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Marek A, Meijer EFJ, Tartari E, Zakhour J, Chowdhary A, Voss A, Kanj SS, Bal AM. Environmental monitoring for filamentous fungal pathogens in hematopoietic cell transplant units. Med Mycol 2023; 61:myad103. [PMID: 37793805 DOI: 10.1093/mmy/myad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023] Open
Abstract
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.
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Affiliation(s)
- Aleksandra Marek
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Eelco F J Meijer
- Canisius-Wilhelmina Hospital (CWZ), Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Johnny Zakhour
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Abhijit M Bal
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
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Menu E, Filori Q, Dufour JC, Ranque S, L’Ollivier C. A Repertoire of Clinical Non-Dermatophytes Moulds. J Fungi (Basel) 2023; 9:jof9040433. [PMID: 37108888 PMCID: PMC10146755 DOI: 10.3390/jof9040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Humans are constantly exposed to micromycetes, especially filamentous fungi that are ubiquitous in the environment. In the presence of risk factors, mostly related to an alteration of immunity, the non-dermatophyte fungi can then become opportunistic pathogens, causing superficial, deep or disseminated infections. With new molecular tools applied to medical mycology and revisions in taxonomy, the number of fungi described in humans is rising. Some rare species are emerging, and others more frequent are increasing. The aim of this review is to (i) inventory the filamentous fungi found in humans and (ii) provide details on the anatomical sites where they have been identified and the semiology of infections. Among the 239,890 fungi taxa and corresponding synonyms, if any, retrieved from the Mycobank and NCBI Taxonomy databases, we were able to identify 565 moulds in humans. These filamentous fungi were identified in one or more anatomical sites. From a clinical point of view, this review allows us to realize that some uncommon fungi isolated in non-sterile sites may be involved in invasive infections. It may present a first step in the understanding of the pathogenicity of filamentous fungi and the interpretation of the results obtained with the new molecular diagnostic tools.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Quentin Filori
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
| | - Jean-Charles Dufour
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, 13385 Marseille, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
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3
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de Carvalho Patricio BF, da Silva Lopes Pereira JO, Sarcinelli MA, de Moraes BPT, Rocha HVA, Gonçalves-de-Albuquerque CF. Could the Lung Be a Gateway for Amphotericin B to Attack the Army of Fungi? Pharmaceutics 2022; 14:2707. [PMID: 36559201 PMCID: PMC9784761 DOI: 10.3390/pharmaceutics14122707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
Fungal diseases are a significant cause of morbidity and mortality worldwide, primarily affecting immunocompromised patients. Aspergillus, Pneumocystis, and Cryptococcus are opportunistic fungi and may cause severe lung disease. They can develop mechanisms to evade the host immune system and colonize or cause lung disease. Current fungal infection treatments constitute a few classes of antifungal drugs with significant fungi resistance development. Amphotericin B (AmB) has a broad-spectrum antifungal effect with a low incidence of resistance. However, AmB is a highly lipophilic antifungal with low solubility and permeability and is unstable in light, heat, and oxygen. Due to the difficulty of achieving adequate concentrations of AmB in the lung by intravenous administration and seeking to minimize adverse effects, nebulized AmB has been used. The pulmonary pathway has advantages such as its rapid onset of action, low metabolic activity at the site of action, ability to avoid first-pass hepatic metabolism, lower risk of adverse effects, and thin thickness of the alveolar epithelium. This paper presented different strategies for pulmonary AmB delivery, detailing the potential of nanoformulation and hoping to foster research in the field. Our finds indicate that despite an optimistic scenario for the pulmonary formulation of AmB based on the encouraging results discussed here, there is still no product registration on the FDA nor any clinical trial undergoing ClinicalTrial.gov.
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Affiliation(s)
- Beatriz Ferreira de Carvalho Patricio
- Pharmacology Laboratory, Biomedical Institute, Federal University of State of Rio de Janeiro, 94 Frei Caneca Street, Rio de Janeiro 20211-010, Brazil
- Postgraduate Program in Molecular and Cell Biology, Biomedical Institute, Federal University of State of Rio de Janeiro, 94 Frei Caneca Street, Rio de Janeiro 20211-010, Brazil
| | | | - Michelle Alvares Sarcinelli
- Laboratory of Micro and Nanotechnology, Institute of Technology of Drugs, Oswaldo Cruz Foundation, Brazil Av., 4036, Rio de Janeiro 213040-361, Brazil
| | - Bianca Portugal Tavares de Moraes
- Postgraduate Program in Biotechnology, Biology Institute, Federal Fluminense University, Rua Prof. Marcos Waldemar de Freitas Reis, Niterói 24210-201, Brazil
- Immunopharmacology Laboratory, Biomedical Institute, Federal University of State of Rio de Janeiro, 94 Frei Caneca Street, Rio de Janeiro 20211-010, Brazil
| | - Helvécio Vinicius Antunes Rocha
- Laboratory of Micro and Nanotechnology, Institute of Technology of Drugs, Oswaldo Cruz Foundation, Brazil Av., 4036, Rio de Janeiro 213040-361, Brazil
| | - Cassiano Felippe Gonçalves-de-Albuquerque
- Postgraduate Program in Molecular and Cell Biology, Biomedical Institute, Federal University of State of Rio de Janeiro, 94 Frei Caneca Street, Rio de Janeiro 20211-010, Brazil
- Postgraduate Program in Biotechnology, Biology Institute, Federal Fluminense University, Rua Prof. Marcos Waldemar de Freitas Reis, Niterói 24210-201, Brazil
- Immunopharmacology Laboratory, Biomedical Institute, Federal University of State of Rio de Janeiro, 94 Frei Caneca Street, Rio de Janeiro 20211-010, Brazil
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Impact of mold growth on di(2-ethylhexyl) phthalate emission from moist wallpaper. Heliyon 2022; 8:e10404. [PMID: 36119884 PMCID: PMC9479013 DOI: 10.1016/j.heliyon.2022.e10404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022] Open
Abstract
Flood damage can increase indoor concentrations of di(2-ethylhexyl) phthalate (DEHP) and molds in households with wallpaper. Wallpaper water content can affect its DEHP emission into indoor environments; however, the influence of mold growth on this DEHP emission remains unclear. Here, we evaluated whether mold growth affects DEHP emission from moist wallpaper (moist WP). Experiments were conducted in glass chambers with wallpaper containing 12.7% (w/w) DEHP and a dust tray sample system at approximately 28 °C and 100% relative humidity (RH). The experimental groups were (1) moist WP, (2) moist WP + Aspergillus versicolor (AV), (3) moist WP + Cladosporium cladosporioides, (4) moist WP + Penicillium chrysogenum, and (5) moist WP + mold mixture. Mold growth on the wallpaper and DEHP emission into air and onto dust were analyzed at nine time-points over 30 days. Initially, the moist WP group emitted relatively high concentrations of DEHP into air, but after at least 8 days, the concentration of DEHP emitted by the mold-added groups exceeded that of the moist WP group. DEHP emission onto dust, especially from the moist WP group, increased considerably at day 15. During the experimental period, the moist WP (13.63 ± 4.67 μg) and moist WP + AV (13.93 ± 0.49 μg) groups emitted higher cumulative amounts of DEHP onto dust. During the 30-day experimental period, obvious mold growth occurred over days 15–30. Moreover, the moist WP group exhibited relatively higher and lower cumulative DEHP emission into air than the mold-added groups during days 2–10 (2.71 vs. 1.94–2.94 μg) and 15–30 (1.16 vs. 1.61–2.12), respectively; a contrasting trend was observed for cumulative DEHP emission onto dust. In conclusion, mold growth affects DEHP emission from water-damaged wallpaper, and the removal or cleaning of wet wallpaper, particularly those with visible mold growth, is critical from a public health perspective.
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Ability of Essential Oil Vapours to Reduce Numbers of Culturable Aerosolised Coronavirus, Bacteria and Fungi. Antibiotics (Basel) 2022; 11:antibiotics11030393. [PMID: 35326856 PMCID: PMC8944824 DOI: 10.3390/antibiotics11030393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Transmission of pathogens present in the indoor air can occur through aerosols. This study evaluated the efficacy of an evaporated mix of essential oils to reduce the numbers of culturable aerosolized coronavirus, bacterium and fungus. The essential oil-containing gel was allowed to vaporize inside a glass chamber for 10 or 20 min. Aerosols of a surrogate of SARS-CoV-2, murine hepatitis coronavirus MHV-1, Escherichia coli or Aspergillus flavus spores were produced using a collision nebuliser and passed through the essential oil vapours, then collected on a six-stage Andersen sampler. The six-stages of the impact sampler capture aerosols in sizes ranging from 7 to 0.65 µm. The number of culturable microbes present in the aerosols collected in the different stages were enumerated and compared to the number of culturable microbes in control microbial aerosols that were not exposed to the evaporated essential oils. After 10 and 20 min evaporation, the essential oils reduced the numbers of culturable aerosolized coronavirus by 48% (log10 reduction = 0.3; p = 0.002 vs. control) and 53% (log10 reduction = 0.3; p = 0.001 vs. control), respectively. The essential oils vaporised for 10 min, reduced the number of viable E. coli by 51% (log10 reduction = 0.3; p = 0.032 vs. control). The Aspergillus flavus spores were mostly observed in the larger aerosols (7.00 µm to 2.10 µm) and the essential oils vaporised for 10 min reduced the number of viable spores by 72% (log10 reduction = 0.6; p = 0.008 vs. control). The vapours produced by a gel containing naturally occurring essential oils were able to significantly reduce the viable numbers of aerosolized coronavirus, bacteria and fungal spores. The antimicrobial gel containing the essential oils may be able to reduce aerosol transmission of microbes when used in domestic and workplace settings.
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van Rhijn N, Coleman J, Collier L, Moore C, Richardson MD, Bright-Thomas RJ, Jones AM. Meteorological Factors Influence the Presence of Fungi in the Air; A 14-Month Surveillance Study at an Adult Cystic Fibrosis Center. Front Cell Infect Microbiol 2021; 11:759944. [PMID: 34900752 PMCID: PMC8662344 DOI: 10.3389/fcimb.2021.759944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cystic fibrosis is an inherited disease that predisposes to progressive lung damage. Cystic fibrosis patients are particularly prone to developing pulmonary infections. Fungal species are commonly isolated in lower airway samples from patients with cystic fibrosis. Fungal spores are prevalent in the air. Methods We performed environmental air sampling surveillance at the Manchester Adult Cystic Fibrosis Centre, UK (MACFC) over a 14-month period to assess fungal growth inside and outside the CF center. Results Airborne counts of fungal spores peaked from May to October, both in outdoor and indoor samples. Collection of meteorological data allowed us to correlate fungal presence in the air with elevated temperatures and low wind speeds. Additionally, we demonstrated patient rooms containing windows had elevated fungal counts compared to rooms not directly connected to the outdoors. Conclusions This study suggests that airborne Aspergillus fumigatus spores were more abundant during the summer months of the survey period, which appeared to be driven by increased temperatures and lower wind speeds. Indoor counts directly correlated to outdoor A. fumigatus levels and were elevated in patient rooms that were directly connected to the outdoor environment via an openable window designed for ventilation purposes. Further studies are required to determine the clinical implications of these findings for cystic fibrosis patients who are predisposed to Aspergillus related diseases, and in particular whether there is seasonal influence on incidence of Aspergillus related conditions and if screening for such complications such be increased during summer months and precautions intensified for those with a known history of Aspergillus related disease.
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Affiliation(s)
- Norman van Rhijn
- Manchester Fungal Infection Group, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - James Coleman
- Manchester Adult Cystic Fibrosis Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Lisa Collier
- Manchester Adult Cystic Fibrosis Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Caroline Moore
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Mycology Reference Centre, European Confederation of Medical Mycology (ECMM) Excellence Centre of Medical Mycology, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Malcolm D Richardson
- Manchester Fungal Infection Group, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom.,Mycology Reference Centre, European Confederation of Medical Mycology (ECMM) Excellence Centre of Medical Mycology, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Rowland J Bright-Thomas
- Manchester Adult Cystic Fibrosis Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Mycology Reference Centre, European Confederation of Medical Mycology (ECMM) Excellence Centre of Medical Mycology, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
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7
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Lin CJ, Hou YH, Chen YL. The histone acetyltransferase GcnE regulates conidiation and biofilm formation in Aspergillus fumigatus. Med Mycol 2020; 58:248-259. [PMID: 31100153 DOI: 10.1093/mmy/myz043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/22/2019] [Accepted: 04/11/2019] [Indexed: 01/03/2023] Open
Abstract
Histone modifications play a crucial role in eukaryotic gene regulation. The Spt-Ada-Gcn5-acetyltransferase (SAGA) complex controls histone acetylation, with Gcn5 (GcnE) acting as the acetyltransferase. In the Aspergillus species, GcnE has been shown to regulate asexual development and secondary metabolism. Apart from this, GcnE is required for pathogenicity in plant fungal pathogen A. flavus; however, the role of GcnE in the pathogenicity of human pathogenic fungus A. fumigatus is unknown. In this study, we uncovered the key roles of GcnE in A. fumigatus conidiation, stress responses, and biofilm formation. We observed that deletion of gcnE resulted in aberrant conidiation in which conidiophores displayed abnormal phialide formation. In addition, the ΔgcnE mutant grew slightly faster under limited nitrogen sources (1 mM of ammonium or nitrate) compared to the wild type. The ΔgcnE mutant exhibited increased susceptibility to cell wall-perturbing agents, H2O2 and menadione but enhanced tolerance to LiCl. Furthermore, we showed that GcnE is involved in biofilm formation, and overexpression of adherence-related genes such as somA or uge3 partially rescued biofilm formation defects in the ΔgcnE mutant background. Interestingly, GcnE was not required for virulence in a neutropenic murine model of invasive aspergillosis. These results suggest that GcnE is critical for conidiation and biofilm formation but not virulence in A. fumigatus.
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Affiliation(s)
- Chi-Jan Lin
- Department of Plant Pathology and Microbiology, National Taiwan University, 10617 Taipei, Taiwan
| | - Yi-Hsuan Hou
- Department of Plant Pathology and Microbiology, National Taiwan University, 10617 Taipei, Taiwan
| | - Ying-Lien Chen
- Department of Plant Pathology and Microbiology, National Taiwan University, 10617 Taipei, Taiwan
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8
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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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9
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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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Demuyser T, De Cock E, Sermijn E. Airborne Aspergillus fumigatus contamination in an intensive care unit: Detection, management and control. J Infect Public Health 2019; 12:904-906. [PMID: 31078493 DOI: 10.1016/j.jiph.2019.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 11/30/2022] Open
Abstract
Intensive care unit (ICU) patients are often extremely vulnerable to suffer an infection from airborne pathogens. Therefore, an environmental outbreak of Aspergillus fumigatus in an ICU should be handled in a concise and efficient way. In this short report, we describe an outbreak of A. fumigatus in the ICU of a Belgian secondary care hospital. Following initial detection of a humidity problem and airborne A. fumigatus, the department of infection prevention took urgent measures for damage control and resolution of the problem. As such a timely resolution has been provided, with assurance of a clean and healthy environment for the critical patients.
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Affiliation(s)
- Thomas Demuyser
- Department of Microbiology, Algemeen Stedelijk Ziekenhuis (ASZ), Merestraat 80, 9300 Aalst, Belgium
| | - Evelien De Cock
- Department of Infection Prevention, Algemeen Stedelijk Ziekenhuis (ASZ), Merestraat 80, 9300 Aalst, Belgium
| | - Erica Sermijn
- Department of Infection Prevention, Algemeen Stedelijk Ziekenhuis (ASZ), Merestraat 80, 9300 Aalst, Belgium.
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Sabino R, Veríssimo C, Viegas C, Viegas S, Brandão J, Alves-Correia M, Borrego LM, Clemons KV, Stevens DA, Richardson M. The role of occupational Aspergillus exposure in the development of diseases. Med Mycol 2019; 57:S196-S205. [PMID: 30816970 DOI: 10.1093/mmy/myy090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/19/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022] Open
Abstract
Aspergillus spp. have a high nutritional versatility and good growth on a large variety of construction materials. They also colonize soil or food, but decaying vegetation is their primary ecological niche. Therefore, exposure to fungi may occur at home, during hospitalization, during specific leisure activities, or at the workplace. The development of Aspergillus infections depends on the interplay between host susceptibility and the organism. Environments with high counts of fungal elements (conidia, hyphal fragments and others), high levels of bioarerosols, and elevated concentrations of mycotoxins or other volatile organic compounds should be considered as potential hazards, since they may present a risk to the exposed person. Rural tasks as well as work related to wood and food industries, poultries, swineries, waste handling plants, and other occupational environments involving contaminated organic material are among the ones posing higher respiratory risks to the workers. This paper presents a review of several studies related to occupational and indoor exposure to Aspergillus, potential health effects related to that exposure, and associated exposure assessment procedures.
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Affiliation(s)
- Raquel Sabino
- Nacional Institute of Health Dr. Ricardo Jorge - URSZ- Infectious Diseases Department, Lisbon, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa
| | - Cristina Veríssimo
- Nacional Institute of Health Dr. Ricardo Jorge - URSZ- Infectious Diseases Department, Lisbon, Portugal
| | - Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - Susana Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - João Brandão
- Nacional Institute of Health Dr. Ricardo Jorge - Department of Environmental Health, Lisbon, Portugal
| | | | - Luís-Miguel Borrego
- Allergy Unit, CUF Descobertas Hospital, Lisbon.,The Chronic Diseases Research Center, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Karl V Clemons
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States.,California Institute for Medical Research, San Jose, California, United States
| | - David A Stevens
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States.,California Institute for Medical Research, San Jose, California, United States
| | - Malcolm Richardson
- Mycology Reference Centre, Manchester University NHS Foundation Trust.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, United Kingdom
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Bolookat F, Hassanvand MS, Faridi S, Hadei M, Rahmatinia M, Alimohammadi M. Assessment of bioaerosol particle characteristics at different hospital wards and operating theaters: A case study in Tehran. MethodsX 2018; 5:1588-1596. [PMID: 30622921 PMCID: PMC6313819 DOI: 10.1016/j.mex.2018.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study was aimed to investigate the types and number of bacterial and fungal bioaerosols in indoor air of hospitals according to the type of wards and operating theaters. Bacterial and fungal samples were collected using the passive sampling method of 1/1/1 scheme during a six months' period in the Khatam-Al-Anbia hospital, Tehran, Iran. A simple linear regression was used to determine the relationship between bioaerosol concentrations and the number of active beds. Bacterial bioaerosol concentrations were mainly higher than fungi in all sampling sites. A significant association was found between airborne fungal concentrations and the numbers of beds (R2 = 0.76, p < 0.05), but not observed for bacteria (R2 = 0.02, p < 0.05). Our findings provided an exposure database of airborne bacterial and fungal bioaerosol in hospital wards and operating theaters in Tehran. •Due to the importance of the exposure risk to bioaerosols for patients and medical personnel, we focused on identification of the density and diversity of bacterial and fungal bioaerosols in different wards and operating theaters.•Our results showed that the numbers of the beds have a significant effect on airborne fungal concentrations.•The results of this study can be used to set indoor air quality standards for hospital wards and operating theatres.
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Affiliation(s)
- Fatemeh Bolookat
- Department of Environment Engineering, Faculty of Environment & Energy, Islamic Azad University Science and Research Branch, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Rahmatinia
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Alimohammadi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
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13
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ENVIRONMENTAL FUNGAL LOADS IN AN INDOOR–OUTDOOR AFRICAN PENGUIN (SPHENISCUS DEMERSUS) EXHIBIT. J Zoo Wildl Med 2018; 49:542-555. [DOI: 10.1638/2017-0119.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Kaya H, Ozaki J, Okumura H. Usefulness of Aspergillus Galactomannan Antigen Testing and the Prediction of an Outbreak during Hospital Reconstruction. Intern Med 2018. [PMID: 29526943 PMCID: PMC6096021 DOI: 10.2169/internalmedicine.0269-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective This study retrospectively evaluated fungal dissemination due to hospital reconstruction and explored effective methods of predicting an outbreak. Methods Patients suspected of having invasive aspergillosis were tested for Aspergillus galactomannan antigen before and after reconstruction, and the mean values of three months of testing for positive patients were determined. The characteristics of patients with aspergillosis during this period were also assessed. Results Forty-five patients were positive for Aspergillus antigen (>0.5 cut-off index) from January 2013 to December 2014. Mean Aspergillus antigen values significantly increased following reconstruction (p<0.05). Three patients developed pneumonia due to Aspergillus and were diagnosed with "probable" invasive aspergillosis according to the European Organization for Research and Treatment of Cancer and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. We also discovered that the anteroom to contain dust was not prefabricated and a negative pressure system to remove dust was not used. After construction of the unit, no new cases of aspergillosis were diagnosed. Conclusion Many Aspergillus spores may be transiently floating during hospital reconstruction. Therefore, monthly surveillance with frequent serum galactomannan antigen testing to predict outbreaks is necessary. Surveillance of all patients in the hematology ward is especially important. Reconsideration of prophylactic antifungals may also be necessary during hospital reconstruction.
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Affiliation(s)
- Hiroyasu Kaya
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Japan
| | - Jun Ozaki
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Japan
| | - Hirokazu Okumura
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Japan
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15
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Rodriguez-Goncer I, Thomas S, Foden P, Richardson MD, Ashworth A, Barker J, Geraghty CG, Muldoon EG, Felton TW. Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation. Eur J Clin Microbiol Infect Dis 2018; 37:1251-1257. [PMID: 29623451 PMCID: PMC6015116 DOI: 10.1007/s10096-018-3241-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/19/2018] [Indexed: 12/25/2022]
Abstract
To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary hospital in Manchester (UK) between January 2012 and December 2016. Data collected included epidemiological data, microbiological cultures, radiographic findings and outcomes. Cases were classified as proven IPA, putative IPA or Aspergillus colonisation according to a validated clinical algorithm. One hundred thirty-four patients were supported with vv-ECMO, median age of 45.5 years (range 16.4-73.4). Ten (7%) patients had putative IPA and nine (7%) had Aspergillus colonisation. Half of the patients with putative IPA lacked classical host risk factors for IPA. The median number of days on ECMO prior to Aspergillus isolation was 5 days. Immunosuppression and influenza A infection were significantly associated with developing IPA in a logistic regression model. Cox regression model demonstrates a three times greater hazard of death associated with IPA. Overall 6-month mortality rate was 38%. Patients with putative IPA and colonised patients had a 6-month mortality rate of 80 and 11%, respectively. Immunosuppression and influenza A infection are independent risk factors for IPA. IPA, but not Aspergillus colonisation, is associated with high long-term mortality in patients supported with vv-ECMO.
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Affiliation(s)
- I Rodriguez-Goncer
- Infectious Diseases Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Thomas
- Microbiology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Foden
- Medical Statistics Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M D Richardson
- Mycology Reference Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Ashworth
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Barker
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C G Geraghty
- Manchester Medical School, University of Manchester, Manchester, UK
| | - E G Muldoon
- Infectious Diseases Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
- Infectious Diseases Department, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 R2WY, Ireland.
| | - T W Felton
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
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16
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Buters JTM, Antunes C, Galveias A, Bergmann KC, Thibaudon M, Galán C, Schmidt-Weber C, Oteros J. Pollen and spore monitoring in the world. Clin Transl Allergy 2018; 8:9. [PMID: 29636895 PMCID: PMC5883412 DOI: 10.1186/s13601-018-0197-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Ambient air quality monitoring is a governmental duty that is widely carried out in order to detect non-biological ("chemical") components in ambient air, such as particles of < 10 µm (PM10, PM2.5), ozone, sulphur dioxide, and nitrogen oxides. These monitoring networks are publicly funded and air quality data are open to the public. The situation for biological particles that have detrimental effects on health, as is the case of pollen and fungal spores, is however very different. Most pollen and spore monitoring networks are not publicly funded and data are not freely available. The information regarding which biological particle is being monitored, where and by whom, is consequently often not known, even by aerobiologists themselves. This is a considerable problem, as local pollen data are an important tool for the prevention of allergic symptoms. Objective The aim of this study was to review pollen monitoring stations throughout the world and to create an interactive visualization of their distribution. Methods The method employed to collect information was based on: (a) a review of the recent and historical bibliography related to pollen and fungal spore monitoring, and (b) personal surveys of the managers of national and regional monitoring networks. The interactive application was developed using the R programming language. Results We have created an inventory of the active pollen and spore monitoring stations in the world. There are at least 879 active pollen monitoring stations in the world, most of which are in Europe (> 500). The prevalent monitoring method is based on the Hirst principle (> 600 stations). The inventory is visualised as an interactive and on-line map. It can be searched, its appearance can be adjusted to the users' needs and it is updated regularly, as new stations or changes to those that already exist can be submitted online. Conclusions The map shows the current situation of pollen and spore monitoring and facilitates collaboration among those individuals who are interested in pollen and spore counts. It might also help to improve the monitoring of biological particles up to the current level employed for non-biological components.
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Affiliation(s)
- J T M Buters
- 1Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technische Universität München/Helmholtz Center, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - C Antunes
- 2ICAAM - Institute of Mediterranean Crop and Environmental Sciences, University of Évora, Évora, Portugal
| | - A Galveias
- 2ICAAM - Institute of Mediterranean Crop and Environmental Sciences, University of Évora, Évora, Portugal
| | - K C Bergmann
- 3Allergy-Center-Charité, Charité University Hospital, Berlin, Germany
| | - M Thibaudon
- RNSA (Réseau National de Surveillance Aérobiologique), Brussieu, France
| | - C Galán
- 5Department of Botany, Ecology and Plant Physiology, University of Córdoba, International Campus of Excellence on Agrifood (ceiA3), Córdoba, Spain
| | - C Schmidt-Weber
- 1Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technische Universität München/Helmholtz Center, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - J Oteros
- 1Center of Allergy and Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technische Universität München/Helmholtz Center, Biedersteinerstrasse 29, 80802 Munich, Germany
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17
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Alonso V, Aminahuel C, Díaz Vergara L, Pereyra C, Poloni V, Dalcero A, Cavaglieri L. Ecophysiology of environmental Aspergillus fumigatus and comparison with clinical strains on gliotoxin production and elastase activity. Lett Appl Microbiol 2016; 62:160-8. [PMID: 26551056 DOI: 10.1111/lam.12523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/31/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED The aim of this manuscript was to study the influence of water activity (aW ) and pH in the ecophysiological behaviour of Aspergillus fumigatus strains at human body temperature. In addition, gliotoxin production and enzymatic ability among environmental (n = 2) and clinical (n = 5) strains were compared. Ecophysiological study of environmental strains was performed on agar silage incubated at 37°C, studying the interaction at eight aW levels (0·8, 0·85, 0·9, 0·92, 0·94, 0·96, 0·98 and 0·99) and eight pH levels (3·5, 4, 4·5, 5, 6, 7, 7·5 and 8). Considering the influence of the assumed lung conditions on growth of A. fumigatus (aW 0·98/0·99 and pH of 7/7·5), the optimal condition for the development of A. fumigatus RC031 was at aW 0·99 at pH 7. At aW 0·98/0·99 and pH of 7/7·5, the highest growth rate and the lowest lag phase was reported, whereas there were no significant differences at aW 0·98/0·99 and pH 7/7·5 interactions on growth of A. fumigatus RC032. Gliotoxin production of A. fumigatus strains was evaluated. The gliotoxin production was similar in clinical and environmental strains. Elastin activity was studied in solid medium, highest elastase activity index was found for clinical strain A. fumigatus RC0676, followed by the environmental strain A. fumigatus RC031. Opportunistic environmental strains can be considered as pathogenic in some cases when rural workers are exposed constantly to handling silage. SIGNIFICANCE AND IMPACT OF THE STUDY Aspergillus fumigatus is one of the main opportunist pathogen agents causing invasive aspergillosis. Rural workers present a constant exposition to A. fumigatus spores caused by feed-borne manipulation. In this study, environmental A. fumigatus strains were able to grow and produce gliotoxin onto the studied conditions including the lung ones. Environmental and clinical strains were physiologically similar and could be an important putative infection source in rural workers.
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Affiliation(s)
- V Alonso
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - C Aminahuel
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - L Díaz Vergara
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - C Pereyra
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - V Poloni
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - A Dalcero
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
| | - L Cavaglieri
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917 (C1033AAJ) CABA Républica, Argentina
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18
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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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Tang JW, Wilson P, Shetty N, Noakes CJ. Aerosol-Transmitted Infections-a New Consideration for Public Health and Infection Control Teams. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015; 7:176-201. [PMID: 32226323 PMCID: PMC7100085 DOI: 10.1007/s40506-015-0057-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since the emergence of the 2003 severe acute respiratory syndrome (SARS), the 2003 reemergence of avian A/H5N1, the emergence of the 2009 pandemic influenza A/H1N1, the 2012 emergence of Middle East respiratory syndrome (MERS), the 2013 emergence of avian A/H7N9 and the 2014 Ebola virus outbreaks, the potential for the aerosol transmission of infectious agents is now routinely considered in the investigation of any outbreak. Although many organisms have traditionally been considered to be transmitted by only one route (e.g. direct/indirect contact and/or faecal-orally), it is now apparent that the aerosol transmission route is also possible and opportunistic, depending on any potentially aerosol-generating procedures, the severity of illness and the degree and duration of pathogen-shedding in the infected patient, as well as the environment in which these activities are conducted.This article reviews the evidence and characteristics of some of the accepted (tuberculosis, measles, chickenpox, whooping cough) and some of the more opportunistic (influenza, Clostridium difficile, norovirus) aerosol-transmitted infectious agents and outlines methods of detecting and quantifying transmission.
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Affiliation(s)
- Julian W. Tang
- Clinical Microbiology, Leicester Royal Infirmary, University Hospitals Leicester, Leicester NHS Trust, Leicester, LE1 5WW UK
| | - Peter Wilson
- Clinical Microbiology, University College London Hospitals NHS Trust, London, UK
| | - Nandini Shetty
- Clinical Microbiology, University College London Hospitals NHS Trust, London, UK
| | - Catherine J. Noakes
- Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UK
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20
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Microbiological assessment of indoor air quality at different hospital sites. Res Microbiol 2015; 166:557-63. [PMID: 25869221 DOI: 10.1016/j.resmic.2015.03.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 01/29/2023]
Abstract
Poor hospital indoor air quality (IAQ) may lead to hospital-acquired infections, sick hospital syndrome and various occupational hazards. Air-control measures are crucial for reducing dissemination of airborne biological particles in hospitals. The objective of this study was to perform a survey of bioaerosol quality in different sites in a Portuguese Hospital, namely the operating theater (OT), the emergency service (ES) and the surgical ward (SW). Aerobic mesophilic bacterial counts (BCs) and fungal load (FL) were assessed by impaction directly onto tryptic soy agar and malt extract agar supplemented with antibiotic chloramphenicol (0.05%) plates, respectively using a MAS-100 air sampler. The ES revealed the highest airborne microbial concentrations (BC range 240-736 CFU/m(3) CFU/m(3); FL range 27-933 CFU/m(3)), exceeding, at several sampling sites, conformity criteria defined in national legislation [6]. Bacterial concentrations in the SW (BC range 99-495 CFU/m(3)) and the OT (BC range 12-170 CFU/m(3)) were under recommended criteria. While fungal levels were below 1 CFU/m(3) in the OT, in the SW (range 1-32 CFU/m(3)), there existed a site with fungal indoor concentrations higher than those detected outdoors. Airborne Gram-positive cocci were the most frequent phenotype (88%) detected from the measured bacterial population in all indoor environments. Staphylococcus (51%) and Micrococcus (37%) were dominant among the bacterial genera identified in the present study. Concerning indoor fungal characterization, the prevalent genera were Penicillium (41%) and Aspergillus (24%). Regular monitoring is essential for assessing air control efficiency and for detecting irregular introduction of airborne particles via clothing of visitors and medical staff or carriage by personal and medical materials. Furthermore, microbiological survey data should be used to clearly define specific air quality guidelines for controlled environments in hospital settings.
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21
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Gheith S, Ranque S, Bannour W, Ben Youssef Y, Khelif A, Ben Said M, Njah M, Saghrouni F. Hospital environment fungal contamination and aspergillosis risk in acute leukaemia patients in Sousse (Tunisia). Mycoses 2015; 58:337-42. [PMID: 25809008 DOI: 10.1111/myc.12320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/06/2015] [Indexed: 11/27/2022]
Abstract
Hospital environment is considered the main source of invasive aspergillosis (IA) in leukemic patients. This study aimed to describe Aspergillus colonisation in leukemic patients and their hospital environment and to test whether Aspergillus environmental contamination was associated with IA. For a 2-year period including 14-month renovation work, 91 acute leukaemia inpatients at the hematology department of University hospital in Sousse (Tunisia) were prospectively included. The incidence of probable IA (EORTC/MSG criteria) was 9.9%. Fifty-six Aspergillus were isolated from 53 (6.5%) of 811 sputa collected from 35 (38.5%) patients. Aspergillus spp. were isolated in 59.7% of 494 air samples and in 52.8% of 1579 surface samples taken in the patients' room. Aspergillus section Nigri (72.7%) was the most frequent. Aspergillus contamination peaked in autumn and winter on surface and in summer and autumn in air samples and was higher (P = 0.03) during the renovation work period. Multivariate analysis showed that for each Aspergillus section Nigri CFU airborne contamination IA risk increased by 1.05 (P = 0.04). In Tunisia, Aspergillus section Nigri and Flavi, but not Fumigati, are chiefly involved in IA. Our findings support swift implementation of airborne fungal contamination control measures in areas where immunocompromised patient are hospitalised.
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Affiliation(s)
- Soukeina Gheith
- Service d'Hygiène Hospitalière, CHU Farhat Hached Sousse, Sousse, Tunisie.,Unité de recherche UR 12SP31, Ministère de la Santé Publique, Tunis, Tunisie.,Laboratoire de Parasitologie -Mycologie, CHU Farhat Hached, Sousse, Tunisie
| | - Stéphane Ranque
- Laboratoire de Parasitologie -Mycologie, CHU Timone-Adultes, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Université, IP-TPT UMR MD3, Marseille, France
| | - Wadiaa Bannour
- Service d'Hygiène Hospitalière, CHU Farhat Hached Sousse, Sousse, Tunisie
| | | | | | - Moncef Ben Said
- Laboratoire de Parasitologie -Mycologie, CHU Farhat Hached, Sousse, Tunisie
| | - Mansour Njah
- Service d'Hygiène Hospitalière, CHU Farhat Hached Sousse, Sousse, Tunisie.,Unité de recherche UR 12SP31, Ministère de la Santé Publique, Tunis, Tunisie
| | - Fatma Saghrouni
- Laboratoire de Parasitologie -Mycologie, CHU Farhat Hached, Sousse, Tunisie
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Merlos R, Amighi K, Wauthoz N. Recent Developments in Inhaled Triazoles Against Invasive Pulmonary Aspergillosis. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-014-0199-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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MONITORING OF FUNGAL LOADS IN SEABIRD REHABILITATION CENTERS WITH COMPARISONS TO NATURAL SEABIRD ENVIRONMENTS IN NORTHERN CALIFORNIA. J Zoo Wildl Med 2014; 45:29-40. [DOI: 10.1638/2012-0051r1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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24
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Cafarchia C, Camarda A, Iatta R, Danesi P, Favuzzi V, Di Paola G, Pugliese N, Caroli A, Montagna MT, Otranto D. Environmental contamination by Aspergillus spp. in laying hen farms and associated health risks for farm workers. J Med Microbiol 2014; 63:464-470. [PMID: 24430250 DOI: 10.1099/jmm.0.065946-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Data on the occurrence and epidemiology of Aspergillus spp. in laying hens farms are scant. With the aims of determining levels of airborne contamination in laying hen farms and evaluating the potential risk of infection for workers and animals, 57 air samples from 19 sheds (Group I), 69 from faeces (Group II), 19 from poultry feedstuffs (Group III) and 60 from three anatomical sites (i.e. nostrils, pharynx, ears) of 20 farm workers (Group IV) were cultured. The Aspergillus spp. prevalence in samples ranged from 31.6% (Group III) to 55.5% (Group IV), whereas the highest conidia concentration was retrieved in Group II (1.2 × 10(4) c.f.u. g(-1)) and in Group III (1.9 × 10(3) c.f.u. g(-1)). The mean concentration of airborne Aspergillus spp. conidia was 70 c.f.u. m(-3) with Aspergillus fumigatus (27.3%) being the most frequently detected species, followed by Aspergillus flavus (6.3%). These Aspergillus spp. were also isolated from human nostrils (40%) and ears (35%) (P<0.05) (Group IV). No clinical aspergillosis was diagnosed in hens. The results demonstrate a relationship between the environmental contamination in hen farms and presence of Aspergillus spp. on animals and humans. Even if the concentration of airborne Aspergillus spp. conidia (i.e. 70 c.f.u. m(-3)) herein detected does not trigger clinical disease in hens, it causes human colonization. Correct management of hen farms is necessary to control environmental contamination by Aspergillus spp., and could lead to a significant reduction of animal and human colonization.
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Affiliation(s)
- Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Antonio Camarda
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Roberta Iatta
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Patrizia Danesi
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 1035020 Legnaro (PD), Italy
| | - Vincenza Favuzzi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Giancarlo Di Paola
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Nicola Pugliese
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Anna Caroli
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Maria Teresa Montagna
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
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Mattei AS, Madrid IM, Santin R, Schuch LFD, Meireles MCA. In vitro activity of disinfectants against Aspergillus spp. Braz J Microbiol 2013; 44:481-4. [PMID: 24294243 PMCID: PMC3833149 DOI: 10.1590/s1517-83822013000200024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/23/2012] [Indexed: 11/22/2022] Open
Abstract
Fungi of the Aspergillus genus are widespread and contaminate the environment. Thousands of conidia are released from each phialide and dispersed in the air every day. These fungi are considered important mycose-causing agents in hospitals. Due to this, research to determine prevalent fungi from the Aspergillus genus in hospital environments, and an adequate disinfection program in these areas is are needed. This study evaluated the susceptibility of Aspergillus spp. isolated from a veterinary environment against four disinfectants. Successive dilutions of disinfectants (log2) were used according to CLSI M38-A2 microdilution technique adapted to chemical agents against 18 isolates of this genus. After 72 hours of incubation, the Minimum Inhibiting Concentration and Minimum Fungicidal Concentration capable of inhibiting 50% and 90% of the isolates were determined. Chlorexidine-cetrimine, benzalconium chloride and a chlorophenol derivative proved to be effective against all isolates with a lower MIC than that suggested by the manufacturer, except for the A. flavus strain. Sodium hypochlorite was ineffective against three A. fumigatus, three A. flavus and one A. niger isolate. These results demonstrated that all studied disinfectants were effective against environmental isolates, with the exception of sodium hypochlorite, which showed lower effectiveness.
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Affiliation(s)
- A S Mattei
- Laboratório de Doenças Infecciosas, Setor Micologia, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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Fernández M, Cattana M, Rojas F, Sosa MDLÁ, Aguirre C, Vergara M, Giusiano G. [Aspergillus species in hospital environments with pediatric patients in critical condition]. Rev Iberoam Micol 2013; 31:176-81. [PMID: 24120420 DOI: 10.1016/j.riam.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/31/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Aspergillus is a group of opportunistic fungi that cause infections, with high morbimortality in immunosuppressed patients. Aspergillus fumigatus is the most frequent species in these infections, although the incidence of other species has increased in the last few years. AIMS To evaluate the air fungal load and the diversity of Aspergillus species in hospitals with pediatric patients in critical condition. METHODS The Intensive Care Unit and Burns Unit of a pediatric hospital were sampled every 15 days during the autumn and spring seasons. The air samples were collected with SAS Super 100(®) and the surface samples were collected by swab method. RESULTS The UFC/m(3) counts found exceeded the acceptable levels. The UFC/m(3) and the diversity of Aspergillus species found in the Intensive Care Unit were higher than those found in the Burns Unit. The fungal load and the diversity of species within the units were higher than those in control environments. The use of both methods -SAS and swab- allowed the detection of a higher diversity of species, with 96 strains of Aspergillus being isolated and 12 species identified. The outstanding findings were Aspergillus sydowii, Aspergillus niger, Aspergillus flavus, Aspergillus terreus and Aspergillus parasiticus, due to their high frequency. Aspergillus fumigatus, considered unacceptable in indoor environments, was isolated in both units. CONCLUSIONS Aspergillus was present with high frequency in these units. Several species are of interest in public health for being potential pathogenic agents. Air control and monitoring are essential in the prevention of these infections.
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Affiliation(s)
- Mariana Fernández
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina.
| | - María Cattana
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | - Florencia Rojas
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | - María de Los Ángeles Sosa
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | | | - Marta Vergara
- Hospital Pediátrico Juan Pablo II, Corrientes, Argentina
| | - Gustavo Giusiano
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
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Pemán J, Salavert M. [Epidemiology and prevention of nosocomial invasive infections by filamentous fungi and yeasts]. Enferm Infecc Microbiol Clin 2013; 31:328-41. [PMID: 23561595 DOI: 10.1016/j.eimc.2013.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
Knowledge of the epidemiology of invasive fungal diseases in health care settings helps to establish the action levels necessary for its prevention. A first step is to identify groups of patients at high risk of invasive fungal diseases, establish accurate risk factors, observing the periods of greatest risk, and analyze the epidemiological profile in genera and species, as well as the patterns of antifungal resistance. Secondly, mechanisms to avoid persistent exposure to potential fungal pathogens must be established, protecting areas and recommending measures, such as the control of the quality of the air and water inside and outside the hospital, and determining and promoting appropriate architectural designs of health institutions. Finally, apart from the correct implementation of these measures, the use of antifungal prophylaxis should be considered in selected patients at very high risk, following the guidelines published.
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Affiliation(s)
- Javier Pemán
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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28
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Duret C, Wauthoz N, Sebti T, Vanderbist F, Amighi K. New inhalation-optimized itraconazole nanoparticle-based dry powders for the treatment of invasive pulmonary aspergillosis. Int J Nanomedicine 2012; 7:5475-89. [PMID: 23093903 PMCID: PMC3477927 DOI: 10.2147/ijn.s34091] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Itraconazole (ITZ) dry powders for inhalation (DPI) composed of nanoparticles (NP) embedded in carrier microparticles were prepared and characterized. METHODS DPIs were initially produced by reducing the ITZ particle size to the nanometer range using high-pressure homogenization with tocopherol polyethylene 1000 succinate (TPGS, 10% w/w ITZ) as a stabilizer. The optimized nanosuspension and the initial microsuspension were then spray-dried with different proportions of or in the absence of mannitol and/or sodium taurocholate. DPI characterization was performed using scanning electron microscopy for morphology, laser diffraction to evaluate the size-reduction process, and the size of the dried NP when reconstituted in aqueous media, impaction studies using a multistage liquid impactor to determine the aerodynamic performance and fine-particle fraction that is theoretically able to reach the lung, and dissolution studies to determine the solubility of ITZ. RESULTS Scanning electron microscopy micrographs showed that the DPI particles were composed of mannitol microparticles with embedded nano- or micro-ITZ crystals. The formulations prepared from the nanosuspension exhibited good flow properties and better fine-particle fractions, ranging from 46.2% ± 0.5% to 63.2% ± 1.7% compared to the 23.1% ± 0.3% that was observed with the formulation produced from the initial microsuspension. Spray-drying affected the NP size by inducing irreversible aggregation, which was able to be minimized by the addition of mannitol and sodium taurocholate before the drying procedure. The ITZ NP-based DPI considerably increased the ITZ solubility (58 ± 2 increased to 96 ± 1 ng/mL) compared with that of raw ITZ or an ITZ microparticle-based DPI (<10 ng/mL). CONCLUSION Embedding ITZ NP in inhalable microparticles is a very effective method to produce DPI formulations with optimal aerodynamic properties and enhanced ITZ solubility. These formulations could be applied to other poorly water-soluble drugs and could be a very effective alternative for treating invasive pulmonary aspergillosis.
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Affiliation(s)
- Christophe Duret
- Laboratoire de Pharmacie Galénique et de Biopharmacie, Université Libre de Bruxelles, Brussels, Belgium.
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29
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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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30
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New Respirable and Fast Dissolving Itraconazole Dry Powder Composition for the Treatment of Invasive Pulmonary Aspergillosis. Pharm Res 2012; 29:2845-59. [DOI: 10.1007/s11095-012-0779-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/11/2012] [Indexed: 11/27/2022]
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31
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Burco JD, Ziccardi MH, Clemons KV, Tell LA. Evaluation of Plasma (1→3) β-D-glucan Concentrations in Birds Naturally and Experimentally Infected with Aspergillus fumigatus. Avian Dis 2012; 56:183-91. [DOI: 10.1637/9697-030111-reg.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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32
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Pelaez T, Munoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, Bouza E. Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit. Clin Infect Dis 2012; 54:e24-31. [DOI: 10.1093/cid/cir771] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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33
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Kirkpatrick WR, Najvar LK, Vallor AC, Wiederhold NP, Bocanegra R, Pfeiffer J, Perkins K, Kugler AR, Sweeney TD, Patterson TF. Prophylactic efficacy of single dose pulmonary administration of amphotericin B inhalation powder in a guinea pig model of invasive pulmonary aspergillosis. J Antimicrob Chemother 2012; 67:970-6. [DOI: 10.1093/jac/dkr567] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Ruiz-Camps I, Aguado J, Almirante B, Bouza E, Ferrer-Barbera C, Len O, Lopez-Cerero L, Rodríguez-Tudela J, Ruiz M, Solé A, Vallejo C, Vazquez L, Zaragoza R, Cuenca-Estrella M. Guidelines for the prevention of invasive mould diseases caused by filamentous fungi by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Clin Microbiol Infect 2011; 17 Suppl 2:1-24. [DOI: 10.1111/j.1469-0691.2011.03477.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Alangaden GJ. Nosocomial fungal infections: epidemiology, infection control, and prevention. Infect Dis Clin North Am 2011; 25:201-25. [PMID: 21316001 DOI: 10.1016/j.idc.2010.11.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fungal infections are an increasing cause of morbidity and mortality in hospitalized patients. This article reviews the current epidemiology of nosocomial fungal infections in adult patients, with an emphasis on invasive candidiasis and aspergillosis. Recently published recommendations and guidelines for the control and prevention of these nosocomial fungal infections are summarized.
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Affiliation(s)
- George J Alangaden
- Division of Infectious Diseases, Wayne State University, 3990 John R, Suite 5930, Detroit, MI 48201, USA.
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36
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Docampo S, Trigo MM, Recio M, Melgar M, García-Sánchez J, Cabezudo B. Fungal spore content of the atmosphere of the Cave of Nerja (southern Spain): diversity and origin. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 409:835-843. [PMID: 21138779 DOI: 10.1016/j.scitotenv.2010.10.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 05/30/2023]
Abstract
Fungal spores are of great interest in aerobiology and allergy due to their high incidence in both outdoor and indoor environments and their widely recognized ability to cause respiratory diseases and other pathologies. In this work, we study the spore content of the atmosphere of the Cave of Nerja, a karstic cavity and an important tourist attraction situated on the eastern coast of Malaga (southern Spain), which receives more than half a million visitors every year. This study was carried out over an uninterrupted period of 4 years (2002-2005) with the aid of two Hirst-type volumetric pollen traps (Lanzoni VPPS 2000) situated in different halls of the cave. In the atmosphere of the Cave of Nerja, 72 different spore types were detected during the studied period and daily mean concentrations of up to 282,195 spores/m(3) were reached. Thirty-five of the spore types detected are included within Ascomycota and Basidiomycota (19 and 16 types, respectively). Of the remaining spore types, 32 were categorized within the group of so-called imperfect fungi, while Oomycota and Myxomycota were represented by 2 and 3 spore types, respectively. Aspergillus/Penicillium was the most abundant spore type with a yearly mean percentage that represented 50% of the total, followed by Cladosporium. Finally, the origin of the fungal spores found inside the cave is discussed on the basis of the indoor/outdoor concentrations and the seasonal behaviour observed.
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Affiliation(s)
- Silvia Docampo
- Department of Plant Biology, University of Málaga, Málaga, Spain.
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37
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Ruiz-Camps I, Aguado JM, Almirante B, Bouza E, Ferrer Barbera C, Len O, López-Cerero L, Rodríguez-Tudela JL, Ruiz M, Solé A, Vallejo C, Vázquez L, Zaragoza R, Cuenca-Estrella M. Recomendaciones sobre la prevención de la infección fúngica invasora por hongos filamentosos de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Enferm Infecc Microbiol Clin 2010; 28:172.e1-172.e21. [DOI: 10.1016/j.eimc.2009.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 11/24/2009] [Indexed: 11/30/2022]
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38
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Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, Wingard JR, Young JAH, Boeckh MJ, Boeckh MA. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143-238. [PMID: 19747629 PMCID: PMC3103296 DOI: 10.1016/j.bbmt.2009.06.019] [Citation(s) in RCA: 1155] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/23/2009] [Indexed: 02/07/2023]
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40
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Pathogenesis of Aspergillus fumigatus in Invasive Aspergillosis. Clin Microbiol Rev 2009; 22:447-65. [PMID: 19597008 DOI: 10.1128/cmr.00055-08] [Citation(s) in RCA: 661] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aspergillus species are globally ubiquitous saprophytes found in a variety of ecological niches. Almost 200 species of aspergilli have been identified, less than 20 of which are known to cause human disease. Among them, Aspergillus fumigatus is the most prevalent and is largely responsible for the increased incidence of invasive aspergillosis (IA) in the immunocompromised patient population. IA is a devastating illness, with mortality rates in some patient groups reaching as high as 90%. Studies identifying and assessing the roles of specific factors of A. fumigatus that contribute to the pathogenesis of IA have traditionally focused on single-gene deletion and mutant characterization. In combination with recent large-scale approaches analyzing global fungal responses to distinct environmental or host conditions, these studies have identified many factors that contribute to the overall pathogenic potential of A. fumigatus. Here, we provide an overview of the significant findings regarding A. fumigatus pathogenesis as it pertains to invasive disease.
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41
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Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection? J Hosp Infect 2009; 73:58-63. [PMID: 19646785 DOI: 10.1016/j.jhin.2009.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 06/04/2009] [Indexed: 01/19/2023]
Abstract
Various reliable body heat-regulating systems have been designed and developed with the aim of maintaining an adequate body temperature in the course of major surgery. This is crucial to avoid the onset of potentially severe complications that are especially serious in elderly and debilitated subjects. Among these systems, the Bair Hugger blanket has demonstrated excellent efficacy. However, some reports in the literature have suggested that the use of such devices can increase the risk of nosocomial infections, particularly surgical wound infections. The aim of this study was to assess the risk of contamination of the surgical site correlated to the use of the Bair Hugger blanket during hip replacement surgery. To this end, the level of bacterial contamination of the air in the operating theatre was quantified with and without the use of the Bair Hugger, during the course of 30 total non-cemented hip implants performed in patients with osteoarthritis. Sampling was done both in the empty theatre and during surgical procedures, in different zones around the operating table and on the patient's body surface. Statistical analysis of the results demonstrated that the Bair Hugger system does not pose a real risk for nosocomial infections, whereas it does offer the advantage of preventing the potentially very severe consequences of hypothermia during major orthopaedic surgery. In addition, monitoring patients over the six months following the operation allowed us to exclude a later manifestation of a nosocomial infection.
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42
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Vanhee LME, Nelis HJ, Coenye T. Rapid detection and quantification of Aspergillus fumigatus in environmental air samples using solid-phase cytometry. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2009; 43:3233-3239. [PMID: 19534140 DOI: 10.1021/es803435a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aspergillus fumigatus is an ubiquitous fungus capable of causing severe infections such as aspergilloma, allergic bronchopulmonary aspergillosis, and invasive aspergillosis, especially in immunocompromised patients. Monitoring the number of Aspergillus fumigatus spores in the air is crucial for infection control. In the present study, a novel approach for the quantification of Aspergillus fumigatus, based on solid-phase cytometry (SPC) and immunofluorescent labeling, was developed. The sensitivity and specificity of the assay were confirmed by testing pure cultures. Paecilomyces variotii and Rhizopus stolonifer were codetected but could be excluded on the basis of morphology of the microcolonies. The SPC method has considerable advantages compared to the culture-based method, including its low detection limit (4 cells/m3), its speed (results are obtained within 24 h), and the straightforward microscopic identification of Aspergillus fumigatus. Additionally, comparison of results obtained with both methods demonstrated that they are equally accurate for the quantification of Aspergillus fumigatus in environmental air samples.
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Affiliation(s)
- Lies M E Vanhee
- Laboratory of Pharmaceutical Microbiology, Ghent University, Harelbekestraat 72, B-9000 Ghent, Belgium
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43
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Ortiz G, Yagüe G, Segovia M, Catalán V. A study of air microbe levels in different areas of a hospital. Curr Microbiol 2009; 59:53-8. [PMID: 19330376 DOI: 10.1007/s00284-009-9398-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 02/21/2009] [Accepted: 02/23/2009] [Indexed: 11/28/2022]
Abstract
Airborne transmission is an important route for many microbial pathogens in outdoor and indoor environments, including hospitals. A 2-year-long survey of bioaerosol quality in operating theatres (OT), hospital rooms (HR) and maternity wards (MW) at a hospital in Murcia, Spain, was performed. Total aerobic counts (TAC) and fungal load (FL) were assessed using a microbiological air sampler (MAS-100 single-stage impactor). While fungal levels were below 1 cfu/m(3) (0-7.33 cfu/m(3)) in OT, they were higher in MW (mean, 6.9 cfu/m(3); range 0.44-44.67 cfu/m(3)) and in HR (mean, 10.6 cfu/m(3); range, 0-266 cfu/m(3)). In OT the aerobic counts were considerably higher, with a mean of 25.6 cfu/m(3) (range, 1.67-157 cfu/m(3)). MW and HR also showed higher means for total aerobic counts compared to OT. Seasonal changes were not detected in mould and bacteria levels in OT. Hospital renovation occurred during this study and OT adjacent to renovated areas were closed. A survey of TAC and FL in OT resumed when renovation was completed. We observed an outstanding increase in FL (more than 100 cfu/m(3)), particularly Aspergillus spp., during this period, but no significant changes in TAC were observed after renovation.
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44
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Xavier M, Meinerz A, Cleff M, Osório L, Schuch L, Nobre M, Silva Filho R, Meireles M. Eficácia da clorexidina-cetrimida na desinfecção ambiental contra Aspergillus spp. ARQ BRAS MED VET ZOO 2008. [DOI: 10.1590/s0102-09352008000400015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliou-se a ação in loco da clorexidina-cetrimida no controle de Aspergillus spp., considerando-se a influência de fatores climáticos e populacionais, em um centro de recuperação de animais marinhos. Durante dois anos, realizaram-se colheitas de amostras de ar por meio da técnica de sedimentação, com implantação no segundo ano de um programa de desinfecção com clorexidina-cetrimida. Os resultados do isolamento fúngico nos dois anos foram comparados estatisticamente pelo programa Epinfo 8.0. Demonstrou-se que o isolamento de Aspergillus spp. não apresentou relação significativa com fatores climáticos e populacionais e que a diminuição da concentração de conídios de Aspergillus spp. do ambiente ocorreu devido ao programa eficaz de desinfecção com a clorexidina-cetrimida.
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45
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Freeman J, Rogers K, Roberts S. Pseudo-outbreak of Aspergillus keratitis following construction in an ophthalmology ward. J Hosp Infect 2007; 67:104-5. [PMID: 17719132 DOI: 10.1016/j.jhin.2007.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/02/2007] [Indexed: 12/01/2022]
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46
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McLellan E, Fenton P. The problem with Penicillium. J Hosp Infect 2007; 66:87-8. [PMID: 17428578 DOI: 10.1016/j.jhin.2007.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 02/16/2007] [Indexed: 11/28/2022]
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47
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Sixt N, Dalle F, Lafon I, Aho S, Couillault G, Valot S, Calinon C, Danaire V, Vagner O, Cuisenier B, Sautour M, Besancenot JP, L'Ollivier C, Caillot D, Bonnin A. Reduced fungal contamination of the indoor environment with the Plasmair™ system (Airinspace). J Hosp Infect 2007; 65:156-62. [PMID: 17178429 DOI: 10.1016/j.jhin.2006.10.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 10/30/2006] [Indexed: 11/23/2022]
Abstract
Aspergillus spp. and other moulds cause life-threatening opportunistic infections in immunocompromised patients. Indoor contamination and construction work that liberate fungal spores are a major source of nosocomial aspergillosis. Dijon hospital is a tertiary care institution in northeast France undergoing construction work beside high-risk clinical units. To determine the impact of this activity, a surveillance programme was implemented one year before building work began in order to establish baseline levels of contamination. Air and surface fungal contamination in adult and paediatric haematology units were prospectively examined following use, or not, of a new air-treatment system with mobile Plasmair units (Airinspace). There were significant reductions in overall fungal contamination for the Plasmair treated rooms for air and surface samples in both clinical units. Plasmair treatment also significantly reduced A. fumigatus in the air. These data suggest that Plasmair units may provide an efficient method of reducing indoor fungal contamination in hospitals.
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Affiliation(s)
- N Sixt
- Environmental Microbiology, Hôpital du Bocage, BP 77908, 21079 Dijon Cedex, France
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Panagopoulou P, Filioti J, Farmaki E, Maloukou A, Roilides E. Filamentous fungi in a tertiary care hospital: environmental surveillance and susceptibility to antifungal drugs. Infect Control Hosp Epidemiol 2006; 28:60-7. [PMID: 17230389 DOI: 10.1086/508832] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 03/10/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate filamentous fungi with respect to environmental load and potential drug resistance in a tertiary care teaching hospital. DESIGN Monthly survey in 2 buildings of the hospital during a 12-month period. SETTING Hippokration Hospital in Thessaloniki, Greece. METHODS Air, surface, and tap water sampling was performed in 4 departments with high-risk patients. As sampling sites, the solid-organ transplantation department and the hematology department (in the older building) and the pediatric oncology department and the pediatric intensive care unit (in the newer building) were selected. RESULTS From January to May of 2000, the fungal load in air (FLA) was low, ranging from 0 to 12 colony-forming units (cfu) per m(3) in both buildings. During the summer months, when high temperature and humidity predominate, the FLA increased to 4-56 cfu/m(3). The fungi commonly recovered from culture of air specimens were Aspergillus niger (25.9%), Aspergillus flavus (17.7%), and Aspergillus fumigatus (12.4%). Non-Aspergillus filamentous fungi, such as Zygomycetes and Dematiaceous species, were also recovered. The pediatric intensive care unit had the lowest mean FLA (7.7 cfu/m(3)), compared with the pediatric oncology department (8.7 cfu/m(3)), the solid-organ transplantation department (16.1 cfu/m(3)), and the hematology department (22.6 cfu/m(3)). Environmental surfaces were swabbed, and 62.7% of the swab samples cultured yielded filamentous fungi similar to the fungi recovered from air but with low numbers of colony-forming units. Despite vigorous sampling, culture of tap water yielded no fungi. The increase in FLA observed during the summer coincided with renovation in the building that housed the solid-organ transplantation and hematology departments. All 54 Aspergillus air isolates randomly selected exhibited relatively low minimum inhibitory or effective concentrations for amphotericin B, itraconazole, voriconazole, posaconazole, micafungin, and anidulafungin. CONCLUSION Air and surface fungal loads may vary in different departments of the same hospital, especially during months when the temperature and humidity are high. Environmental Aspergillus isolates are characterized by lack of resistance to clinically important antifungal agents.
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Affiliation(s)
- Paraskevi Panagopoulou
- Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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Engelhart S, Glasmacher A, Simon A, Exner M. Air sampling of Aspergillus fumigatus and other thermotolerant fungi: comparative performance of the Sartorius MD8 airport and the Merck MAS-100 portable bioaerosol sampler. Int J Hyg Environ Health 2006; 210:733-739. [PMID: 17142101 DOI: 10.1016/j.ijheh.2006.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 10/10/2006] [Accepted: 10/31/2006] [Indexed: 11/18/2022]
Abstract
The purpose of our field study was to compare the performance of two portable bioaerosol samplers (Sartorius MD8 airport, and Merck MAS-100) for sampling Aspergillus fumigatus and other airborne thermotolerant fungi. From October 2001 to November 2001, a total of 336 samples were analyzed at 12 sampling days. During the sampling period fungal plate counts ranged from <1 to 300 CFU/m(3) for total thermotolerant fungi and from <1 to 76 CFU/m(3) for A. fumigatus. As compared to the MD8, the relative recovery of the MAS 100 was 0.96 for total thermotolerant fungi and 0.84 for A. fumigatus. We found a good correlation (Pearson's r=0.94 for single, 0.95 for the mean of two, and 0.96 for the mean of three sequential samples) between both portable bioaerosol samplers. The spectrum of thermotolerat fungal genera and Aspergillus species showed only minor differences. We conclude that under the given conditions the results of both samplers are approximately comparable.
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Affiliation(s)
- Steffen Engelhart
- Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - Axel Glasmacher
- Department of Internal Medicine I, University of Bonn, Germany
| | - Arne Simon
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Bonn, Germany
| | - Martin Exner
- Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Fulleringer SL, Seguin D, Warin S, Bezille A, Desterque C, Arné P, Chermette R, Bretagne S, Guillot J. Evolution of the Environmental Contamination by Thermophilic Fungi in a Turkey Confinement House in France. Poult Sci 2006; 85:1875-80. [PMID: 17032816 DOI: 10.1093/ps/85.11.1875] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fungal species constitute a major part of environmental contaminants in facilities where animals are housed. The present investigation was aimed at describing the relative abundances of fungal species and their concentrations in a turkey confinement house in France. Fungal cultures from poultry feed, litter, and air were undertaken every week throughout the 16-wk period of breeding. The incubation temperature of 40 degrees C was selected to isolate thermophilic fungal species (especially Aspergillus spp. and Candida albicans) that are potentially pathogenic for birds. The 2 species Aspergillus fumigatus and Aspergillus flavus were recovered at a mean of 10.5 and 37.0 cfu/m(3) of air sampled, respectively. Individual samplings yielded concentrations of up to 150.0 cfu/m(3) for A. flavus in the first weeks of the investigation. Other fungal species were recovered at a mean of 18.9 cfu/m(3) (maximum 36.3 cfu/m(3)) in the air. The yeast C. albicans was first detected at wk 4 from litter samples and at wk 7 from poultry feed. Densities of C. albicans remained very high in litter samples (63.2 cfu/g) even after new litter was added at wk 10. To analyze the genetic polymorphism of A. fumigatus, the most pathogenic mold in birds, a total number of 198 isolates (134 from air, 34 from litter, and 30 from feed samples) were genotyped using 2 polymorphic microsatellite markers. More than half (42 out of 73, 57.5%) of the genotypes were detected only once. This finding suggests that the contamination of the breeding environment is not due to a single source and confirms the very high genetic diversity of environmental A. fumigatus isolates. As during the study period, no outbreak of fungal infections occurred; the levels of fungal contaminations reported here do not seem sufficient, at least alone, to trigger fungal infections.
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Affiliation(s)
- S L Fulleringer
- INRA, AFSSA, ENVA, UPVM, UMR 956 Biologie Moléculaire et Immunologie Parasitaires et Fongiques, Ecole Nationale Vétérinaire d'Alfort, 94700 Maisons-Alfort, France
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