Assessment of multi-contaminant exposure in a cancer treatment center: a 2-year monitoring of molds, mycotoxins, endotoxins, and glucans in bioaerosols

Environmental monitoring for filamentous fungal pathogens in hematopoietic cell transplant units

The incidence of invasive fungal disease (IFD) is on the rise due to increasing numbers of highly immunocompromized patients. Nosocomial IFD remains common despite our better understanding of its risk factors and pathophysiology. High-efficiency particulate air filtration with or without laminar air flow, frequent air exchanges, a positive pressure care environment, and environmental hygiene, amongst other measures, have been shown to reduce the mould burden in the patient environment. Environmental monitoring for moulds in areas where high-risk patients are cared for, such as hematopoietic cell transplant units, has been considered an adjunct to other routine environmental precautions. As a collaborative effort between authors affiliated to the Infection Prevention and Control Working Group and the Fungal Infection Working Group of the International Society of Antimicrobial Chemotherapy (ISAC), we reviewed the English language literature and international guidance to describe the evidence behind the need for environmental monitoring for filamentous fungi as a quality assurance approach with an emphasis on required additional precautions during periods of construction. Many different clinical sampling approaches have been described for air, water, and surface sampling with significant variation in laboratory methodologies between reports. Importantly, there are no agreed-upon thresholds that correlate with an increase in the clinical risk of mould infections. We highlight important areas for future research to assure a safe environment for highly immunocompromized patients.

Seasonal variation characteristics of inhalable bacteria in bioaerosols and antibiotic resistance genes in Harbin

Bioaerosols have received extensive attention due to their impact on climate, ecological environment, and human health. This study aimed to reveal the driving factors that structure bacterial community composition and the transmission route of antibiotic resistance genes (ARGs) in PM_2.5. The results showed that the bacterial concentration in spring (8.76 × 10⁵ copies/m³) was significantly higher than that in summer (1.03 × 10⁵ copies/m³) and winter (4.74 × 10⁴ copies/m³). Low temperatures and air pollution in winter negatively affected bacterial concentrations. Keystone taxa were identified by network analysis. Although about 50 % of the keystone taxa had low relative abundances, the strong impact of complex interactions between keystone taxa and other taxa on bacterial community structure deserved attention. The bacterial community assembly was dominated by stochastic processes (79.3 %). Interactions between bacteria and environmental filtering together affected bacterial community composition. Vertical gene transfer played an important role in the transmission of airborne ARGs. Given the potential integration and expression of ARGs in recipients, the human exposure risk due to high concentrations of ARGs and mobile genetic elements cannot be ignored. This study highlights human exposure to inhalable bacterial pathogens and ARGs in urban areas.

Settled dust assessment in clinical environment: useful for the evaluation of a wider bioburden spectrum

The collection and analysis of settled dust samples from indoor environments has become one of several environmental sampling methods used to assess bioburden indoors. The aim of the study was to characterize the bioburden in vacuumed settled dust from 10 Primary Health Care Centers by culture based and molecular methods. Results for bacterial load ranged from 1 to 12 CFU.g^-1 of dust and Gram-negative bacteria ranged between 1 to 344 CFU.g^-1 of dust. Fungal load ranged from 0 CFU.g^-1 of dust to uncountable. Aspergillus section Fumigati was detected in 4 sampling sites where culture base-methods could not identify this section. Mucorales (Rhizopus sp.) was observed on 1 mg/L voriconazole. Three out of 10 settled dust samples were contaminated by mycotoxins. Settled dust sampling coupled with air sampling in a routine way might provide useful information about bioburden exposure.

Occupational Exposure to Mycotoxins-Different Sampling Strategies Telling a Common Story Regarding Occupational Studies Performed in Portugal (2012-2020)

In occupational settings where exposure to organic dust occurs (e.g., intensive animal production, waste management, farming and many others) workers can also be exposed to mycotoxins. However, recognizing exposure to mycotoxins in workplace environments does not happen commonly and, consequently, remains as a not identified occupational risk factor. In the last decade, work developed in different occupational settings, using different sampling approaches reported that occupational exposure to mycotoxins occurs and it's of upmost importance to be seen as an occupational concern that needs to be tackled. This paper intends to discuss the several possibilities available for assessing and characterizing the occupational exposure to mycotoxins through the description of the advantages and limitations of the different sampling strategies. Overviewing the approaches and the main achievements used in several field campaigns developed in Portugal, the knowledge obtained will be used to support the identification of the main aspects to consider when designing new occupational studies. The need for additional research work will also be discussed where new directions to follow will be debated.

Impact of a New Portable Air Purification Technology Device in the Pediatric Hospital Setting - A Pre-post Assessment Study

Introduction

We assessed whether portable photo-electrochemical oxidation (PECO) air purification in the pediatric hospital room setting could improve health outcomes for patients admitted with respiratory distress. 

Methods

We performed a prospective study evaluating the use of a portable air purifier with PECO technology. The historical control group comprised matched patients. Twenty-seven PECO-equipped portable air filtration devices were placed in the rooms. Clinical endpoints included length of stay in the hospital, length of stay in the intensive care unit (ICU), rates of intubation, non-invasive ventilation, and nebulizer use.

Results

The mean length of ICU stay was 0.7 days in the pre-intervention period and decreased to 0.4 days post-intervention. The mean length of overall hospitalization reduced by 0.3 days. The rate of non-invasive ventilation use was 77% in the pre-intervention period and decreased to 23% in the post-intervention period. The rate of nebulizer use was 59% in the pre-intervention period and 41% in the post-intervention period. The rate of intubation was 57.1% in the pre-intervention period and 43% in the post-intervention period. 

Conclusion 

Portable PECO air purification may reduce hospital length of stay, rates of intubation, and need for non-invasive intervention and nebulizers for pediatric patients admitted with respiratory distress. 

Environmental exposure to endotoxin and its health outcomes: A systematic review

Exposure to endotoxin occurs environmentally and occupationally. There are several differences between them in terms of the variety and severity of health outcomes, possible exposed groups and type and route of exposure. Occupational exposures caused adverse health outcomes in almost all cases, but there is disparity in the incidence of significant health outcomes due to environmental exposure to endotoxin. This study has therefore endeavoured to investigate health outcomes from environmental exposure to endotoxin. A systematic review was conducted of three databases and non-occupational studies reporting the environmental concentration of endotoxin, and observed health outcomes in exposed groups were included in the review (n = 27). The studies showed that first exposure to endotoxin occurs in infancy by the inhalation route. Inhalation is the only exposure route that can induce inflammation as the main symptom of exposure to endotoxin. The studies included were conducted using four approaches: molecular immunology, measurement of lung volumes, clinical sensitisation test and diagnosis of asthmatic and respiratory symptoms such as wheezing. By the immunological approach, all the included studies reported that environmental exposure to endotoxin, especially at a younger age, has a protective effect on the incidence of asthma in adolescence. The main disparity observed was in studies using the approach of diagnosed asthma. Overall, however, they confirm the protective effect of exposure to endotoxin although, in the case of children with non-atopic asthma, the results could be different.

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

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.

Metabolic Activity of Micromycetes Affecting Urban Concrete Constructions

Concrete resistance to the destructive action of microorganisms is considered as a measure of its durability and is increasingly being raised as an important issue. We focused our study on the biodeterioration of concrete specimens widely used as a building material of urban houses by micromycetes isolated from the inner wall surface of the former military hospital in Kazan city, Tatarstan, Russia. Fungal community consists of 9 Penicillium isolates, 6 Aspergillus, 2 Trichoderma, and 1 isolate of Alternaria. First, we have identified two dominant isolates, Aspergillus fumigatus and Penicillium brevicompactum, and characterized their destructive properties according to the radial growth rate, antagonistic activity towards bacterial habitants of concrete, and production of organic acids. Then, we have demonstrated that five tested brands of high-strength concrete differ in bioreceptivity. The alterations in concrete resistances to compression and flexure after fungal attack were recorded at the trend level, mainly due to a short exposure time of concrete to fungal destructors in tests recommended by national Russian standard. Finally, using scanning electron microscopy we have shown that colonization of concrete by the dominant fungi includes their penetration into the thickness of concrete and germination in cracks. Elementary analysis revealed the decrease of calcium content on about 41% after fungal growth on the concrete in liquid phase and on 32% by superficial growth in comparison with the samples without fungal treatment.

Profiles of Environmental Mold: Indoor and Outdoor Air Sampling in a Hematology Hospital in Seoul, South Korea

Inhalation of fungal spores can cause various spectrums of fungal diseases in immunocompromised hosts. The aim of this study was to evaluate the concentrations and profiles of fungal species in air collected at different locations in hematology wards and outside of the hospital in Seoul St. Mary's Hospital over the course of a year. Air sampling was performed at four locations-outside the hospital (O), in the general ward (GW), in the lounge in the cleanroom (CR_L), and in the patients' room in the cleanroom (CR_R)-by using Andersen single-stage air sampler at every two weeks between May 2017 and May 2018. The results showed higher mean fungal density in summer, and the concentrations of fungi decreased as follows: O (954.8 colony-forming units, CFU/m³) > GW (4.2 CFU/m³) > CR_L (0.7 CFU/m³) > CR_R (0 CFU/m³). Aspergillus was most prevalent both inside (47%) and outside (62%) of the hospital. However, the outdoor fungal profile was more diverse than the indoor profile. Within the hospital, Penicillium was the second most dominant species. In conclusion, the outdoor fungal profile is diverse even in Seoul, a highly urbanized area in Korea. The distribution of indoor air fungi is significantly different from outdoor due to air quality systems. Heating, ventilation, and air conditioning (HVAC), as well as high-efficiency particulate air (HEPA)-filtered systems should be established to effectively reduce levels of indoor fungi.

Influence of Heat Events on the Composition of Airborne Bacterial Communities in Urban Ecosystems

Airborne bacteria are significantly affected by meteorological and environmental conditions. However, there is little quantitative data available on the effects of these factors on airborne bacteria in urban ecosystems. In the present study, we analyzed weather-dependent changes in the composition of airborne bacterial communities using high throughput sequencing. Samples were collected before and after a period of constant hot weather at four selected sampling sites (YRBS, ZJGUSJC, TJCR, and BLQG) in Hangzhou. Our results show that the average amount of bacterial 16S rRNA gene copy numbers per m³ of air decreased significantly after constant high temperature. In addition, the number of operational taxonomic units and the Shannon⁻Wiener diversity indexes of the samples at all four selected sampling sites were significantly decreased after the heat event, showing notable impact on bacterial diversity. We also detected a significant increase in the abundances of spore-forming bacteria. Firmicutes increased from 3.7% to 9.9%, Bacillales increased from 2.6% to 7.6%, and Bacillaceae increased from 1.5% to 5.9%. In addition, we observed an increase in beta-Proteobacteria (18.2% to 50.3%), Rhodocyclaceae (6.9% to 29.9%), and Burkholderiaceae (8.1% to 15.2%). On the other hand, the abundance of alpha-Proteobacteria (39.6% to 9.8%), Caulobacteraceae (17.9% to 0.5%), Sphingomonadaceae (7.2% to 3.3%), and Xanthomonadaceae (3.0% to 0.5%) was significantly lower. Taken together, our data suggest that the composition of airborne bacterial communities varies greatly dependent on heat events, and that such communities include several species that are highly susceptible to high-temperature related stressors such as high air temperature, low relative humidity, and high intensity of solar radiation.

Evaluation of micro-well collector for capture and analysis of aerosolized Bacillus subtilis spores

Bioaerosol sampling and identification are vital for the assessment and control of airborne pathogens, allergens, and toxins. In-situ analysis of chemical and biological particulate matter can significantly reduce the costs associated with sample preservation, transport, and analysis. The analysis of conventional filters is challenging, due to dilute samples in large collection regions. A low-cost cartridge for collection and analysis of aerosols is developed for use in epidemiological studies and personal exposure assessments. The cartridge collects aerosol samples in a micro-well which reduces particles losses due to the bounce and does not require any coating. The confined particle collection area (dwell~1.4 mm) allows reducing the elution volume for subsequent analysis. The performance of the cartridge is validated in laboratory studies using aerosolized bacterial spores (Bacillus subtilis). Colony forming unit analysis is used for bacterial spore enumeration. Cartridge collection efficiency is evaluated by comparison with the reference filters and found to be consistent with tested flow rates. Sample recovery for the pipette elution is ~80%. Due to the high density of the collected sample, the cartridge is compatible with in-situ spectroscopic analysis and sample elution into the 10-20 μl liquid volume providing a significant increase in sample concentration for subsequent analysis.

Fungal burden exposure assessment in podiatry clinics from Ireland

Fungi are amongst the bioaerosols of most importance, as indicated by the growing interest in this field of research. The aim was to characterize the exposure to fungal burden in podiatry clinics using culture-based and molecular methods.

METHODS

Airborne fungi were collected using an impaction air sampler and surface samples were also performed. Fourteen air samples were collected for direct detection of fungal DNA from filamentous fungi and dermatophytes. Overall, 63.6 % of the evening samples and 46 % of the morning samples surpassed the threshold values (150 CFU/m³). Molecular detection, by real time PCR, of the target fungal species/strains (Aspergillus and Stachybotrys species) was negative for all samples collected. Trichophyton rubrum was detected by PCR analysis in one DNA sample collected on day six. Results suggest the use of both culture-based and molecular methodologies are desirable for a complete evaluation of fungal burden in this particular health care setting.

Biocorrosion of materials and sick building syndrome

The problem of biological damage of mineral building materials and structures based on them is multifaceted and covers all types of industry. The most destructive biocorrosion impacts are on building materials in cities with a large water area. Various types of microorganisms, including pathogens, and especially the filamentous fungi of the genera Aspergillus, Penicillium, Trichoderma, etc., occupy the surfaces of mineral building materials, cause their destruction, disturb the ecological balance of cities and endanger the human health. The term ‘sick building syndrome' (SBS) is used to describe a situation when the residents of a building experience acute health- or comfort-related effects that seem to be linked directly to the time spent in the building wherein no specific illness or cause can be identified. Biological contaminants, in particular micromycetes, can present one of the possible causes of SBS. Here, we assessed the biodeterioration level of structural materials on the basis of fine-grained concrete widely used in construction practice and architecture. First, we determined the strength characteristics of the material that has been biologically damaged; second, we identified the damaging micromycetes and analysed their metabolic activity related both to the induction of biocorrosion and to the impacts of fungi on human health. Applying a new integrated approach, which combines methods of molecular microbiology and genetic toxicology with standard methods for determining the strength of building structures, we confirmed the relation between biodestructive and pathogenic properties of micromycete isolates.