1
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Tariq S, Mariam A, Ul-Haq Z, Mehmood U. Spatial and temporal variations in PM 2.5 and associated health risk assessment in Saudi Arabia using remote sensing. CHEMOSPHERE 2022; 308:136296. [PMID: 36075363 DOI: 10.1016/j.chemosphere.2022.136296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
Air pollutants, especially ambient particulate matter (PM2.5), detrimentally impact human health and cause premature deaths. The dynamic characteristics and associated health risks of PM2.5 are analyzed based on the standard deviational ellipse (SDE) and trend analysis in Saudi Arabia (SAU) from 1998 to 2018 by utilizing recently updated satellite-derived PM2.5 concentrations (V4.GL.03). The outcomes show that the national average PM2.5 concentration increased from 28 μg/m3 to 45 μg/m3 with a growth rate of 2.3 μg/m3/year. The center of median PM2.5 concentrations moved to the southeast over the years studied due to the presence of vast sandy deserts, sand dunes, a busy port, and coastal and industrial areas in this region. The areas of SAU that experienced PM2.5 concentrations above 35 μg/m3 increased from 20% to 70%. The rapid-fast growth (RFG) class acquired from the unsupervised classification has the fastest growth rate of 2.5 μg/m3/yr, occurring in southeastern SAU, namely Ash-Sharqiyah, Ar-Riyad, and Najran. It covered ∼27% of the total area of SAU over the study period. Whereas, the slow growth (SG) class with a less than 0.2 μg/m3/yr growth rate covered 12% of the total area of SAU, distributed in northwestern regions. The extent of extremely-high risk areas corresponding to greater than 1 × 103 μg·person/m3 increased from 4% to 11%, particularly in Makkah, Central Al-Madinah, and western Asir, Jizan, mid-eastern Najran, Al-Quassim, and mid-eastern Ar-Riyad and Ash Sharqiyah.
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Affiliation(s)
- Salman Tariq
- Department of Space Science, University of the Punjab, Lahore, Pakistan; Remote Sensing, GIS and Climatic Research Lab (National Center of GIS and Space Applications), Centre for Remote Sensing, University of the Punjab, Lahore, Pakistan.
| | - Ayesha Mariam
- Remote Sensing, GIS and Climatic Research Lab (National Center of GIS and Space Applications), Centre for Remote Sensing, University of the Punjab, Lahore, Pakistan
| | - Zia Ul-Haq
- Remote Sensing, GIS and Climatic Research Lab (National Center of GIS and Space Applications), Centre for Remote Sensing, University of the Punjab, Lahore, Pakistan
| | - Usman Mehmood
- Remote Sensing, GIS and Climatic Research Lab (National Center of GIS and Space Applications), Centre for Remote Sensing, University of the Punjab, Lahore, Pakistan; University of management and technology, Lahore, Pakistan
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2
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Suleyman G, Alangaden GJ. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infect Dis Clin North Am 2021; 35:1027-1053. [PMID: 34752219 DOI: 10.1016/j.idc.2021.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Invasive fungal infections are an important cause of morbidity and mortality in hospitalized patients and in the immunocompromised population. This article reviews the current epidemiology of nosocomial fungal infections in adult patients, with an emphasis on invasive candidiasis (IC) and invasive aspergillosis (IA). Included are descriptions of nosocomial infections caused by Candida auris, an emerging pathogen, and IC- and IA-associated with coronavirus disease 2019. The characteristics and availability of newer nonculture-based tests for identification of nosocomial fungal pathogens are discussed. Recently published recommendations and guidelines for the control and prevention of these nosocomial fungal infections are summarized.
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Affiliation(s)
- Geehan Suleyman
- Infection Prevention and Control, Henry Ford Hospital, Wayne State University, 2799 West Grand Boulevard, CFP Suite 317, Detroit, MI 48202, USA
| | - George J Alangaden
- Division of Infectious Diseases, Henry Ford Hospital, Wayne State University, 2799 West Grand Boulevard, CFP Suite 316, Detroit, MI 48202, USA.
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3
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Snen H, Kallel A, Blibech H, Jemel S, Salah NB, Marouen S, Mehiri N, Belhaj S, Louzir B, Kallel K. Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma. Front Immunol 2021; 12:695954. [PMID: 34239516 PMCID: PMC8259593 DOI: 10.3389/fimmu.2021.695954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 01/26/2023] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Its diagnosis could be difficult in some cases due to atypical presentations especially when there is no medical history of asthma. Treatment of ABPA is frequently associated to side effects but cumulated drug toxicity due to different molecules is rarely reported. An accurate choice among the different available molecules and effective on ABPA is crucial. We report a case of ABPA in a woman without a known history of asthma. She presented an acute bronchitis with wheezing dyspnea leading to an acute respiratory failure. She was hospitalized in the intensive care unit. The bronchoscopy revealed a complete obstruction of the left primary bronchus by a sticky greenish material. The culture of this material isolated Aspergillus fumigatus and that of bronchial aspiration fluid isolated Pseudomonas aeruginosa. The diagnosis of ABPA was based on elevated eosinophil count, the presence of specific IgE and IgG against Aspergillus fumigatus and left segmental collapse on chest computed tomography. The patient received an inhaled treatment for her asthma and a high dose of oral corticosteroids for ABPA. Her symptoms improved but during the decrease of corticosteroids, the patient presented a relapse. She received itraconazole in addition to corticosteroids. Four months later, she presented a drug-induced hepatitis due to itraconazole which was immediately stopped. During the monitoring of her asthma which was partially controlled, the patient presented an aseptic osteonecrosis of both femoral heads that required surgery. Nine months after itraconazole discontinuation, she presented a second relapse of her ABPA. She received voriconazole for nine months associated with a low dose of systemic corticosteroid therapy with an improvement of her symptoms. After discontinuation of antifungal treatment, there was no relapse for one year follow-up.
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Affiliation(s)
- Houda Snen
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Aicha Kallel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Hana Blibech
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Sana Jemel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Nozha Ben Salah
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Sonia Marouen
- Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Nadia Mehiri
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Slah Belhaj
- Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Bechir Louzir
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Kalthoum Kallel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
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4
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Nakanishi Y, Kasahara K, Koizumi A, Tokutani J, Yoshihara S, Mikasa K, Imamura T. Evaluation of Nosocomial Infection Control Measures to Minimize the Risk of Aspergillus Dispersion During Major Demolition Work: A Case Study of a Japanese University Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:58-74. [PMID: 33957793 DOI: 10.1177/19375867211009979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To verify the effectiveness of our infection control measures based on the infection control risk assessment (ICRA) to minimize the risk of Aspergillus dispersion before, during, and after demolition work in a university hospital. BACKGROUND It is widely accepted that invasive aspergillosis is associated with construction, renovation, and demolition activities within or close to hospital sites. However, the risk is underestimated, and only limited preventive measures are taken in Japanese hospitals. METHOD The demolition process, carried out in July 2014, was supervised by our facility management in collaboration with the infection prevention team and followed an adapted ICRA tool. Dust containment measures were implemented to reduce the risk of airborne Aspergillus contamination. Air sampling was performed at four wards in the adjacent hospital buildings to assess the containment measures' effectiveness. RESULTS A high, undetermined number of colonies of bacteria and molds were detected on all outside balconies before demolition. During demolition, Aspergillus spp. was detected only in the ward closest to the demolition site. However, no case of aspergillosis was reported. The difference-in-difference analysis revealed that the interaction between the demolition activity, height of the ward, and distance of the air intake to the demolition activities resulted in a significant increase in the numbers of Aspergillus spp. CONCLUSIONS When large-scale demolition work occurs in hospital premises, Aspergillus spp. may increase in the ward where the vertical and horizontal distance of air intake from the demolition site is close, even though infection control measures based on the ICRA are implemented.
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Affiliation(s)
- Yasuhiro Nakanishi
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan.,Corporate Administration Department, Research Promotion Division, 12967Nara Medical University, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, 12967Nara Medical University, Japan.,Infection Control Team, 243062Nara Medical University Hospital, Japan
| | - Akira Koizumi
- Infection Control Team, 243062Nara Medical University Hospital, Japan.,Central Clinical Laboratory, 243062Nara Medical University Hospital, Japan
| | - Junko Tokutani
- Infection Control Team, 243062Nara Medical University Hospital, Japan.,Department of Nursing, 243062Nara Medical University Hospital, Japan
| | - Shingo Yoshihara
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan.,Center for Infectious Diseases, 12967Nara Medical University, Japan
| | - Keiichi Mikasa
- Center for Infectious Diseases, 12967Nara Medical University, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan
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5
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Mitra S, Das R. Health risk assessment of construction workers from trace metals in PM 2.5 from Kolkata, India. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 77:125-140. [PMID: 33337288 DOI: 10.1080/19338244.2020.1860877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Construction activities have long been recognized as a pertinent source of PM2.5 though limited information exists regarding chemical characteristics of aerosols generated during building demolition/construction. A comprehensive investigation was carried out to assess the physical (SEM analysis) and chemical (ICP MS analysis) properties of PM2.5 in a building demolition and construction site and compared with background. Average concentrations of PM2.5 at both the sites exceeded the National Ambient Air Quality Standards (NAAQS). Overall trend of the total metal concentrations of PM2.5 followed the order of (Na, Ca, Al, Mg, Fe, Zn) > (Ti, Sr, Cd, Ba, Pb, V, Cr, Mn, Co, Ni, Cu) in both the sites. Sr, Ba, Mg, Zn, Ti, Cd, Al, Cr, Fe, Co, Mn, V, Ni, Ca, and Zn showed a ∼1.3-3.0 fold increase, and Pb showed the highest increase of almost >3.5 times when compared to the background concentrations. Health risk estimates based on the bio-available concentration of metals indicated that hazard quotient (HQ) values for non-carcinogenic metals were within the prescribed limit (HQ ≤ 1). However, the excess lifetime cancer risk (ELCR) for the carcinogenic metals Pb, Ni, Cd, and Cr(VI) were higher than the guideline limits of USEPA.
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Affiliation(s)
- Shoumick Mitra
- School of Environmental Studies, Jadavpur University, Kolkata, India
| | - Reshmi Das
- School of Environmental Studies, Jadavpur University, Kolkata, India
- Earth Observatory of Singapore, Nanyang Technological University, Singapore, Singapore
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6
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Mousavi E, Sharma V, Gajjar D, Shoai Naini S. Renovation in hospitals: a case study on the use of control cubes for local repairs in health-care facilities. JOURNAL OF FACILITIES MANAGEMENT 2020. [DOI: 10.1108/jfm-02-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to evaluate the effectiveness of the control cubes for dust control in health-care facilities. Research shows that more than 80% of pathogenic agents in hospitals are spread into the air, where they either remain airborne or deposit on the surface. At the same time, renovation and repair activities, including regular maintenance, are a necessity in active health-care facilities and a multitude of studies have documented their impact on indoor air quality. The dust that is generated by construction activities may potentially carry pathogenic agents, varying from coarse particles (≤10 µm, PM10) to fine particles (≤2.5 µm, PM2.5), including airborne bacteria, and fungal spores linked to high patient mortality in immune-compromised patients.
Design/methodology/approach
This study measures the impact and effectiveness of one such preventative measure, namely, the control cube (CC), on air quality during renovation and repair. CC is a temporary structure, typically made from stainless steel, around the local repair zone to minimize the spread of dust and potential microorganisms. The current paper presents a comparative analysis to identify the effectiveness of a CC equipped with the high-efficiency particulate filtration (HEPA) filter in a hospital setting by simulating construction renovation and repair work.
Findings
A baseline was established to measure the effectiveness of CCs and the impact of negative pressure on the indoor air quality in a hospital during simulated renovation work. Results showed that CCs are very effective in minimizing the spread of dust due to construction activities in the hospital. However, it is imperative to ensure that the air inside the CC is cleaned via filtration.
Originality/value
CCs are very effective, and this paper investigates the best approach for facility managers to implement this strategy.
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7
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Renovation in hospitals: Training construction crews to work in health care facilities. Am J Infect Control 2020; 48:403-409. [PMID: 31676158 DOI: 10.1016/j.ajic.2019.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health care facilities require frequent renovations to maintain or enhance their service, and to meet the dynamic demands of their patients. Construction activities in active health care facilities are a significant contributor to various challenges that range from infection to death. It is therefore essential to minimize the adverse impacts of construction activities on health care units as well as their adjacent sites. METHODS A questionnaire was developed to study current training modules to prepare construction crews to work in health care environments. The survey was disseminated among professionals of the top 15 health care contractors. A total of 129 individuals participated, and their responses were analyzed using descriptive and categorical statistics. RESULTS This study investigates current training practices regarding (1) the level of training, (2) the frequency of training, and (3) the impact that the sensitivity of the project has on the training. To effectively prepare construction crews, special training must be provided to them. CONCLUSIONS There are uncertainties about the sufficiency and impact of the existing training. Existing trainings are tailored for upper management positions, and the amount/frequency of training for construction crews are substantially low. Findings of this study contribute to characterizing the activities and conditions pertaining to training of construction crews.
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8
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Loeffert ST, Melloul E, Gustin MP, Hénaff L, Guillot C, Dupont D, Wallon M, Cassier P, Dananché C, Bénet T, Botterel F, Guillot J, Vanhems P. Investigation of the Relationships Between Clinical and Environmental Isolates of Aspergillus fumigatus by Multiple-locus Variable Number Tandem Repeat Analysis During Major Demolition Work in a French Hospital. Clin Infect Dis 2020; 68:321-329. [PMID: 30247539 DOI: 10.1093/cid/ciy498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/17/2018] [Indexed: 01/28/2023] Open
Abstract
Background Genotyping is needed to explore the link between clinical cases from colonization of invasive aspergillosis (IA) and major building construction. Attempts to correlate Aspergillus fumigatus strains from clinical infection or colonization with those found in the environment remain controversial due to the lack of a large prospective study. Our aim in this study was to compare the genetic diversity of clinical and environmental A. fumigatus isolates during a demolition period. Methods Fungal contamination was monitored daily for 11 months in 2015. Environmental surveillance was undertaken indoors and outdoors at 8 locations with automatic agar samplers. IA infection cases were investigated according to 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 criteria. Isolates were identified by amplification and sequencing of the β- tubulin gene. They were genotyped by multiple-locus variable number tandem repeat analysis (MLVA). The phylogenetic relationships between isolates were assessed by generating a minimum spanning tree. Results Based on 3885 samples, 394 A. fumigatus isolates (383 environmental and 11 clinical) were identified and genotyped using MLVA. Clinical isolates were collected from patients diagnosed as having probable IA (n = 2), possible IA (n = 1), or bronchial colonization (n = 6). MLVA generated 234 genotypes. Seven clinical isolates shared genotypes identical to environmental isolates. Conclusions Among the diversity of genotypes described, similar genotypes were found in clinical and environmental isolates, indicating that A. fumigatus infection and colonization may originate from hospital environments.
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Affiliation(s)
- Sophie T Loeffert
- Equipe Epidémiologie et Santé Internationale, Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon
| | - Elise Melloul
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil
| | - Marie-Paule Gustin
- Département de Santé Publique, Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie, Université Claude Bernard Lyon 1
| | - Laetitia Hénaff
- Equipe Epidémiologie et Santé Internationale, Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon
| | - Chloé Guillot
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil
| | - Damien Dupont
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon
| | - Martine Wallon
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon
| | - Pierre Cassier
- Laboratoire de Biologie Sécurité Environnement, Groupement Hospitalier Centre, Hospices Civils de Lyon
| | - Cédric Dananché
- Equipe Epidémiologie et Santé Internationale, Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon.,Unité d'Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, France
| | - Thomas Bénet
- Unité d'Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, France
| | - Françoise Botterel
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil
| | - Jacques Guillot
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil
| | - Philippe Vanhems
- Equipe Epidémiologie et Santé Internationale, Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure de Lyon.,Unité d'Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, France
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9
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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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10
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Denham ST, Wambaugh MA, Brown JCS. How Environmental Fungi Cause a Range of Clinical Outcomes in Susceptible Hosts. J Mol Biol 2019; 431:2982-3009. [PMID: 31078554 PMCID: PMC6646061 DOI: 10.1016/j.jmb.2019.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/18/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
Environmental fungi are globally ubiquitous and human exposure is near universal. However, relatively few fungal species are capable of infecting humans, and among fungi, few exposure events lead to severe systemic infections. Systemic infections have mortality rates of up to 90%, cost the US healthcare system $7.2 billion annually, and are typically associated with immunocompromised patients. Despite this reputation, exposure to environmental fungi results in a range of outcomes, from asymptomatic latent infections to severe systemic infection. Here we discuss different exposure outcomes for five major fungal pathogens: Aspergillus, Blastomyces, Coccidioides, Cryptococcus, and Histoplasma species. These fungi include a mold, a budding yeast, and thermal dimorphic fungi. All of these species must adapt to dramatically changing environments over the course of disease. These dynamic environments include the human lung, which is the first exposure site for these organisms. Fungi must defend themselves against host immune cells while germinating and growing, which risks further exposing microbe-associated molecular patterns to the host. We discuss immune evasion strategies during early infection, from disruption of host immune cells to major changes in fungal cell morphology.
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Affiliation(s)
- Steven T Denham
- Division of Microbiology and Immunology, Pathology Department, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Morgan A Wambaugh
- Division of Microbiology and Immunology, Pathology Department, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Jessica C S Brown
- Division of Microbiology and Immunology, Pathology Department, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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11
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Mousavi MS, Hadei M, Majlesi M, Hopke PK, Yarahmadi M, Emam B, Kermani M, Shahsavani A. Investigating the effect of several factors on concentrations of bioaerosols in a well-ventilated hospital environment. ENVIRONMENTAL MONITORING AND ASSESSMENT 2019; 191:407. [PMID: 31165312 DOI: 10.1007/s10661-019-7559-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
This study characterized and quantified the bacterial and fungal bioaerosols in nine wards of the Razavi Hospital (Mashhad, Iran) that is equipped with an advanced heating, ventilating, and air conditioning (HVAC) system including HEPA filters for air cleaning. In this study, 432 samples were taken from the indoor air of multiple hospital wards during the morning and afternoon shifts during summer and autumn. The particle number concentrations with sizes of > 0.3, > 0.5, > 1, > 2, > 5, and > 10 μm were measured using a 6-channel handheld particle counter. A greater diversity of bioaerosol types were observed during the morning shifts and during summer. The microbial load was not affected significantly by the temperature, relative humidity, working shift, season, and number of visitors, indicating the effectiveness of a well-designed ventilation system to eliminate site-specific variations. For microbial number concentrations, a significant correlation was only observed between the number of particles with a diameter of > 10 μm and the airborne microbial loading. Thus, passive sampling may not properly reflect the actual concentrations of smaller bioaerosols. In conclusion, HEPA filters in the HVAC system successfully decreased the bioaerosol concentrations in the hospital environment. Additionally, we recommend that active sampling be used in cases where a well-functioning HVAC system exists.
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Affiliation(s)
| | - Mostafa Hadei
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Monireh Majlesi
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY, 13699, USA
| | - Maryam Yarahmadi
- Environmental and Occupational Health Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Bahahran Emam
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Kermani
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Shahsavani
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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12
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Improved delivery of voriconazole to Aspergillus fumigatus through solid lipid nanoparticles as an effective carrier. Colloids Surf A Physicochem Eng Asp 2018. [DOI: 10.1016/j.colsurfa.2018.08.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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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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14
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Park CE, Jeong NY, Yang MJ, Kim HW, Joo SI, Kim KH, Seong HK, Hwang YY, Lim HM, Son JC, Yoon SH, Yoon NS, Jang IH. Study on the Standardization of a Surveillance Culture Laboratory in Infection Control Fields. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.3.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
| | - Na-Yeon Jeong
- Infection Control Office, Samsung Medical Center, Seoul, Korea
| | - Min-Ji Yang
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han-Wool Kim
- Infection Control Office, Pusan National University Hospital, Busan, Korea
| | - Sei-Ick Joo
- Department of Biomedical Laboratory Science, Daejeon University, Daejeon, Korea
| | - Keon-Han Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hee-Kyung Seong
- Department of Biomedical Laboratory Science, Dong-Eui Institute of Technology, Busan, Korea
| | - Yu-Yean Hwang
- Department of Laboratory Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyun-Mi Lim
- Department of Laboratory Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Jae-Cheol Son
- Department of Pulmonology, Chungbuk National University Hospital, Cheongju, Korea
| | | | - Nam-Seob Yoon
- Department of Laboratory Medicine, Asan Medical Center, Seoul, Korea
| | - In-Ho Jang
- Department of Biomedical Laboratory Science, SangJi University, Wonju, Korea
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15
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The spectrum of pulmonary aspergillosis. Respir Med 2018; 141:121-131. [PMID: 30053957 DOI: 10.1016/j.rmed.2018.06.029] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022]
Abstract
Notable progress has been made in the past years in the classification, diagnosis and treatment of pulmonary aspergillosis. New criteria were proposed by the Working Group of the International Society for Human and Animal Mycology (ISHAM) for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The latest classification of chronic pulmonary aspergillosis (CPA) suggested by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) has become widely accepted among clinicians. Subacute invasive pulmonary aspergillosis is now considered a type of CPA, yet it is still diagnosed and treated similarly to invasive pulmonary aspergillosis (IPA). Isavuconazole, an extended-spectrum triazole, has recently been approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of IPA. The most recent Infectious Diseases Society of America (IDSA) guidelines strongly recommend reducing mold exposure to patients at high risk for pulmonary aspergillosis. The excessive relapse rate following discontinuation of therapy remains a common reality to all forms of this semi-continuous spectrum of diseases. This highlights the need to continuously reassess patients and individualize therapy accordingly. Thus far, the duration of therapy and the frequency of follow-up have to be well characterized.
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16
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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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17
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Could we predict airborne Aspergillus contamination during construction work? Am J Infect Control 2017; 45:39-41. [PMID: 27665035 DOI: 10.1016/j.ajic.2016.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Aspergillus fumigatus is a major opportunistic pathogen causing nosocomial infection. Hospital outbreaks of invasive aspergillosis have been associated with demolition and building construction. This study was designed to examine the impact of meteorologic factors and different periods of work on outdoor fungal airborne concentrations. METHODS The study was conducted at Necker Enfants Malades Hospital, a 650-bed teaching care hospital recently involved in a large construction program, including renovation, construction, and demolition. During the work phases, prospective external air samplings were performed 3 times a week, and meteorologic parameters were collected every day. RESULTS Two hundred and one samples were collected. Aspergillus spp were found in 80.1% of samples, with a median concentration of 16 colony forming units (CFU)/m3. A significant increase in the colony count of molds occurred after demolition. In the multivariate analysis, factors associated with overall fungi concentration were the type of work construction and temperature. Elevated Aspergillus spp concentrations (>20 CFU/m3) were associated with higher temperature. CONCLUSIONS Our findings underline the importance of environmental surveillance. According to our results we suggest that demolition work should be performed during the winter and fall seasons.
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18
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Azarmi F, Kumar P, Marsh D, Fuller G. Assessment of the long-term impacts of PM10 and PM2.5 particles from construction works on surrounding areas. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2016; 18:208-21. [PMID: 26705547 DOI: 10.1039/c5em00549c] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Construction activities are common across cities; however, the studies assessing their contribution to airborne PM10 (≤10 μm) and PM2.5 (≤2.5 μm) particles on the surrounding air quality are limited. Herein, we assessed the impact of PM10 and PM2.5 arising from construction works in and around London. Measurements were carried out at 17 different monitoring stations around three construction sites between January 2002 and December 2013. Tapered element oscillating microbalance (TEOM 1400) and OSIRIS (2315) particle monitors were used to measure the PM10 and PM2.5 fractions in the 0.1-10 μm size range along with the ambient meteorological data. The data was analysed using bivariate concentration polar plots and k-means clustering techniques. Daily mean concentrations of PM10 were found to exceed the European Union target limit value of 50 μg m(-3) at 11 monitoring stations but remained within the allowable 35 exceedences per year, except at two monitoring stations. In general, construction works were found to influence the downwind concentrations of PM10 relatively more than PM2.5. Splitting of the data between working (0800-1800 h; local time) and non-working (1800-0800 h) periods showed about 2.2-fold higher concentrations of PM10 during working hours when compared with non-working hours. However, these observations did not allow to conclude that this increase was from the construction site emissions. Together, the polar concentration plots and the k-means cluster analysis applied to a pair of monitoring stations across the construction sites (i.e. one in upwind and the other in downwind) confirmed the contribution of construction sources on the measured concentrations. Furthermore, pairing the monitoring stations downwind of the construction sites showed a logarithmic decrease (with R(2) about 0.9) in the PM10 and PM2.5 concentration with distance. Our findings clearly indicate an impact of construction activities on the nearby downwind areas and a need for developing mitigation measures to limit their escape from the construction sites.
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Affiliation(s)
- Farhad Azarmi
- Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK.
| | - Prashant Kumar
- Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK. and Environmental Flow (EnFlo) Research Centre, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Daniel Marsh
- MRC PHE Centre for Environment and Health, King's College London, London SE1 9NH, UK
| | - Gary Fuller
- MRC PHE Centre for Environment and Health, King's College London, London SE1 9NH, UK
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19
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Sodeau J, O'Connor D. Bioaerosol Monitoring of the Atmosphere for Occupational and Environmental Purposes. THE QUALITY OF AIR 2016. [DOI: 10.1016/bs.coac.2016.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Barreiros G, Akiti T, Magalhães ACG, Nouér SA, Nucci M. Effect of the implosion and demolition of a hospital building on the concentration of fungi in the air. Mycoses 2015; 58:707-13. [DOI: 10.1111/myc.12418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/04/2015] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gloria Barreiros
- Hospital Universitário Clementino Fraga Filho; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Tiyomi Akiti
- Hospital Universitário Clementino Fraga Filho; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | | | - Simone A. Nouér
- Hospital Universitário Clementino Fraga Filho; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Marcio Nucci
- Hospital Universitário Clementino Fraga Filho; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
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21
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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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22
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Azarmi F, Kumar P, Mulheron M. The exposure to coarse, fine and ultrafine particle emissions from concrete mixing, drilling and cutting activities. JOURNAL OF HAZARDOUS MATERIALS 2014; 279:268-279. [PMID: 25068443 DOI: 10.1016/j.jhazmat.2014.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/26/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
Building activities generate coarse (PM10≤10μm), fine (PM2.5≤2.5μm) and ultrafine particles (<100nm) making it necessary to understand both the exposure levels of operatives on site and the dispersion of ultrafine particles into the surrounding environment. This study investigates the release of particulate matter, including ultrafine particles, during the mixing of fresh concrete (incorporating Portland cement with Ground Granulated Blastfurnace Slag, GGBS or Pulverised Fuel Ash, PFA) and the subsequent drilling and cutting of hardened concrete. Particles were measured in the 5-10,000nm size range using a GRIMM particle spectrometer and a fast response differential mobility spectrometer (DMS50). The mass concentrations of PM2.5-10 fraction contributed ∼52-64% of total mass released. The ultrafine particles dominated the total particle number concentrations (PNCs); being 74, 82, 95 and 97% for mixing with GGBS, mixing with PFA, drilling and cutting, respectively. Peak values measured during the drilling and cutting activities were 4 and 14 times the background. Equivalent emission factors were calculated and the total respiratory deposition dose rates for PNCs for drilling and cutting were 32.97±9.41×10(8)min(-1) and 88.25±58.82×10(8)min(-1). These are a step towards establishing number and mass emission inventories for particle exposure during construction activities.
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Affiliation(s)
- Farhad Azarmi
- Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences (FEPS), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Prashant Kumar
- Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences (FEPS), University of Surrey, Guildford GU2 7XH, United Kingdom; Environmental Flow (EnFlo) Research Centre, FEPS, University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Mike Mulheron
- Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences (FEPS), University of Surrey, Guildford GU2 7XH, United Kingdom
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23
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Alshareef F, Robson GD. Prevalence, persistence, and phenotypic variation of Aspergillus fumigatus in the outdoor environment in Manchester, UK, over a 2-year period. Med Mycol 2014; 52:367-75. [DOI: 10.1093/mmy/myu008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Abstract
Invasive fungal infections (IFI) have become a leading cause of morbidity and mortality in cancer patients. Infections with these organisms are often difficult to diagnose and treat. Appropriate and timely diagnosis requires a high index of suspicion and invasive procedures, including biopsy, to confirm the diagnosis. Treatment may be difficult, secondary to variable susceptibility and difficulty with exact and specific characterization of the fungal pathogen. The pathogens that are seen range from yeasts to invasive molds. Fortunately newer, noninvasive diagnostic techniques are available to aid in the diagnosis and treatments have become better tolerated and more efficacious.
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Affiliation(s)
- Michael Angarone
- Division of Infectious Disease, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 900, Chicago, IL, 60611, USA,
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25
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Monitoring the occurrence of indoor fungi in a hospital. Rev Iberoam Micol 2012; 29:227-34. [DOI: 10.1016/j.riam.2012.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/24/2022] Open
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27
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Kumar P, Morawska L, Harrison RM. Nanoparticles in European Cities and Associated Health Impacts. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2012. [DOI: 10.1007/698_2012_161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Comparison of two control measures of weatherstripping in reducing blowing dust during hospital renovations. J Infect Chemother 2010; 16:431-5. [PMID: 20981562 DOI: 10.1007/s10156-010-0173-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Hospital renovation projects pose risks of invasive infection by fungi from dust that is blown about during the period in question. Control measures to reduce the amount of dust during hospital renovation are thus necessary. Currently, no study has compared different control measures for effectiveness through more than one period of renovation. In this study, we examined the capacities of two control measures of weatherstripping (0.15 mm poly film and adhesive tape) to reduce the amount of blowing dust during two different hospital renovations (in 2008 and 2009). The amount of dust in the air of the hospital before and during the renovation was measured about once a week in both 2008 and 2009, and the between-year and within-year differences were tested. Our study revealed that the weatherstripping used in 2009 (adhesive tape) was significantly more effective than the measures taken in 2008 (0.15 mm poly film) to reduce the amount of dust during the renovations (p < 0.001), while in both years the amount of dust became significantly higher during the renovations than before the renovations. Differences in the effectiveness of weatherstripping during renovations between floors of the hospital were not significant in both 2008 and 2009. The number of Aspergillus-positive samples did not significantly increase compared with the number observed before the start of the hospital renovations (2006-2007) in 2008 and 2009, respectively. The weatherstripping potentially reduced the associated risk of airborne fungal infection.
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29
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Panackal AA, Li H, Kontoyiannis DP, Mori M, Perego CA, Boeckh M, Marr KA. Geoclimatic influences on invasive aspergillosis after hematopoietic stem cell transplantation. Clin Infect Dis 2010; 50:1588-97. [PMID: 20450414 PMCID: PMC3024009 DOI: 10.1086/652761] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA). METHODS Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate. RESULTS In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25-2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate. CONCLUSIONS Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers.
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Affiliation(s)
| | - Hong Li
- Biostatistics and Design Program, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston
| | - Motomi Mori
- Biostatistics and Design Program, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Cheryl A. Perego
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston
| | - Michael Boeckh
- Program in Infectious Diseases, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kieren A. Marr
- Program in Infectious Diseases, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland
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