidity.
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Affiliation(s)
| | - Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences
| | - Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences
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Rudramurthy SM, Paul RA, Chakrabarti A, Mouton JW, Meis JF. Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management. J Fungi (Basel) 2019; 5:jof5030055. [PMID: 31266196 PMCID: PMC6787648 DOI: 10.3390/jof5030055] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Aspergillus flavus is the second most common etiological agent of invasive aspergillosis (IA) after A. fumigatus. However, most literature describes IA in relation to A. fumigatus or together with other Aspergillus species. Certain differences exist in IA caused by A. flavus and A. fumigatus and studies on A. flavus infections are increasing. Hence, we performed a comprehensive updated review on IA due to A. flavus. A. flavus is the cause of a broad spectrum of human diseases predominantly in Asia, the Middle East, and Africa possibly due to its ability to survive better in hot and arid climatic conditions compared to other Aspergillus spp. Worldwide, ~10% of cases of bronchopulmonary aspergillosis are caused by A. flavus. Outbreaks have usually been associated with construction activities as invasive pulmonary aspergillosis in immunocompromised patients and cutaneous, subcutaneous, and mucosal forms in immunocompetent individuals. Multilocus microsatellite typing is well standardized to differentiate A. flavus isolates into different clades. A. flavus is intrinsically resistant to polyenes. In contrast to A. fumigatus, triazole resistance infrequently occurs in A. flavus and is associated with mutations in the cyp51C gene. Overexpression of efflux pumps in non-wildtype strains lacking mutations in the cyp51 gene can also lead to high voriconazole minimum inhibitory concentrations. Voriconazole remains the drug of choice for treatment, and amphotericin B should be avoided. Primary therapy with echinocandins is not the first choice but the combination with voriconazole or as monotherapy may be used when the azoles and amphotericin B are contraindicated.
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Affiliation(s)
- Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India.
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 3015GD Rotterdam, The Netherlands.
| | - Raees A Paul
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 3015GD Rotterdam, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ) and Center of Expertise, 6532SZ Nijmegen, The Netherlands
- Center of Expertise in Mycology Radboudumc/CWZ, 6532SZ Nijmegen, The Netherlands
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Assessment of Airborne Bacterial and Fungal Communities in Selected Areas of Teaching Hospital, Kandy, Sri Lanka. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7393926. [PMID: 31309114 PMCID: PMC6594343 DOI: 10.1155/2019/7393926] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/13/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023]
Abstract
Nosocomial infections, in lay term known as hospital acquired infections, are caused mainly by airborne pathogens found in healthcare facilities and their surroundings. The aim of this study was to quantify and identify bacteria and fungi in a hospital, which is an understudied area of air quality in Sri Lanka. Air samples were collected in agar medium and petri plates containing sterile filter papers. The number of culturable and total airborne microorganisms was estimated by manual counting and fluorescent microscopy, respectively. The morphologically distant bacteria and fungi were identified by DNA sequencing. The statistical analysis revealed significant variances between studied sites (p < 0.05) where Outpatients Department and Respiratory Unit showed higher levels of airborne microbial load. Culturable microbial count was higher at noon (hospital visiting hours) compared to other sampling periods (after hospital visiting hours) within the hospital. Total count of airborne microbes was found to be the highest during the afternoon. The most sensitive zones such as Operating Theatre and Intensive Care Unit showed considerably higher counts of airborne microbes. Identification by molecular means revealed the presence of human pathogens in the hospital air including Bacillus sp, Micrococcus sp, Pseudomonas sp, Staphylococcu ssp, Exiguobacterium sp, Enterobacter sp, Escherichia sp, Sphingomonas sp, Massilia sp, Kocuria sp, Fusarium sp, and Aspergillus sp. In conclusion, the results from this study indicate that the hospital air was generally contaminated. Therefore, the implementation of proactive policies and strategies are needed to monitor hospital air quality in sensitive zones as well as other areas of the hospitals.
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Risk of invasive fungal infections during hospital construction: how to minimize its impact in immunocompromised patients. Curr Opin Infect Dis 2019; 32:322-329. [PMID: 31157630 DOI: 10.1097/qco.0000000000000566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Fungal outbreaks have been reported in healthcare settings, showing that construction activities are a serious threat to immunocompromised hosts. Preventive measures to control fungal outbreaks (especially Aspergillus spp.) are considered essential during hospital construction. In this article, we update the main advances in each of preventive strategies. RECENT FINDINGS Anticipation and multidisciplinary teamwork are the keystone for fungal outbreaks prevention. Strategies focused on environmental control measures of airborne dissemination of fungal spores have proven to be successful. It is important to recommend azole-resistant Aspergillus fumigatus active surveillance from both air (outdoors and indoors) and clinical samples during hospital construction works. Apart from genotyping, studies should be further encouraged to understand the environmental dynamics. Risk assessment and implement preventive measures (environment control strategies, air surveillance, inpatients immunocompromised patients in high-efficiency particulate air filters rooms, patient education, antifungal prophylaxis in high-risk patient groups, etc.) have shown that these accomplish to reduce the incidence of invasive fungal infection (IFI). SUMMARY In general, it is not only a strategy that should be implemented to reduce the risk of IFI but is a bundle of preventive measures, which have proven to be successful in control infection and prevention of airborne transmission of fungi.
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Newcomer DA, LaPuma P, Brandys R, Northcross A, Dasgupta A. Measuring airflow through the portable high-efficiency air filtration (PHEAF) device to assess reliability of instrument and sample location. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2019; 69:734-742. [PMID: 30698506 DOI: 10.1080/10962247.2019.1576554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
The portable high-efficiency air filtration (PHEAF) device is an engineering control common to the environmental remediation industry. Damage to the high-efficiency particulate air (HEPA) filter (e.g., filtration media, gasket), improper installation of the filter into the mounting frame, or defects in the filtration housing affect the capture efficiency of the device. PHEAF devices operating at less than marketed efficiencies justify periodic leak testing of the PHEAF device, especially when the filtered air is exhausted into occupied spaces. A leak test is accomplished by injecting a known concentration of aerosol upstream of the HEPA filter and measuring the percentage of aerosol penetrating through the filtration system. The test protocol scripted for stationary systems (i.e., biological safety cabinets) states that upstream concentrations can be empirically determined using the aerosol photometer to measure particulate matter (PM) in the airstream. This practice requires a homogenous mixture of the aerosol challenge agent within the airstream. However, design of the PHEAF device does not include a validated induction point for the aerosol. Absent of an acceptable means to achieve a homogenous mixture for upstream measurement, the aerosol concentration is mathematically derived based on the measured air volume passing through the PHEAF equipment. In this study, intake volume and exhaust volume for each PHEAF device were measured by either the balometer or the hot wire anemometer. Variability of measurements was examined by instrument and sample location (intake vs. exhaust) to understand which combination would be most consistent for measuring airflow volume. From this study, the authors conclude that the balometer is preferred compared with the hot wire anemometer for measuring airflow through the PHEAF device. Exhaust measurement by balometer seems more reliable than intake measurements by hot wire anemometer. Implications: Although testing of PHEAF devices is recommended by various public health authorities, no nationally recognized test protocol has been published in the United States. In support of measuring the performance of the PHEAF device in a field setting, this study evaluated the hot wire anemometer and balometer techniques and sample locations (intake vs. exhaust) to reliably measure airflow through the PHEAF device. Since accuracy of the particle measurement is associated with airflow volume, it is essential to obtain a true airflow reading. This study suggests that the balometer was more consistent in measuring airflow through the PHEAF device.
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Affiliation(s)
- Derek A Newcomer
- a Division of Occupational Health and Safety, Office of Research Services , National Institutes of Health , Bethesda , MD , USA
| | - Peter LaPuma
- b Department of Environmental and Occupational Health, Milken Institute School of Public Health , George Washington University , Washington , DC , USA
| | - Robert Brandys
- c Occupational & Environmental Health Consulting Services, Inc ., Las Vegas , NV , USA
| | - Amanda Northcross
- b Department of Environmental and Occupational Health, Milken Institute School of Public Health , George Washington University , Washington , DC , USA
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Park JH, Ryu SH, Lee JY, Kim HJ, Kwak SH, Jung J, Lee J, Sung H, Kim SH. Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study. Antimicrob Resist Infect Control 2019; 8:88. [PMID: 31161035 PMCID: PMC6542016 DOI: 10.1186/s13756-019-0543-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Invasive aspergillosis (IA) is an opportunistic fungal infection that mostly occurs in immunocompromised patients, such as those having hematologic malignancy or receiving hematopoietic stem cell transplantation. Inhalation of Aspergillus spores is the main transmission route of IA in immunocompromised patients. Construction work in hospitals is a risk factor for environmental fungal contamination. We measured airborne fungal contamination and the incidence of IA among immunocompromised patients, and evaluated their correlation with different types of construction works. Methods Our tertiary hospital in Seoul, Korea underwent facility construction from September 2017 to February 2018. We divided the entire construction period into period 1 (heavier works: demolition and excavation) and period 2 (lighter works: framing, interior designing, plumbing, and finishing). We conducted monthly air sampling for environmental spore surveillance in three hematologic wards. We evaluated the incidence of IA among all immunocompromised patients hospitalized in the three hematologic wards (2 adult wards and 1 pediatric ward) during this period. IA was categorized into proven, probable, and possible aspergillosis based on the revised European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Results A total of 15 patients was diagnosed with proven (1 case), probable (8 cases), or possible (6 cases) hospital-acquired IA during period 1. In period 2, 14 patients were diagnosed with either proven (1 case), probable (10 cases), or possible (3 cases) hospital-acquired IA. Total mold and Aspergillus spp. spore levels in the air tended to be higher in period 1 (p = 0.06 and 0.48, respectively). The incidence rate of all IA by the EORTC/MSG criteria was significantly higher in period 1 than in period 2 (1.891 vs. 0.930 per 1000 person-days, p = 0.05). Conclusions Airborne fungal spore levels tended to be higher during the period with heavier construction works involving demolition and excavation, during which the incidence of IA was significantly higher as well. We recommend monitoring airborne fungal spore levels during construction periods in hospitals with immunocompromised patients. Subsequently, the effect of airborne fungal spore level monitoring in reducing hospital-acquired IA should be evaluated. Electronic supplementary material The online version of this article (10.1186/s13756-019-0543-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joung Ha Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea
| | - Seung Hee Ryu
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Young Lee
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeon Jeong Kim
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Kwak
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.,2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jina Lee
- 3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heungsup Sung
- 4Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.,2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abdel-Rahim IR, Nafady NA, Bagy MMK, Abd-Alla MH, Abd-Alkader AM. Fungi-induced paint deterioration and air contamination in the Assiut University hospital, Egypt. INDOOR AND BUILT ENVIRONMENT 2019; 28:384-400. [DOI: 10.1177/1420326x18765256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Ismail R. Abdel-Rahim
- Faculty of Science, Botany and Microbiology Department, Assiut University, Assiut, Egypt
| | - Nivien A. Nafady
- Faculty of Science, Botany and Microbiology Department, Assiut University, Assiut, Egypt
| | - Magdy M. K. Bagy
- Faculty of Science, Botany and Microbiology Department, Assiut University, Assiut, Egypt
| | - Mohamed H. Abd-Alla
- Faculty of Science, Botany and Microbiology Department, Assiut University, Assiut, Egypt
| | - Ahmad M. Abd-Alkader
- Faculty of Science, Botany and Microbiology Department, Assiut University, Assiut, Egypt
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Shajahan A, Culp CH, Williamson B. Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients' medical outcomes: A review of scientific research on hospital buildings. INDOOR AIR 2019; 29:161-176. [PMID: 30588679 PMCID: PMC7165615 DOI: 10.1111/ina.12531] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 05/04/2023]
Abstract
The indoor environment of a mechanically ventilated hospital building controls infection rates as well as influences patients' healing processes and overall medical outcomes. This review covers the scientific research that has assessed patients' medical outcomes concerning at least one indoor environmental parameter related to building heating, ventilation, and air conditioning (HVAC) systems, such as indoor air temperature, relative humidity, and indoor air ventilation parameters. Research related to the naturally ventilated hospital buildings was outside the scope of this review article. After 1998, a total of 899 papers were identified that fit the inclusion criteria of this study. Of these, 176 papers have been included in this review to understand the relationship between the health outcomes of a patient and the indoor environment of a mechanically ventilated hospital building. The purpose of this literature review was to summarize how indoor environmental parameters related to mechanical ventilation systems of a hospital building are impacting patients. This review suggests that there is a need for future interdisciplinary collaborative research to quantify the optimum range for HVAC parameters considering airborne exposures and patients' positive medical outcomes.
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Affiliation(s)
- Amreen Shajahan
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
| | - Charles H. Culp
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
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Monteiro C, Pinheiro D, Maia M, Faria MA, Lameiras C, Pinto E. Aspergillus species collected from environmental air samples in Portugal-molecular identification, antifungal susceptibility and sequencing of cyp51A gene on A. fumigatus sensu stricto itraconazole resistant. J Appl Microbiol 2019; 126:1140-1148. [PMID: 30735287 DOI: 10.1111/jam.14217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
AIMS Aspergillus sp. are ubiquitous saprophytic fungi and their conidia easily inhaled. This is particularly important in immunocompromised patients, more susceptible to developing invasive aspergillosis. In addition to A. fumigatus sensu stricto, cryptic species, many resistant to antifungal drugs, have been associated with invasive infections, making it important to assess their presence and diversity in different environments. Therefore, the aim of this study was to assess the presence, diversity and susceptibility to antifungal drugs of airborne fungi. Moreover, in azole-resistant A. fumigatus sensu stricto isolates the presence of underlying molecular mechanisms of resistance was investigated. METHODS AND RESULTS Eighty-four Aspergillus isolates were collected from the environment air in hospitals and the Water Treatment Plant. The use of molecular tools allowed to detect 12 different cryptic species, showing a prevalence of 21·4%. The majority of isolates (69·0%) belonged to A. fumigatus complex and 65·4% were A. fumigatus sensu stricto. Among these, 21·8% were resistant to itraconazole (ITZ), 38·2% to posaconazole and 87·3% to isavuconazole; none of them were resistant to voriconazole or amphotericin B. Sequencing of the cyp51A gene on the 12 A. fumigatus sensu stricto ITZ-resistant isolates revealed the presence of mutations. CONCLUSION Our study reports a large number of environmental-resistant Aspergillus species, including A. fumigatus sensu stricto that display an important role in invasive fungal infections. None of the environmental isolates showed mutations on cyp51A gene related to azole resistance. SIGNIFICANT AND IMPACT OF THE STUDY This study is the first assessment of molecular resistance mechanisms in A. fumigatus sensu stricto environmental isolates, in Portugal. Since TR34/L98H and TR46/Y121F/T289A cyp51A mutations were already reported in the clinical setting in Portugal (Monteiro et al. J Glob Antimicron Resist 13: 190-191, 2018; Pinto et al. Front Microbiol 9: 1656, 2018), and have been linked to environmental route, it is utmost importance to perform surveillance network for azole-resistant A. fumigatus.
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Affiliation(s)
- C Monteiro
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal
| | - D Pinheiro
- Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar S. João EPE, Porto, Portugal
| | - M Maia
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal
| | - M A Faria
- LAQV-REQUIMTE, Laboratory of Bromatology and Hydrology, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - C Lameiras
- Microbiology Service, Laboratorial Diagnostic Department, Instituto Português de Oncologia do Porto FG, EPE (IPOFG-Porto), Porto, Portugal
| | - E Pinto
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal.,Interdisciplinary Centre of Marine and Environmental Research (CIIMAR/CIMAR), University of Porto, Matosinhos, Portugal
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Monitoring of mycoflora in outdoor air of different localities of Ahvaz, Iran. J Mycol Med 2019; 28:87-93. [PMID: 29402620 DOI: 10.1016/j.mycmed.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/03/2017] [Accepted: 12/15/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Airborne fungi are considered important causes of respiratory allergy and diseases. The knowledge of these fungi in a city or region is important for the ecological diagnosis and specific treatment of respiratory manifestations induced by inhalation of fungal agents. Therefore, in recent years bioaerosols and their density in the air is highly regarded. Identifying fungi with common mycological methods as well as molecular about 5% of people are prone to allergic symptoms of the respiratory tract caused by molds during their lives. Fungi are being considered as one of the most common triggers of asthma, allergic rhinitis and other respiratory problems. AIMS We aimed at the investigation of the airborne fungi of Ahvaz, Khuzestan province, Iran, during spring and autumn months. MATERIALS AND METHODS A total of 224 Petri dishes with Sabouraud dextrose agar medium containing chloramphenicol were exposed at seven different regions in the city. Two hundred and twenty-four samples (112 samples per season) were taken from outdoor air seven areas of Ahvaz using microbial sampler (Quick Take-30, SKC, USA) with Debbi 14.3L/min during 5minutes directly on Sabouraud dextrose agar medium with Chloramphenicol and Dechlorane. The effects of environmental factors such as temperature, humidity and wind velocity on bioaerosol concentrations were studied. RESULTS The dishes exposed yielded 1240 fungal colonies of 24 genera. The most predominant were: Cladosporium spp. (37.1%), Alternaria spp. (25.7%), Aspergillus spp. (13.5%), Penicillium spp. (5.9%), Drechslera spp. (3.46%) and Stemphylium spp. (3.46%). The maximum and minimum numbers of airborne fungi were isolated from humid (32.3%) and industrial (17%) environments, respectively. In addition, positive correlation was observed between the number of fungi and relative humidity (r=0.476, P=0.000) in spring and autumn seasons. CONCLUSION This study indicated that the incidence of airborne fungi with clinical significance had a direct relationship with the variation of environmental conditions.
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Karimpour Roshan S, Godini H, Nikmanesh B, Bakhshi H, Charsizadeh A. Study on the relationship between the concentration and type of fungal bio-aerosols at indoor and outdoor air in the Children's Medical Center, Tehran, Iran. ENVIRONMENTAL MONITORING AND ASSESSMENT 2019; 191:48. [PMID: 30610385 DOI: 10.1007/s10661-018-7183-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
Fungal bio-aerosols are of concern due to their adverse health effects, especially in indoor environments. The aim of this study was to evaluate the relationship between the concentration and type of fungal bio-aerosols in the indoor and outdoor of Children's Medical Center in Tehran, Iran. In the present descriptive-analytical study, the fungal bio-aerosols' concentrations in both indoor and outdoor of the hospital air were measured. The measurements were carried out by the Anderson method using a Quick Take 30 pump at 28.3 L min-1 and 2.5 min sampling that was placed on a Sabouraud dextrose agar with chloramphenicol. The average concentrations of total fungal bio-aerosols in the hospital indoor and outdoor air were 40.48 and 119.6 CFU/m3, respectively. Onco-hematology and bone marrow transplantation wards were the most and least contaminated units, respectively (11.09 CFU/m3 vs 1.47 CFU/m3). The most common fungi isolated from the indoor environment were Penicillium spp. (45.86%) which was followed by Cladosporium spp. (31.92%), Aspergillus section Nigri (6.26%), sterilized mycelia (5.05%), and Aspergillus section Flavi (2.83%). Cladosporium spp. (61.10 CFU/m3) and Penicillium spp. (18.56 CFU/m3) had the highest mean concentrations in outdoor and indoor air, respectively. The indoor-to-outdoor ratio of fungal aerosols was < 1 at most sampling sites, indicating that the indoor fungal bio-aerosols may have originated from the outdoor environment.
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Affiliation(s)
- Sedighe Karimpour Roshan
- Research Center for Health, Safety and Environment (HSE), Alborz University of Medical Sciences, Karaj, Iran
- Department of Environmental Health, School of health, Alborz University of Medical Sciences, Karaj, Iran
| | - Hatam Godini
- Research Center for Health, Safety and Environment (HSE), Alborz University of Medical Sciences, Karaj, Iran.
- Department of Environmental Health, School of health, Alborz University of Medical Sciences, Karaj, Iran.
| | - Bahram Nikmanesh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Heidar Bakhshi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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64
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Airborne Aspergillus fumigatus spore concentration during demolition of a building on a hospital site, and patient risk determination for invasive aspergillosis including azole resistance. J Hosp Infect 2018; 100:e91-e97. [DOI: 10.1016/j.jhin.2018.07.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/22/2018] [Indexed: 11/18/2022]
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65
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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66
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Sood G, Vaidya D, Dam L, Grubb LM, Zenilman J, Krout K, Khouri-Stevens Z, Bennett R, Blanding R, Riedel S, Milner S, Price LA, Perl TM. A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy. Am J Infect Control 2018; 46:1047-1050. [PMID: 29609856 DOI: 10.1016/j.ajic.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe a polymicrobial fungal outbreak after Hurricane Sandy. DESIGN An observational concurrent outbreak investigation and retrospective descriptive review. SETTING A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. PATIENTS Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. METHODS An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. RESULTS A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. CONCLUSIONS Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.
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Affiliation(s)
- Geeta Sood
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD.
| | - Dhananjay Vaidya
- The Johns Hopkins University, School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Lisa Dam
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Lisa M Grubb
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Jonathan Zenilman
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD
| | - Kelly Krout
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | | | | | - Stefan Riedel
- The Johns Hopkins University, School of Medicine, Department of Pathology, Division of Microbiology, Baltimore, MD
| | - Stephen Milner
- The Johns Hopkins University, School of Medicine, Department of Plastic Surgery, Baltimore, MD
| | - Leigh Ann Price
- The Johns Hopkins University, School of Medicine, Department of Plastic Surgery, Baltimore, MD
| | - Trish M Perl
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD
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67
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Echeverri GJ, Caicedo LA, Delgado A, Thomas LS, Garcia VH, Gomez C, Aristizabal AM, Arrunátegui AM, Rosso F. Aspergillus hepatic artery thrombosis in liver transplantation. Med Mycol Case Rep 2018; 22:27-29. [PMID: 30101055 PMCID: PMC6083899 DOI: 10.1016/j.mmcr.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
We present the first cirrhotic patient who underwent liver transplantation (LT) and presented a hepatic artery thrombosis of the graft due to Aspergillus fumigatus, within the first month of LT. This culminated in graft loss, re-transplant with multiple biliary and infectious complications. To our knowledge, this is a case report of an early hepatic artery thrombosis due to Aspergillus fumigatus in an infection-free patient.
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Affiliation(s)
- Gabriel J Echeverri
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Luis-Armando Caicedo
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia
| | - Alejandro Delgado
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Laura-Sofia Thomas
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Victor H Garcia
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Catalina Gomez
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Ana M Aristizabal
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cl. 18 #122-135, Cali 76008, Colombia
| | - Ana M Arrunátegui
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Pathology department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia
| | - Fernando Rosso
- Transplant Surgery Department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Clinical Research Center, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia.,Infectious disease department, Fundación Valle de Lilí, Carrera 98 # 18-49, Cali 760032, Colombia
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68
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Ashu EE, Xu J. Strengthening the One Health Agenda: The Role of Molecular Epidemiology in Aspergillus Threat Management. Genes (Basel) 2018; 9:genes9070359. [PMID: 30029491 PMCID: PMC6071254 DOI: 10.3390/genes9070359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
The United Nations’ One Health initiative advocates the collaboration of multiple sectors within the global and local health authorities toward the goal of better public health management outcomes. The emerging global health threat posed by Aspergillus species is an example of a management challenge that would benefit from the One Health approach. In this paper, we explore the potential role of molecular epidemiology in Aspergillus threat management and strengthening of the One Health initiative. Effective management of Aspergillus at a public health level requires the development of rapid and accurate diagnostic tools to not only identify the infecting pathogen to species level, but also to the level of individual genotype, including drug susceptibility patterns. While a variety of molecular methods have been developed for Aspergillus diagnosis, their use at below-species level in clinical settings has been very limited, especially in resource-poor countries and regions. Here we provide a framework for Aspergillus threat management and describe how molecular epidemiology and experimental evolution methods could be used for predicting resistance through drug exposure. Our analyses highlight the need for standardization of loci and methods used for molecular diagnostics, and surveillance across Aspergillus species and geographic regions. Such standardization will enable comparisons at national and global levels and through the One Health approach, strengthen Aspergillus threat management efforts.
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Affiliation(s)
- Eta E Ashu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, Ontario, ON L8S 4K1, Canada.
| | - Jianping Xu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, Ontario, ON L8S 4K1, Canada.
- Public Research Laboratory, Hainan Medical University, Haikou, Hainan 571199, China.
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69
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Viegas C, Moreira R, Faria T, Caetano LA, Carolino E, Gomes AQ, Viegas S. Aspergillus prevalence in air conditioning filters from vehicles: Taxis for patient transportation, forklifts, and personal vehicles. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:341-349. [PMID: 29727587 DOI: 10.1080/19338244.2018.1472545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
The frequency and importance of Aspergillus infections is increasing worldwide. This study aimed to assess the occupational exposure of forklifts and taxi drivers to Aspergillus spp. Nineteen filters from air conditioning system of taxis, 17 from forklifts and 37 from personal vehicles were assessed. Filters extract were streaked onto MEA, DG18 and in azole-supplemented media. Real-time quantitative PCR amplification of selected Aspergillus species-complex was also performed. Forklifts filter samples presented higher median values. Aspergillus section Nigri was the most observed in forklifts filters in MEA (28.2%) and in azole-supplemented media. DNA from Aspergillus sections Fumigati and Versicolores was successfully amplified by qPCR. This study enlightens the added value of using filters from the air conditioning system to assess Aspergillus spp. occupational exposure. Aspergillus azole resistance screening should be included in future occupational exposure assessments.
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Affiliation(s)
- Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - Ricardo Moreira
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Tiago Faria
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Liliana Aranha Caetano
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Elisabete Carolino
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Anita Quintal Gomes
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- University of Lisbon Institute of Molecular Medicine, Faculty of Medicine, Lisbon, Portugal
| | - Susana Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
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70
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Loeffert ST, Hénaff L, Dupont D, Bienvenu AL, Dananché C, Cassier P, Bénet T, Wallon M, Gustin MP, Vanhems P. Prospective survey of azole drug resistance among environmental and clinical isolates of Aspergillus fumigatus in a French University hospital during major demolition works. J Mycol Med 2018; 28:469-472. [PMID: 29853288 DOI: 10.1016/j.mycmed.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/04/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Recent studies have reported the emerging worldwide problem of azole drug resistance of A. fumigatus isolates. The aim of this study was to evaluate the antifungal susceptibilities of A. fumigatus isolates recovered from air and clinical samples collected in a French University hospital (Lyon), which underwent major deconstruction works over a one year-period. METHODS A daily surveillance of fungal contamination was implemented during 11-months. Environmental survey was realized by air samplings, outdoor and indoor, with an automatic agar sampler. In parallel, surveillance of IA infection cases was conducted by epidemiological investigation. Environmental and clinical isolates of A. fumigatus were identified by conventional methods and β-tubulin sequencing. Susceptibility testing of A. fumigatus isolates against Itraconazole (ITZ), Voriconazole (VCZ) was performed using Etest method. RESULTS A total of 3885 air samples (1744 outdoor samples and 2141 indoor samples) were collected. From the 3073 identified colonies of A. fumigatus, 400 A. fumigatus isolates were tested for their susceptibility to ITZ and VCZ, including 388 isolates coming from the environment (indoor n:157, outdoor n:231) and 12 isolates coming from clinical samples. All the 400 isolates were susceptible to azoles (≤1μg/mL). CONCLUSIONS No environmental reservoir of A. fumigatus azole resistant strains was found in our hospital which was undergoing major demolition works. Further studies with larger number of A. fumigatus clinical isolates and environmental isolates from agricultural areas and healthcare establishments are needed to better appreciate the occurrence and prevalence of azole resistance.
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Affiliation(s)
- S T Loeffert
- Laboratoire des pathogènes emergents-fondation mérieux, centre international de recherche en infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, université de Lyon 1, 69000 Lyon, France.
| | - L Hénaff
- Institut de parasitologie et de mycologie médicale, hôpital de la Croix-Rousse, 69000 Lyon, France
| | - D Dupont
- Institut de parasitologie et de mycologie médicale, hôpital de la Croix-Rousse, 69000 Lyon, France
| | - A-L Bienvenu
- Institut de parasitologie et de mycologie médicale, hôpital de la Croix-Rousse, 69000 Lyon, France
| | - C Dananché
- Laboratoire des pathogènes emergents-fondation mérieux, centre international de recherche en infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, université de Lyon 1, 69000 Lyon, France; Unité d'hygiène, épidémiologie et prévention, groupement hospitalier centre, hospices civils de Lyon, 69000 Lyon, France
| | - P Cassier
- Laboratoire de biologie sécurité environnement, groupement hospitalier centre, hospices civils de Lyon, 69000 Lyon, France
| | - T Bénet
- Unité d'hygiène, épidémiologie et prévention, groupement hospitalier centre, hospices civils de Lyon, 69000 Lyon, France
| | - M Wallon
- Institut de parasitologie et de mycologie médicale, hôpital de la Croix-Rousse, 69000 Lyon, France
| | - M-P Gustin
- Département de santé publique, institut des sciences pharmaceutiques et biologiques (ISPB)-faculté de pharmacie, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - P Vanhems
- Laboratoire des pathogènes emergents-fondation mérieux, centre international de recherche en infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, université de Lyon 1, 69000 Lyon, France; Unité d'hygiène, épidémiologie et prévention, groupement hospitalier centre, hospices civils de Lyon, 69000 Lyon, France
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71
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Ryan L, O'Mara N, Tansey S, Slattery T, Hanahoe B, Vellinga A, Doyle M, Cormican M. A 2-year comparative study of mold and bacterial counts in air samples from neutral and positive pressure rooms in 2 tertiary care hospitals. Am J Infect Control 2018; 46:590-593. [PMID: 29307752 DOI: 10.1016/j.ajic.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/28/2017] [Accepted: 10/28/2017] [Indexed: 11/16/2022]
Abstract
Immunocompromised patients are at risk of invasive fungal infection. These high-risk patients are nursed in protective isolation to reduce the risk of nosocomial aspergillosis while in hospital-ideally in a positive pressure single room with high-efficiency particulate air filtration. However, neutral pressure rooms are a potential alternative, especially for patients requiring both protective and source isolation. This study examined mold and bacterial concentrations in air samples from positive and neutral pressure rooms to assess whether neutral pressure rooms offer a similar environment to that of positive pressure rooms in terms of mold concentrations in the air. Mold concentrations were found to be similar in the positive and neutral pressure room types examined in this study. These results add to the paucity of literature in this area.
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Affiliation(s)
- Laura Ryan
- Department of Microbiology, Galway University Hospital, Galway, Ireland; Department of Microbiology, University Hospital Waterford, Waterford, Ireland.
| | - Niall O'Mara
- Department of Medicine, University Hospital Waterford, Waterford, Ireland
| | - Sana Tansey
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - Tom Slattery
- Department of Medicine, University Hospital Waterford, Waterford, Ireland
| | - Belinda Hanahoe
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - Akke Vellinga
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Maeve Doyle
- Department of Medicine, University Hospital Waterford, Waterford, Ireland
| | - Martin Cormican
- Department of Microbiology, Galway University Hospital, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
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72
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Loeffert ST, Vanhems P, Tissot E, Dananché C, Cassier P, Bénet T, Perraud M, Thibaudon M, Gustin MP. Evaluation of Hirst-type spore traps in outdoor Aspergillaceae monitoring during large demolition work in hospital. PLoS One 2018; 13:e0191135. [PMID: 29346411 PMCID: PMC5773167 DOI: 10.1371/journal.pone.0191135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022] Open
Abstract
Demolition can generate fungal spore suspensions in association with various adverse health effects, such as high risk of invasive aspergillosis in immunocompromised patients. One block of Edouard Herriot Hospital was entirely demolished. The aim of the present study was to evaluate Hirst-type spore traps utility in monitoring outdoor Aspergillaceae (Aspergillus spp. + Penicillium spp.) spores in part of Edouard Herriot Hospital (Lyon, France) undergoing major demolition. Three periods were scheduled in 2015: (A) Gutting of building and asbestos removal, (B) Demolition of floors, (C) Excavation and earthwork. Outdoor Aspergillaceae fungal load was monitored by cultivable (Air Ideal®, bioMérieux) and non-cultivable methods (Lanzoni VPPS-2000, Analyzair®, Bologna, Italy). Differences of Aspergillaceae recorded with Hirst-type spore traps were observed between Gerland and Edouard Herriot Hospital. Differences between Aspergillaceae were recorded between day time and night time at Gerland and Edouard Herriot Hospital. Daily paired differences between Aspergillaceae recorded with non-cultivable methodology at Edouard Herriot Hospital and in an area without demolition work were significant in Period A vs Period B (p = 10–4) and Period A vs Period C (p = 10–4). Weak correlation of daily Aspergillaceae recorded by both methods at Edouard Herriot Hospital was significant only for Period C (r = 0.26, p = 0.048, n = 58). Meteorological parameters and type of demolition works were found to heavily influenced Aspergillaceae dispersion. Non-cultivable methodology is a promising tool for outdoor Aspergillaceae scrutiny during major demolition work in hospital, helping infection control staff to rapidly implement control measures.
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Affiliation(s)
- Sophie Tiphaine Loeffert
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, France, Université de Lyon 1, France
- * E-mail:
| | - Philippe Vanhems
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, France, Université de Lyon 1, France
- Unité d'hygiène, épidémiologie et prévention, Groupement hospitalier Edouard Herriot, Lyon, France
| | | | - Cédric Dananché
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, France, Université de Lyon 1, France
- Unité d'hygiène, épidémiologie et prévention, Groupement hospitalier Edouard Herriot, Lyon, France
| | - Pierre Cassier
- Laboratoire de Biologie Sécurité Environnement, Groupement hospitalier Edouard Herriot, Lyon, France
| | - Thomas Bénet
- Unité d'hygiène, épidémiologie et prévention, Groupement hospitalier Edouard Herriot, Lyon, France
| | - Michel Perraud
- Laboratoire de Biologie Sécurité Environnement, Groupement hospitalier Edouard Herriot, Lyon, France
| | - Michel Thibaudon
- Réseau National de Surveillance Aérobiologique, Brussieu, France
| | - Marie-Paule Gustin
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, France, Université de Lyon 1, France
- Département de santé publique, Institut des Sciences Pharmaceutiques et Biologiques (ISPB)-Faculté de Pharmacie, Université de Lyon 1, France
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73
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Punia P, Goel N, Singh I, Chaudhary U. Occupational CNS aspergillosis in an immunocompetent individual a diagnostic challange. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 73:381-384. [PMID: 29283878 DOI: 10.1080/19338244.2017.1411328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Immunocompetent individuals are rarely affected by Aspergillus species and its prime importance lies in immunocompromised patients where it can cause disease, ranging from primarily pulmonary infections to dissemination anywhere in the body. Invasive aspergillosis (IA) occurs in patients with risk factors including prolonged neutropenia, neutrophil dysfunction, patient on cytotoxic drugs, steroid therapy, hematological malignancy, AIDS or in patients with bone marrow transplantation. A recently documented risk factor for IA is the exposure to environmental aspergillus spores at construction sites which makes it an important public health issue. We report here a case of primary CNS aspergillosis in an immunocompetent person who was initially diagnosed as a case of meningioma, and had a history of working in an area with excessive ongoing construction. He had no other primary focus of infection anywhere in the body. He was timely diagnosed and broad spectrum antifungals were started immediately. MATERIAL AND METHODS The brain biopsy and pus sampleas were subjected to direct microscopy using KOH mount and lactophenol cotton blue (LPCB) stain and culture on Sabourad's Dextrose Agar in Microbiology laboratory. Later patient was started on fluconazole and caspofungin. RESULTS Thin, hyaline, septate hyphae on direct microscopy and growth of Aspergillus flavus on SDA culture were observed. The patient improved only with antifungals, without surgery. DISCUSSION This case study highlights the importance of keeping the differential diagnosis of Aspergillus spp. in mind even in individuals with no immunodeficiency. The immunocompetent individuals have better prognosis and if timely diagnosed, can be treated even without surgery. The prevalence of aspergillus spores at construction and demolition sites makes it an important public health issue, hence precautions must be advocated at these sites.
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Affiliation(s)
- Parul Punia
- a Demonstrator, Department of Microbiology, PGIMS , Rohtak , India
| | - Nidhi Goel
- b Professor, Department of Microbiology, PGIMS , Rohtak , India
| | - Ishwar Singh
- c Senior Professor and Head of the Department, Department of Neurosurgery , PGIMS Rohtak , India
| | - Uma Chaudhary
- c Senior Professor and Head of the Department, Department of Neurosurgery , PGIMS Rohtak , India
- d Senior Professor and Head of the Department, Department of Microbiology , PGIMS Rohtak , India
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Combariza JF, Toro LF, Orozco JJ, Arango M. Cost-effectiveness analysis of interventions for prevention of invasive aspergillosis among leukemia patients during hospital construction activities. Eur J Haematol 2017; 100:140-146. [PMID: 29105850 DOI: 10.1111/ejh.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Invasive Aspergillosis (IA) is a serious problem among hematological patients and it is associated with high mortality. This situation can worsen at times of hospital construction, however there are several preventive measures available. This work aims to define the cost-effectiveness of some of these interventions. PATIENTS AND METHODS A decision tree model was used, it was divided into four arms according to each 1 of the interventions performed. A cost-effectiveness incremental analysis comparing environmental control measures, high efficiency particulate absorption (HEPA) filter installation and prophylaxis with posaconazole was done. Probabilistic and deterministic sensitivity analyses were also carried out. RESULTS Among 86 patients with 175 hospitalization episodes, the incidence of IA with environmental protection measures, antifungal prophylaxis and hospitalization in rooms with HEPA filters was 14.4%, 6.3% and 0%, respectively. An Incremental Cost Effectiveness Ratio analysis was performed and it was found that HEPA filtered rooms and environmental protection measures are cost saving interventions when compared with posaconazole prophylaxis (-$2665 vs -$4073 vs $42 531 US dollars, respectively) for IA episode prevented. CONCLUSION The isolation of inpatients with acute leukemia during hospital construction periods in HEPA filtered rooms could reduce the incidence of IA and might be a cost-effective prevention strategy.
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Qualitative and Quantitative Assessment of Airborne Fungal Spores in the Hospitals Environment of Ahvaz City (2016). Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Benedict K, Richardson M, Vallabhaneni S, Jackson BR, Chiller T. Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks. THE LANCET. INFECTIOUS DISEASES 2017; 17:e403-e411. [PMID: 28774697 DOI: 10.1016/s1473-3099(17)30443-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/12/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers' hands, contaminated medical products, and transplantation of infected organs. Outbreak investigations provide important insights into the epidemiology of IFIs, uncover risk factors for infection, and identify opportunities for preventing similar events in the future. Well recognised challenges with IFI outbreak recognition, response, and prevention include the need for improved rapid diagnostic methods, the absence of routine surveillance for most IFIs, adherence to infection control practices, and health-care provider awareness. Additionally, IFI outbreak investigations have revealed several emerging issues, including new populations at risk because of travel or relocation, occupation, or immunosuppression; fungal pathogens appearing in geographical areas in which they have not been previously recognised; and contaminated compounded medications. This report highlights notable IFI outbreaks in the past decade, with an emphasis on these emerging challenges in the USA.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malcolm Richardson
- Mycology Reference Centre, University Hospital of South Manchester and University of Manchester, Manchester, UK
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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77
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Health Risks Associated with Exposure to Filamentous Fungi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070719. [PMID: 28677641 PMCID: PMC5551157 DOI: 10.3390/ijerph14070719] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 01/06/2023]
Abstract
Filamentous fungi occur widely in the environment, contaminating soil, air, food and other substrates. Due to their wide distribution, they have medical and economic implications. Regardless of their use as a source of antibiotics, vitamins and raw materials for various industrially important chemicals, most fungi and filamentous fungi produce metabolites associated with a range of health risks, both in humans and in animals. The association of filamentous fungi and their metabolites to different negative health conditions in humans and animals, has contributed to the importance of investigating different health risks induced by this family of heterotrophs. This review aims to discuss health risks associated with commonly occurring filamentous fungal species which belong to genera Aspergillus, Penicillium and Fusarium, as well as evaluating their pathogenicity and mycotoxic properties.
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78
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Bloomberg School of Public Health, Johns Hopkins School of Medicine, 725 North Wolfe Street, Suite 228 PCTB, Baltimore, MD 21205, USA
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Sagar Vijay Kumar P, Suresh L, Chandramouli G. Ionic liquid catalysed multicomponent synthesis, antifungal activity, docking studies and in silico ADMET properties of novel fused Chromeno-Pyrazolo-Phthalazine derivatives. JOURNAL OF SAUDI CHEMICAL SOCIETY 2017. [DOI: 10.1016/j.jscs.2015.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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80
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Briffa M, Decelis S, Brincat JP, Grima JN, Gatt R, Valdramidis V. Evaluation of polyurethane foam materials as air filters against fungal contamination. Food Control 2017. [DOI: 10.1016/j.foodcont.2016.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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81
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Rudramurthy SM, Singh G, Hallur V, Verma S, Chakrabarti A. High fungal spore burden with predominance of Aspergillus in hospital air of a tertiary care hospital in Chandigarh. Indian J Med Microbiol 2017; 34:529-532. [PMID: 27934837 DOI: 10.4103/0255-0857.195359] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The prevalence of fungal spores in the hospital air is essential to understand the hospital-acquired fungal infections. Air conditioners (ACs) used in hospitals may either reduce spores in air or be colonised by fungi and aid in its dissemination. The present study was conducted to assess the fungal spore burden in AC and non-AC areas. We found a high fungal spore count in air irrespective of whether the area was AC or non-AC. The most predominant species isolated were Aspergillus flavus and Aspergillus fumigatus. Such high concentrations of pathogenic fungi in air may predispose individuals to develop disease.
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Affiliation(s)
- S M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Hallur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Verma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hospital Environments and Epidemiology of Healthcare-Associated Infections. SPRINGERBRIEFS IN PUBLIC HEALTH 2017. [PMCID: PMC7120574 DOI: 10.1007/978-3-319-49160-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Today, hospitals are facing difficult challenges: increasing proportion of immunologically vulnerable patients often affected by diseases requiring high complex level of healthcare; rapidly evolving medical technologies and healthcare models; and budget restrictions. All these features interfere with healthcare and can modify the risk of acquiring healthcare-associated infections (HCAIs). Therefore, HCAI prevention is a high priority for healthcare systems. Authors describe human and environmental origin of HCAIs, focusing on the modality of transmission of those airborne pathogens, including the new insight derived from the recent acquisitions about SARS and Ebola epidemiology. They also describe the state of the art about microorganism concentration (infective dose) required to determine a HCAI and the role played by other virulence factors. Finally, the effective control measures used for the prevention of airborne pathogen transmission are described, focusing mainly on the risk assessment and infection control.
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84
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McKernan K, Spangler J, Helbert Y, Lynch RC, Devitt-Lee A, Zhang L, Orphe W, Warner J, Foss T, Hudalla CJ, Silva M, Smith DR. Metagenomic analysis of medicinal Cannabis samples; pathogenic bacteria, toxigenic fungi, and beneficial microbes grow in culture-based yeast and mold tests. F1000Res 2016; 5:2471. [PMID: 27853518 PMCID: PMC5089129 DOI: 10.12688/f1000research.9662.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 12/26/2022] Open
Abstract
Background: The presence of bacteria and fungi in medicinal or recreational
Cannabis poses a potential threat to consumers if those microbes include pathogenic or toxigenic species. This study evaluated two widely used culture-based platforms for total yeast and mold (TYM) testing marketed by 3M Corporation and Biomérieux, in comparison with a quantitative PCR (qPCR) approach marketed by Medicinal Genomics Corporation. Methods: A set of 15 medicinal
Cannabis samples were analyzed using 3M and Biomérieux culture-based platforms and by qPCR to quantify microbial DNA. All samples were then subjected to next-generation sequencing and metagenomics analysis to enumerate the bacteria and fungi present before and after growth on culture-based media. Results: Several pathogenic or toxigenic bacterial and fungal species were identified in proportions of >5% of classified reads on the samples, including
Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Ralstonia pickettii, Salmonella enterica, Stenotrophomonas maltophilia, Aspergillus ostianus, Aspergillus sydowii, Penicillium citrinum and
Penicillium steckii. Samples subjected to culture showed substantial shifts in the number and diversity of species present, including the failure of
Aspergillus species to grow well on either platform. Substantial growth of
Clostridium botulinum and other bacteria were frequently observed on one or both of the culture-based TYM platforms. The presence of plant growth promoting (beneficial) fungal species further influenced the differential growth of species in the microbiome of each sample. Conclusions: These findings have important implications for the
Cannabis and food safety testing industries.
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Affiliation(s)
| | | | | | - Ryan C Lynch
- Medicinal Genomics Corporation, Woburn, MA, 01801, USA
| | | | - Lei Zhang
- Medicinal Genomics Corporation, Woburn, MA, 01801, USA
| | - Wendell Orphe
- Medicinal Genomics Corporation, Woburn, MA, 01801, USA
| | - Jason Warner
- Medicinal Genomics Corporation, Woburn, MA, 01801, USA
| | - Theodore Foss
- Medicinal Genomics Corporation, Woburn, MA, 01801, USA
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Barton E, Borman A, Johnson E, Sherlock J, Giles A. Pseudo-outbreak of Fusarium oxysporum associated with bronchoscopy. J Hosp Infect 2016; 94:197-8. [DOI: 10.1016/j.jhin.2016.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
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86
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Olmsted RN. Prevention by Design: Construction and Renovation of Health Care Facilities for Patient Safety and Infection Prevention. Infect Dis Clin North Am 2016; 30:713-28. [PMID: 27515144 PMCID: PMC7126634 DOI: 10.1016/j.idc.2016.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The built environment supports the safe care of patients in health care facilities. Infection preventionists and health care epidemiologists have expertise in prevention and control of health care-associated infections (HAIs) and assist with designing and constructing facilities to prevent HAIs. However, design elements are often missing from initial concepts. In addition, there is a large body of evidence that implicates construction and renovation as being associated with clusters of HAIs, many of which are life threatening for select patient populations. This article summarizes known risks and prevention strategies within a framework for patient safety.
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Affiliation(s)
- Russell N Olmsted
- Clinical Intelligence, Unified Clinical Organization, Trinity Health, Mailstop W3B, 20555 Victor Parkway, Livonia, MI 48152, USA.
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87
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Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC, O’Malley C, Pattee SR, Potter-Bynoe G, Reid S, Robinson KA, Sabadosa KA, Schmidt HJ, Tullis E, Webber J, Weber DJ. Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 1:S1-S67. [DOI: 10.1086/676882] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1.The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2.Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistantStaphylococcus aureus(MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
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88
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Diversity, molecular phylogeny and fingerprint profiles of airborne Aspergillus species using random amplified polymorphic DNA. World J Microbiol Biotechnol 2016; 32:96. [DOI: 10.1007/s11274-016-2052-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
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89
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Schweer KE, Jakob B, Liss B, Christ H, Fischer G, Vehreschild MJGT, Cornely OA, Vehreschild JJ. Domestic mould exposure and invasive aspergillosis—air sampling ofAspergillusspp. spores in homes of hematological patients, a pilot study. Med Mycol 2016; 54:576-83. [DOI: 10.1093/mmy/myw007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/14/2022] Open
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90
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Subhedar DD, Shaikh MH, Kalam Khan FA, Sangshetti JN, Khedkar VM, Shingate BB. Facile synthesis of new N-sulfonamidyl-4-thiazolidinone derivatives and their biological evaluation. NEW J CHEM 2016. [DOI: 10.1039/c6nj00021e] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A one-pot three-component facile synthesis of N-sulfonamidyl-4-thiazolidinone derivatives using a [HDBU][HSO4] reusable ionic liquid was carried out, together with an investigation into their antifungal and antioxidant properties and a molecular docking study.
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Affiliation(s)
| | - Mubarak H. Shaikh
- Department of Chemistry
- Dr. Babasaheb Ambedkar Marathwada University
- Aurangabad
- India
| | - Firoz A. Kalam Khan
- Department of Pharmaceutical Chemistry
- Y. B. Chavan College of Pharmacy
- Aurangabad
- India
| | | | - Vijay M. Khedkar
- Combichem-Bioresource Centre
- National Chemical Laboratory
- Pune 411 008
- India
- School of Health Sciences
| | - Bapurao B. Shingate
- Department of Chemistry
- Dr. Babasaheb Ambedkar Marathwada University
- Aurangabad
- India
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91
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In-hospital transfer is a risk factor for invasive filamentous fungal infection among hospitalized patients with hematological malignancies: a matched case-control study. Infect Control Hosp Epidemiol 2015; 36:320-8. [PMID: 25695174 DOI: 10.1017/ice.2014.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Immunocompromised patients now benefit from a longer life expectancy due to advanced medical techniques, but they are also weakened by aggressive treatment approaches and are at high risk for invasive fungal disease. We determined risk factors associated with an outbreak of invasive filamentous fungal infection (IFFI) among hospitalized hemato-oncological patients. METHODS A retrospective, matched, case-control study was conducted between January 1, 2009, and April 31, 2011, including 29 cases (6 proven, 8 probable, and 15 possible) of IFFI and 102 matched control patients hospitalized during the same time period. Control patients were identified from the hospital electronic database. Conditional logistic regression was performed to identify independent risk factors for IFFI. RESULTS Overall mortality associated with IFFI was 20.7% (8.0%-39.7%). Myelodysplastic syndrome was associated with a higher risk for IFFI compared to chronic hematological malignancies. After adjustment for major risk factors and confounders, >5 patient transfers outside the protected environment of the hematology ward increased the IFFI risk by 6.1-fold. The risk increased by 6.7-fold when transfers were performed during neutropenia. CONCLUSION This IFFI outbreak was characterized by a strong association with exposure to the unprotected environment outside the hematology ward during patient transfer. The independent associations of a high number of transfers with the presence of neutropenia suggest that affected patients were probably not sufficiently protected during transport in the corridors. Our study highlights that a heightened awareness of the need for preventive measures during the entire care process of at-risk patients should be promoted among healthcare workers.
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Oberle M, Reichmuth M, Laffer R, Ottiger C, Fankhauser H, Bregenzer T. Non-Seasonal Variation of Airborne Aspergillus Spore Concentration in a Hospital Building. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13730-8. [PMID: 26516890 PMCID: PMC4661610 DOI: 10.3390/ijerph121113730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/25/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
Nosocomial fungal infections are gaining increased attention from infectiologists. An adequate investigation into the levels of airborne Aspergillus and other fungal spores in hospital settings, under normal conditions, is largely unknown. We monitored airborne spore contamination in a Swiss hospital building in order to establish a seasonally-dependent base-line level. Air was sampled using an impaction technique, twice weekly, at six different locations over one year. Specimens were seeded in duplicate on Sabouraud agar plates. Grown colonies were identified to genus levels. The airborne Aspergillus spore concentration was constantly low throughout the whole year, at a median level of 2 spores/m³ (inter-quartile range = IQR 1-4), and displayed no seasonal dependency. The median concentration of other fungal spores was higher and showed a distinct seasonal variability with the ambient temperature change during the different seasons: 82 spores/m³ (IQR 26-126) in summer and 9 spores/m³ (IQR 6-15) in winter. The spore concentration varied considerably between the six sampling sites in the building (10 to 26 spores/m³). This variability may explain the variability of study results in the literature.
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Affiliation(s)
- Michael Oberle
- Kantonsspital Aarau AG, Institute for Laboratory Medicine, Tellstrasse 1, 5001 Aarau, Switzerland.
| | - Markus Reichmuth
- Analytica Medizinische Laboratorien AG, Falkenstrasse 14, 8024 Zürich, Switzerland.
| | - Reto Laffer
- Spital Langenthal, Medizinische Klinik, St. Urbanstrasse 67, 4901 Langenthal, Switzerland.
| | - Cornelia Ottiger
- Kantonsspital Aarau AG, Institute for Laboratory Medicine, Tellstrasse 1, 5001 Aarau, Switzerland.
| | - Hans Fankhauser
- Kantonsspital Aarau AG, Institute for Laboratory Medicine, Tellstrasse 1, 5001 Aarau, Switzerland.
| | - Thomas Bregenzer
- Spital Lachen, Klinik für Innere Medizin, Oberdorfstrasse 41, 8853 Lachen, Switzerland.
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Ashu EE, Xu J. The roles of sexual and asexual reproduction in the origin and dissemination of strains causing fungal infectious disease outbreaks. INFECTION GENETICS AND EVOLUTION 2015; 36:199-209. [PMID: 26394109 DOI: 10.1016/j.meegid.2015.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 12/15/2022]
Abstract
Sexual reproduction commonly refers to the reproductive process in which genomes from two sources are combined into a single cell through mating and then the zygote genomes are partitioned to progeny cells through meiosis. Reproduction in the absence of mating and meiosis is referred to as asexual or clonal reproduction. One major advantage of sexual reproduction is that it generates genetic variation among progeny which may allow for faster adaptation of the population to novel and/or stressful environments. However, adaptation to stressful or new environments can still occur through mutation, in the absence of sex. In this review, we analyzed the relative contributions of sexual and asexual reproduction in the origin and spread of strains causing fungal infectious diseases outbreaks. The necessity of sex and the ability of asexual fungi to initiate outbreaks are discussed. We propose a framework that relates the modes of reproduction to the origin and propagation of fungal disease outbreaks. Our analyses suggest that both sexual and asexual reproduction can play critical roles in the origin of outbreak strains and that the rapid spread of outbreak strains is often accomplished through asexual expansion.
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Affiliation(s)
- Eta Ebasi Ashu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, ON L8S 4K1, Canada
| | - Jianping Xu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, ON L8S 4K1, Canada.
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Chang CC, Ananda-Rajah M, Belcastro A, McMullan B, Reid A, Dempsey K, Athan E, Cheng AC, Slavin MA. Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014. Intern Med J 2015; 44:1389-97. [PMID: 25482747 DOI: 10.1111/imj.12601] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted.
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Affiliation(s)
- C C Chang
- Department of Infectious Diseases, Alfred Health and Monash University, Prahran, Victoria; Centre for Biomedical Research, Burnet Institute, Victoria; Lewin-Cameron Laboratory, The Doherty Institute for Infection and Immunity, Parkville, Victoria
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Picot-Guéraud R, Khouri C, Brenier-Pinchart MP, Saviuc P, Fares A, Sellon T, Thiebaut-Bertrand A, Mallaret MR. En-suite bathrooms in protected haematology wards: a source of filamentous fungal contamination? J Hosp Infect 2015; 91:244-9. [PMID: 26341270 DOI: 10.1016/j.jhin.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In spite of 25 recently built high-risk haematology rooms with a protected environment and fitted with en-suite bathrooms in our university hospital centre in 2008, sporadic cases of hospital-acquired invasive aspergillosis remained in these wards. AIM This study aimed to identify unsuspected environmental sources of filamentous fungal contamination in these rooms. METHODS Over two months, environmental fungal flora in the air (150 samples) as well as air particle counting and physical environmental parameters (airspeed, temperature, humidity, pressure) were prospectively monitored twice on the sampling day in all 25 protected rooms and en-suite bathrooms in use, and on bathroom surfaces (150 samples). FINDINGS In rooms under laminar airflow, in the presence of patients during sampling sessions, fungi were isolated in two samples (4%, 2/50) with a maximum value of 2cfu/500L (none was Aspergillus sp.). However, 88% of the air samples (44/50) in the bathroom were contaminated with a median range and maximum value of 2 and 16cfu/500L. Aspergillus spp. were involved in 24% of contaminated samples (12/44) and A. fumigatus in 6% (3/44). Bathroom surfaces were contaminated by filamentous fungi in 5% of samples (8/150). CONCLUSION This study highlighted that en-suite bathrooms in protected wards are likely to be a source of fungi. Before considering specific treatment of air in bathrooms, technicians have first corrected the identified deficiencies: replacement of high-efficiency particulate air filters, improvement of air control automation, and restoration of initial technical specifications. Assessment of measure effectiveness is planned.
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Affiliation(s)
- R Picot-Guéraud
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France.
| | - C Khouri
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France
| | - M-P Brenier-Pinchart
- CHU Grenoble, Pôle Biologie et Pathologie, Laboratoire de Parasitologie-Mycologie, Grenoble, France; Université Grenoble Alpes, CNRS, LAPM, Grenoble, France
| | - P Saviuc
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France
| | - A Fares
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France
| | - T Sellon
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France
| | | | - M-R Mallaret
- CHU Grenoble, Pôle Santé Publique, Unité d'Hygiène Hospitalière, Grenoble, France; Université Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
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96
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Kanamori H, Rutala WA, Sickbert-Bennett EE, Weber DJ. Review of Fungal Outbreaks and Infection Prevention in Healthcare Settings During Construction and Renovation. Clin Infect Dis 2015; 61:433-44. [DOI: 10.1093/cid/civ297] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/04/2015] [Indexed: 01/08/2023] Open
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97
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Nevalainen A, Täubel M, Hyvärinen A. Indoor fungi: companions and contaminants. INDOOR AIR 2015; 25:125-56. [PMID: 25601374 DOI: 10.1111/ina.12182] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/20/2014] [Indexed: 05/21/2023]
Abstract
This review discusses the role of fungi and fungal products in indoor environments, especially as agents of human exposure. Fungi are present everywhere, and knowledge for indoor environments is extensive on their occurrence and ecology, concentrations, and determinants. Problems of dampness and mold have dominated the discussion on indoor fungi. However, the role of fungi in human health is still not well understood. In this review, we take a look back to integrate what cultivation-based research has taught us alongside more recent work with cultivation-independent techniques. We attempt to summarize what is known today and to point out where more data is needed for risk assessment associated with indoor fungal exposures. New data have demonstrated qualitative and quantitative richness of fungal material inside and outside buildings. Research on mycotoxins shows that just as microbes are everywhere in our indoor environments, so too are their metabolic products. Assessment of fungal exposures is notoriously challenging due to the numerous factors that contribute to the variation of fungal concentrations in indoor environments. We also may have to acknowledge and incorporate into our understanding the complexity of interactions between multiple biological agents in assessing their effects on human health and well-being.
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Affiliation(s)
- A Nevalainen
- Institute for Health and Welfare, Kuopio, Finland
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98
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Loschi M, Thill C, Gray C, David M, Bagatha MF, Chamseddine A, Contentin N, Jardin F, Lanic H, Lemasle E, Lenain P, Stamatoullas A, Tilly H, Lepretre S. Invasive aspergillosis in neutropenic patients during hospital renovation: effectiveness of mechanical preventive measures in a prospective cohort of 438 patients. Mycopathologia 2015; 179:337-45. [PMID: 25637199 DOI: 10.1007/s11046-015-9865-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aspergillus species are the main cause of invasive fungal disease for patients with severe and prolonged neutropenia. Building or renovation works have been shown as one of the major causes of outbreaks of aspergillosis. OBJECTIVES This study aimed to assess the effectiveness of introduction and adaptation by air sampling of mechanical preventive measures on the incidence of invasive pulmonary aspergillosis in neutropenic patients during hospital renovation. PATIENTS All of the patients admitted for prolonged and severe neutropenia during a renovation period from 2003 to 2008 were prospectively enrolled. Invasive pulmonary aspergillosis (IPA) cases were classified as possible, probable, and proven, according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group criteria. The effectiveness of preventive measures was determined by air sampling. RESULTS We recorded 705 hospitalizations for neutropenia concerning 438 patients. The majority of hospitalized neutropenic patients was treated for acute leukemia (38.3 %), followed by patients suffering from non-Hodgkin and Hodgkin lymphomas (33 %). The total cumulative incidence of probable and proven IPA was 4.1 %. Risk factors for developing IPA were underlying disease, treatment course at the time of hospitalization, and the mean duration of hospitalization and of neutropenia. CONCLUSIONS In this prospective study, the incidence of invasive pulmonary aspergillosis did not increase in neutropenic patients during a renovation period because of efficient mechanical preventive measures systematically adjusted using the results of air sampling.
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Affiliation(s)
- Michael Loschi
- Department of Hematology, Centre Henri Becquerel, 1 rue d'Amiens, 76000, Rouen, France
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99
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Alonso V, Vergara LD, Aminahuel C, Pereyra C, Pena G, Torres A, Dalcero A, Cavaglieri L. Physiological behaviour of gliotoxigenic Aspergillus fumigatus sensu stricto isolated from maize silage under simulated environmental conditions. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2015; 32:236-44. [PMID: 25599419 DOI: 10.1080/19440049.2014.996256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Environmental conditions play a key role in fungal development. During the silage production process, humidity, oxygen availability and pH vary among lactic-fermentation phases and among different silage sections. The aim of this work was to study the physiological behaviour of gliotoxicogenic Aspergillus fumigatus strains isolated from maize silage under simulated natural physicochemical conditions - different water activities (a(W)), temperatures (Tº), pH and oxygen pressure - on the growth parameters (growth rate and lag phase) and gliotoxin production. The silage was made with the harvested whole maize plant that was chopped and used for trench-type silo fabrication. Water activity and pH of the silage samples were determined. Total fungal counts were performed on Dichloran Rose Bengal Chloramphenicol agar and Dichloran 18% Glycerol agar. The morphological identification of A. fumigatus was performed with different culture media and at different growth temperature to observe microscopic and macroscopic characteristics. Gliotoxin production by A. fumigatus was determined by HPLC. All strains isolated were morphologically identified as A. fumigatus. Two A. fumigatus strains isolated from the silage samples were selected for the ecophysiological study (A. fumigatus sensu stricto RC031 and RC032). The results of this investigation showed that the fungus grows in the simulated natural physicochemical conditions of corn silage and produces gliotoxin. The study of the physiological behaviour of gliotoxigenic A. fumigatus under simulated environmental conditions allowed its behaviour to be predicted in silage and this will in future enable appropriate control strategies to be developed to prevent the spread of this fungus and toxin production that leads to impairment and reduced quality of silage.
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Affiliation(s)
- V Alonso
- a Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales , Universidad Nacional de Río Cuarto , Río Cuarto , Córdoba , Argentina
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100
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Pasquarella C, Vitali P, Saccani E, Mariotti F, Boccuni C, Manotti P, Ugolotti M, Albertini R. Microbial Air Monitoring as a Useful Tool When Commissioning Bone Marrow Transplant Units. Infect Control Hosp Epidemiol 2015; 33:101-2. [DOI: 10.1086/663646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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