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Olawale KS, Oladele RO, Peters RF, Ekeng BE, Ogunsola FT. Fungal contamination of the water distribution system of a tertiary hospital water supply system in a resource-limited setting. Ther Adv Infect Dis 2024; 11:20499361241265953. [PMID: 39070703 PMCID: PMC11273584 DOI: 10.1177/20499361241265953] [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: 07/15/2023] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
Background Fungal contamination of hospital water distribution systems has been implicated in outbreaks of healthcare-associated infections. Objectives To evaluate the prevalence of fungi in the water distribution system of a tertiary hospital in Nigeria. Design This was a descriptive cross-sectional study. Methods Swabs and water samples were collected from taps and faucets in the hospital categorized into low (Accidents and Emergency Unit, Children Emergency Unit, Acute Stroke Unit and the 24 in-patient hospital wards) and high-risk (Renal Dialysis Unit, Central Sterile Services Department, Theatres and Intensive Care Units (ICUs)) units based on the vulnerability of patients being managed there. The membrane filtration method for water analysis was used. Where possible, isolates cultured were identified to species level. In total, 105 water and 49 swab samples were collected for analysis. Results All analysed water samples grew fungi. A total of 289 (high-risk; n = 178; low-risk; n = 111) and 76 fungi isolates were recorded from water and swab samples, respectively, with 31 different species identified. Aspergillus was the most predominant genus with five different species: Aspergillus niger (9.9%), terreus (4.4%), flavus (3.3%), fumigatus (8.8%) and versicolor (2.20%) isolated. Twenty-five and 18 species of fungi were identified in the low and high-risk units, respectively. The labour ward (n = 46; 25.8%) and modular theatre (n = 47; 42.3%) were the most contaminated units. Cladosporium spp. and Paecilomyces spp. were the most frequently isolated fungi in the low and high-risk units, respectively. The dialysis centre (n = 9; 8.1%) and renal transplant theatre (n = 7; 6.31%) had the lowest contamination rates in the high-risk units. Aspergillus niger, Cephalosporium curtipes, Penicillium chrysogenum and Penicillium glabrum were each identified in 4/6 units from which swabs were taken. The facility had no documented protocol for its water safety and quality. Conclusion Our data reveal a high rate of contamination of hospital water sources by fungi, some of which are known to cause life-threatening infections. For better water treatment and water tank cleaning and disinfection, a standard protocol is advised. Ensuring that the water distribution systems in hospital settings are free of fungal contaminants is important to prevent the possibility of waterborne mycosis outbreaks.
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Affiliation(s)
- Kolapo S. Olawale
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Mycology Reference Centre, Block-M, College of Medicine, Idi-Araba, Mushin, Lagos State, 100254, Nigeria
- Department of Microbiology, Federal College of Agriculture, Akure, Ondo, Nigeria
| | - Rita O. Oladele
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria
- Medical Mycology Society of Nigeria, Lagos, Nigeria
| | - Rebecca F. Peters
- Department of Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria
- Medical Mycology Society of Nigeria, Lagos, Nigeria
| | - Bassey E. Ekeng
- Medical Mycology Society of Nigeria, Lagos, Nigeria
- Department of Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Folasade T. Ogunsola
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Microbiology and Parasitology, Lagos University Teaching Hospital, Lagos, Nigeria
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Calumby RJN, Onofre-Cordeiro NA, Silva KWL, Gomes DCS, Moreira RTF, Araújo MAS. Fungal identification in the air and water of a hemodialysis unit in Brazil. BRAZ J BIOL 2023; 83:e275136. [PMID: 37937629 DOI: 10.1590/1519-6984.275136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/06/2023] [Indexed: 11/09/2023] Open
Abstract
The presence of fungi in healthcare settings, including hemodialysis units, represents a significant risk for immunocompromised patients. This study aimed to investigate the occurrence of fungi in the air and water of a hemodialysis unit located in a tertiary public hospital in Maceió, Alagoas, Brazil. Over a period of three consecutive months, monthly air samples were collected and analyzed using the spontaneous sedimentation technique on Petri dishes containing Sabouraud Dextrose Agar (SDA). Simultaneously, water samples (100 mL) were collected from four specific water distribution points and subjected plating on SDA. Fungi were phenotypically identified based on their macroscopic and microscopic characteristics. In total, 498 colony-forming units (CFUs) of fungi were isolated, with 86 CFUs originating from the air and 412 CFUs from the water. Regarding the water samples, a higher concentration of fungal CFUs was observed in the potable water from the supply network (229 CFUs). Unexpectedly, 23 CFUs were identified in the reverse osmosis samples and 11 CFUs in the storage tank, which are post-treatment points where the presence of microorganisms is not desired. The fungus Cladosporium spp. was the most prevalent in both air and water samples, followed by Penicillium spp. in the air and Rhodotorula spp. in the water. These findings underscore the need to implement effective control and monitoring measures for fungi in the hemodialysis unit to ensure patient safety.
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Affiliation(s)
- R J N Calumby
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | | | - K W L Silva
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | - D C S Gomes
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | - R T F Moreira
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
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Wan Q, Cao R, Wen G, Xu X, Xia Y, Wu G, Li Y, Wang J, Lin Y, Huang T. Sequential use of UV-LEDs irradiation and chlorine to disinfect waterborne fungal spores: Efficiency, mechanism and photoreactivation. JOURNAL OF HAZARDOUS MATERIALS 2022; 423:127102. [PMID: 34482083 DOI: 10.1016/j.jhazmat.2021.127102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
In this work, sequential applications of light-emitting diodes (UV-LEDs) with two wavelengths and chlorine (Cl2) were performed for fungal spores disinfection: UV-Cl2, Cl2-UV, UV/Cl2-UV, UV-UV/Cl2, Cl2-UV/Cl2-Cl2. Overall comparisons of the sequential processes with respect to the inhibitory effect on photoreactivation were also evaluated. According to the evaluation of culturability and membrane permeability, inactivation of fungal spores by UV was not enhanced by prior or post exposure to Cl2, but in the UV/Cl2 process with pre or post UV treatment, the inactivation efficiency was greatly enhanced. Take P. polonicum for example, pre-treatments by UV265 and UV280 (40 mJ/cm2) caused the log count reduction (LCR) of 1.05 log and 0.95 log, then the followed UV265/Cl2 and UV280/Cl2 at the same UV fluence caused additional LCR of 1.80 log and 2.00 log. The permeabilization of P. polonicum was also accelerated in the processes of UV/Cl2-UV and UV-UV/Cl2, especially at the wavelength of 280 nm. In the sequential processes, especially those containing UV/Cl2 or at the wavelength of 280 nm, could promote the formation of intracellular reactive oxygen species (ROS), thus leading to more severe damage to the spores as reflected in the culturability reduction, membrane permeability and inhibition of photoreactivation.
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Affiliation(s)
- Qiqi Wan
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Ruihua Cao
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Gang Wen
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Collaborative Innovation Center of Water Pollution Control and Water Quality Security Assurance of Shaanxi Province, Xi'an University of Architecture and Technology, Xi'an 710055, PR China.
| | - Xiangqian Xu
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yuancheng Xia
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Gehui Wu
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yangfan Li
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Jingyi Wang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yingzi Lin
- School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun 130118, PR China
| | - Tinglin Huang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
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Wan Q, Cao R, Wen G, Xu X, Xia Y, Wu G, Li Y, Wang J, Xu H, Lin Y, Huang T. Efficacy of UV-LED based advanced disinfection processes in the inactivation of waterborne fungal spores: Kinetics, photoreactivation, mechanism and energy requirements. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 803:150107. [PMID: 34525763 DOI: 10.1016/j.scitotenv.2021.150107] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/14/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
The contamination of fungi in water supply systems poses great risks to environment and human health. In this work, UV light-emitting diodes (UV-LEDs)-based advanced disinfection processes (ADPs) including UV-LEDs/hydrogen peroxide (H2O2), UV-LEDs/persulfate (PS) and UV-LEDs/peroxymonosulfate (PMS), were adopted for waterborne fungal spores inactivation. Overall comparisons of the UV-LEDs-based ADPs with respect to the control efficiency of photoreactivation and energy consumption were also evaluated. Results showed that culturability reduction of the fungal spores treated by UV-LEDs was not enhanced with the addition H2O2, PMS, and PS according to the results of heterotrophic plate counts and reaction rate constants; A. niger was expected to have higher UV resistance followed by T. harzianum and P. polonicum. However, UV-LEDs-ADPs inactivation, especially at the wavelengths of 280 and 265/280 nm, could accelerate the permeabilization of fungal spores as characterized by flow cytometry. Take P. polonicum for example, the percentage of membrane permeabilized spores was 98.0%, 98.7%, 97.6% and 82.6% after treatment by UV280/H2O2, UV280/PS, UV280/PMS and UV280 alone, respectively at the fluence of 100 mJ/cm2. The direct attack of free radicals in the processes of UV-LEDs-ADPs further enhanced the membrane damage and lowered the photoreactivation level, thus improved the inactivation efficiency. UV-LEDs/H2O2 was considered as an effective process in the disinfection of fungal spores with the advantages of enhancing the damage of membrane, inhibiting photoreactivation and comparable energy consumption compared with UV-LEDs alone.
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Affiliation(s)
- Qiqi Wan
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Ruihua Cao
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Gang Wen
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Collaborative Innovation Center of Water Pollution Control and Water Quality Security Assurance of Shaanxi Province, Xi'an University of Architecture and Technology, Xi'an 710055, PR China.
| | - Xiangqian Xu
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yuancheng Xia
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Gehui Wu
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yangfan Li
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Jingyi Wang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Huining Xu
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
| | - Yingzi Lin
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun 130118, PR China
| | - Tinglin Huang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, PR China; Collaborative Innovation Center of Water Pollution Control and Water Quality Security Assurance of Shaanxi Province, Xi'an University of Architecture and Technology, Xi'an 710055, PR China
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Thomas-Rüddel D, Schlattmann P, Pletz M, Kurzai O, Bloos F. Risk factors for invasive candida infection in critically ill patients - a systematic review and meta-analysis. Chest 2021; 161:345-355. [PMID: 34673022 PMCID: PMC8941622 DOI: 10.1016/j.chest.2021.08.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy. Research Question What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis? Study Design and Methods We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study. Results We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high. Interpretation Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
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Affiliation(s)
- Daniel Thomas-Rüddel
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany;.
| | - Peter Schlattmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften (IMSID), Jena University Hospital Jena
| | - Mathias Pletz
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Institute for Infectious Diseases and Infection Control, Jena University Hospital Jena
| | - Oliver Kurzai
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena; University of Wuerzburg, Institute for Hygiene and Microbiology, Germany
| | - Frank Bloos
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Anversa L, Lara BR, Romani CD, Saeki EK, Nogueira Nascentes GA, Bonfietti LX, Melhem MDSC, da Silva Ruiz L, Camargo CH, Pereira VBR. Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity. JOURNAL OF WATER AND HEALTH 2021; 19:724-735. [PMID: 34665766 DOI: 10.2166/wh.2021.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017-June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10-40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.
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Affiliation(s)
- Laís Anversa
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | - Bruna Rossini Lara
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | | | - Erika Kushikawa Saeki
- Regional Laboratories Center Presidente Prudente, Adolfo Lutz Institute, Presidente Prudente, Brazil
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Lopes LG, Csonka LA, Castellane JAS, Oliveira AW, de Almeida-Júnior S, Furtado RA, Tararam C, Levy LO, Crivellenti LZ, Moretti ML, Giannini MJSM, Pires RH. Disinfectants in a Hemodialysis Setting: Antifungal Activity Against Aspergillus and Fusarium Planktonic and Biofilm Cells and the Effect of Commercial Peracetic Acid Residual in Mice. Front Cell Infect Microbiol 2021; 11:663741. [PMID: 33996634 PMCID: PMC8116949 DOI: 10.3389/fcimb.2021.663741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aspergillus and Fusarium cause a broad spectrum of infections in humans, mainly in immunocompromised patients. Among these, patients undergoing hemodialysis are highly susceptible to infections, requiring a constant and adequate environmental disinfection program. Nevertheless, monitoring the residual disinfectants can contribute to the morbidity and mortality reduction in these patients. Here, we evaluated the susceptibility of Aspergillus spp. (n=19) and Fusarium spp. (n=13) environmental isolates against disinfectants (acetic acid, citric acid, peracetic acid, sodium hypochlorite, and sodium metabisulphite) at different concentrations and time exposures. Also, we investigated the in vivo toxicity of the peracetic acid residual concentration in mice. Fusarium isolates were identified by F. equiseti, F. oxysporum and F. solani while Aspergillus presented clinically relevant species (A. fumigatus, A. niger and A. terreus) and environmental ones. Against planktonic cells, only two disinfectants (acetic acid and sodium hypochlorite) showed a fungicidal effect on Fusarium spp., while only one (sodium hypochlorite) was effective against Aspergillus spp. Both fungi formed robust in vitro biofilms with large amounts of the extracellular matrix, as evidenced by electron micrographs. Exposure of fungal biofilms to disinfectants showed sensitivity to three (acetic, citric, and peracetic acids), although the concentrations and times of exposure varied according to the fungal genus. Mice exposure to the residual dose of peracetic acid during 60 weeks showed anatomopathological, hematological, and biochemical changes. The implementation of news control measures and those that already exist can help reduce infections, the second cause of death and morbidity in these patients, besides providing safety and well-being to them, a priority of any quality health program.
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Affiliation(s)
- Leonardo G. Lopes
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | - Larissa A. Csonka
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | | | | | | | | | - Cibele Tararam
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | - Regina H. Pires
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
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Afonso TB, Simões LC, Lima N. Occurrence of filamentous fungi in drinking water: their role on fungal-bacterial biofilm formation. Res Microbiol 2020; 172:103791. [PMID: 33197515 DOI: 10.1016/j.resmic.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Abstract
Water is indispensable to life and safe and accessible supply must be available to all. The presence of microorganisms is a threat to this commitment. Biofilms are the main reservoir of microorganisms inside water distribution systems and they are extremely ecologically diverse. Filamentous fungi and bacteria can coexist inside these systems forming inter-kingdom biofilms. This review has the goal of summarizing the most relevant and recent reports on the occurrence of filamentous fungi in water distribution systems along with the current knowledge and gaps about filamentous fungal biofilm formation. Special focus is given on fungal-bacterial interactions in water biofilms.
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Affiliation(s)
| | | | - Nelson Lima
- CEB, Centre of Biological Engineering, University of Minho, Braga, Portugal.
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Oliveira LT, Lopes LG, Ramos SB, Martins CHG, Jamur MC, Pires RH. Fungal biofilms in the hemodialysis environment. Microb Pathog 2018; 123:206-212. [DOI: 10.1016/j.micpath.2018.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
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Montanari LB, Sartori FG, Ribeiro DBM, Leandro LF, Pires RH, Melhem MDSC, de Mello CA, Martins CHG. Yeast isolation and identification in water used in a Brazilian hemodialysis unit by classic microbiological techniques and Raman spectroscopy. JOURNAL OF WATER AND HEALTH 2018; 16:311-320. [PMID: 29676766 DOI: 10.2166/wh.2017.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The use of poorly treated water in hemodialysis centers may lead to fungal contamination, which poses a serious threat to immunologically debilitated hemodialysis patients. This study aimed to isolate and identify yeast species in the water of a Brazilian hemodialysis center by using classic microbiological techniques and Raman spectroscopy. For 12 months, a total of 288 water samples were collected from different points of the hemodialysis treatment distribution center. One hundred and forty-six yeast species were isolated and identified in the samples that tested positive for the presence of yeasts such as Candida parapsilosis (100 isolates, or 68.50%), C. guilliermondii (17 isolates, or 11.65%), Rhodotorula mucilaginosa (23 isolates, or 15.75%), R. glutinis (three isolates, or 2.05%), and Trichosporon inkin (three isolates, or 2.05%). Yeast susceptibility to the antifungal fluconazole was also assayed. Only two C. guilliermondii isolates were resistant to fluconazole: the minimal inhibitory concentrations were higher than 64 μg/mL. The different yeast species present in the water of a Brazilian hemodialysis center call for more effective water disinfection procedures in this unit. Raman spectroscopy is an excellent tool to identify yeast species and is potentially applicable in routine water monitoring in hemodialysis units.
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Affiliation(s)
- Lilian Bueno Montanari
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | - Flávio Garcia Sartori
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | | | - Luís Fernando Leandro
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | - Regina Helena Pires
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | | | - César Alexandre de Mello
- Nucleus of Research in Sciences and Technology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil
| | - Carlos Henrique Gomes Martins
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
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Mandolfo S, Corsi A, Wratten ML, Sereni L, Imbasciati E. Evaluation of Hygiene and Safety Controls for On-Line Paired Hemodiafiltration (PHF). Int J Artif Organs 2018; 29:160-5. [PMID: 16552664 DOI: 10.1177/039139880602900203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background On-line hemodiafiltration is gaining popularity due to increasing evidence of clinical benefits however it also requires strict attention to hygiene and safety as notable quantities of liquid are reinfused into the patient. Although most centers are improving their attention to water quality, a frequent concern is the inadvertent or accidental contamination of water and whether the redundant safety controls are sufficient to protect the patient. In the present study, in order to simulate a worst-case safety condition, we tested in vitro the reliability of paired hemodiafiltration – (PHF), under low, moderate and high bacterial contamination of the water supply. Tests were performed using various bacterial concentrations (range 85–2000 cfu/mL) of Pseudomonas Aeruginosa. Samples were analyzed from different sites throughout the entire on-line hemodiafiltration circuit for bacteria endotoxin, fungus and ability to stimulate whole blood production of TNF α. Results In the in vitro contamination study, with the three bacterial concentrations tested at various points of the circuit, bacteria were below the level of detection and endotoxins were < 0.01 UE/mL. Addition of dialysate samples taken after the first stage of microfiltration, as well as after the first and second stage of ultrafiltration and incubated with whole blood were not associated with stimulated production of TNFα. Conclusions PHF appeared to be a safe and feasible method for on-line hemodiafiltration even in the unforeseen presence of bacterial contamination of the feed water or water distribution system.
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Affiliation(s)
- S Mandolfo
- Renal Unit, Ospedale Maggiore, Lodi, Italy.
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Totaro M, Casini B, Valentini P, Miccoli M, Giorgi S, Porretta A, Privitera G, Lopalco PL, Baggiani A. Evaluation and control of microbial and chemical contamination in dialysis water plants of Italian nephrology wards. J Hosp Infect 2017; 97:169-174. [PMID: 28546028 DOI: 10.1016/j.jhin.2017.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/16/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) has published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. AIM To identify microbial and chemical hazards, and evaluate the quality of disinfection treatment in DW plants. METHODS In 2015 and 2016, water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters provided by ISN guidelines. Chlorinated drinking water was desalinated by reverse osmosis and distributed to the closed loop which feeds all online monitors. Disinfection with peracetic acid was performed in all DW plants on a monthly basis. FINDINGS Over the 24-month study period, seven out of nine DW plants (78%) recorded negative results for all investigated parameters. Closed loop contamination with Burkholderia cepacia was detected in a DW plant from January 2015 to March 2015. Pseudomonas aeruginosa was isolated from March 2016 to May 2016 in the closed loop of another DW plant. These microbial contaminations were eradicated by shock disinfection with sodium hypochlorite and peracetic acid, followed by water flushing. CONCLUSION These results highlight the importance of chemical and physical methods of DW disinfection. The maintenance of control measures in water plants hosted in dialysis wards ensures a microbial risk reduction for all dialysis patients.
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Affiliation(s)
- M Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - B Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P Valentini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P L Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Graça MG, van der Heijden IM, Perdigão L, Taira C, Costa SF, Levin AS. Evaluation of two methods for direct detection of Fusarium spp. in water. J Microbiol Methods 2016; 123:39-43. [PMID: 26844885 DOI: 10.1016/j.mimet.2016.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 12/14/2022]
Abstract
Fusarium is a waterborne fungus that causes severe infections especially in patients with prolonged neutropenia. Traditionally, the detection of Fusarium in water is done by culturing which is difficult and time consuming. A faster method is necessary to prevent exposure of susceptible patients to contaminated water. The objective of this study was to develop a molecular technique for direct detection of Fusarium in water. A direct DNA extraction method from water was developed and coupled to a genus-specific PCR, to detect 3 species of Fusarium (verticillioides, oxysporum and solani). The detection limits were 10 cells/L and 1 cell/L for the molecular and culture methods, respectively. To our knowledge, this is the first method developed to detect Fusarium directly from water.
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Affiliation(s)
- Mariana G Graça
- Department of Infectious Diseases, Faculty of Medicine, University of São Paulo, Brazil; LIM 54, Institute of Tropical Medicine of the University of São Paulo, Brazil.
| | | | - Lauro Perdigão
- Department of Infectious Diseases, Faculty of Medicine, University of São Paulo, Brazil; LIM 54, Institute of Tropical Medicine of the University of São Paulo, Brazil.
| | - Cleison Taira
- Laboratory of Pathogenic Dimorphic Fungi - Institute of Biomedical Sciences, University of São Paulo, Brazil; Laboratory of Medical Investigation 53, Faculty of Medicine, University of São Paulo, Brazil.
| | - Silvia F Costa
- Department of Infectious Diseases, Faculty of Medicine, University of São Paulo, Brazil; LIM 54, Institute of Tropical Medicine of the University of São Paulo, Brazil.
| | - Anna S Levin
- Department of Infectious Diseases, Faculty of Medicine, University of São Paulo, Brazil; LIM 54, Institute of Tropical Medicine of the University of São Paulo, Brazil.
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Kauffmann-Lacroix C, Costa D, Imbert C. Fungi, Water Supply and Biofilms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 931:49-61. [PMID: 27167410 DOI: 10.1007/5584_2016_8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Even though it has been studied for many years, water-related infectious risk still exists in both care and community environments due to the possible presence of numerous microorganisms such as bacteria, fungi and protists. People can be exposed directly to these microorganisms either through aerosols and water, after ingestion, inhalation, skin contact and entry through mucosal membranes, or indirectly usually due to pre-treatment of some medical devices. Species belonging to genera such as Aspergillus, Penicillium, Pseudallesheria, Fusarium, Cuninghamella, Mucor and in some particular cases Candida have been isolated in water from health facilities and their presence is particularly related to the unavoidable formation of a polymicrobial biofilm in waterlines. Fungi isolation methods are based on water filtration combined with conventional microbiology cultures and/or molecular approaches; unfortunately, these are still poorly standardized. Moreover, due to inappropriate culture media and inadequate sampling volumes, the current standardized methods used for bacterial research are not suitable for fungal search. In order to prevent water-related fungal risk, health facilities have implemented measures such as ultraviolet radiation to treat the input network, continuous chemical treatment, chemical or thermal shock treatments, or microfiltration at points of use. This article aims to provide an overview of fungal colonization of water (especially in hospitals), involvement of biofilms that develop in waterlines and application of preventive strategies.
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Affiliation(s)
- Catherine Kauffmann-Lacroix
- Laboratoire de Parasitologie et Mycologie Médicale, CHU de Poitiers, 2 rue de la Milétrie, UBM, BP577, Poitiers, 86021, France.
| | - Damien Costa
- Laboratoire de Parasitologie et Mycologie Médicale, CHU de Poitiers, 2 rue de la Milétrie, UBM, BP577, Poitiers, 86021, France
- Laboratoire Ecologie Biologie des Interactions (EBI), Université de Poitiers, UMR CNRS 7267, équipe Microbiologie de l'Eau, UFR Médecine-Pharmacie, Bat D1, 6 rue de la Milétrie, TSA 51115, Poitiers, 86073, France
| | - Christine Imbert
- Laboratoire de Parasitologie et Mycologie Médicale, CHU de Poitiers, 2 rue de la Milétrie, UBM, BP577, Poitiers, 86021, France
- Laboratoire Ecologie Biologie des Interactions (EBI), Université de Poitiers, UMR CNRS 7267, équipe Microbiologie de l'Eau, UFR Médecine-Pharmacie, Bat D1, 6 rue de la Milétrie, TSA 51115, Poitiers, 86073, France
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Levy L, Block C, Schwartz C, Gross I, Cohen M, Fridlender Z, Moses A, Berkman N, Benenson S. Cluster of Fusarium solani isolations in a Bronchoscopy Unit. Clin Microbiol Infect 2016; 22:e5-e6. [DOI: 10.1016/j.cmi.2015.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 11/24/2022]
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Rao CY, Pachucki C, Cali S, Santhiraj M, Krankoski KLK, Noble-Wang JA, Leehey D, Popli S, Brandt ME, Lindsley MD, Fridkin SK, Arduino MJ. Contaminated Product Water as the Source ofPhialemonium curvatumBloodstream Infection among Patients Undergoing Hemodialysis. Infect Control Hosp Epidemiol 2015; 30:840-7. [DOI: 10.1086/605324] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.We investigated a cluster of cases of bloodstream infection (BSI) due to the moldPhialemoniumat a hemodialysis center in Illinois and conducted a cohort study to identify risk factors.Design.Environmental assessment and cohort study.Setting.A hemodialysis center in a tertiary care hospital.Methods.A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive forPhialemonium curvatumon culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA.Results.We identified 2 case patients with BSI due toP. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolatedP. curvatumfrom the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station.Conclusion.The source ofP. curvatumwas likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due toP. curvatummay be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient's blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility.
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Al-Gabr HM, Zheng T, Yu X. Efficacy of two chemical coagulants and three different filtration media on removal of Aspergillus flavus from surface water. J Environ Sci (China) 2014; 26:274-280. [PMID: 25076518 DOI: 10.1016/s1001-0742(13)60408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aquatic fungi are common in various aqueous environments and play potentially crucial roles in nutrient and carbon cycling as well as interacting with other organisms. Species of Aspergillus are the most common fungi that occur in water. The present study was undertaken to elucidate the efficacy of two coagulants, aluminum sulfate and ferric chloride, used at different concentrations to treat drinking water, in removing Aspergillus flavus, as well as testing three different filtration media: sand, activated carbon, and ceramic granules, for their removal of fungi from water. The results revealed that both coagulants were effective in removing fungi and decreasing the turbidity of drinking water, and turbidity decreased with increasing coagulant concentration. Also, at the highest concentration of the coagulants, A. flavus was decreased by 99.6% in the treated water. Among ceramic granules, activated carbon, and sand used as media for water filtration, the sand and activated carbon filters were more effective in removing A. flavus than ceramic granules while simultaneously decreasing the turbidity levels in the test water samples. Post-treatment total organic carbon (TOC) and total nitrogen (TN) concentrations in the experimental water did not decrease; on the contrary, TN concentrations increased with the increasing dosage of coagulants. The filtration process had no effect in reducing TOC and TN in tested water.
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18
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Schiavano GF, Parlani L, Sisti M, Sebastianelli G, Brandi G. Occurrence of fungi in dialysis water and dialysate from eight haemodialysis units in central Italy. J Hosp Infect 2014; 86:194-200. [PMID: 24556142 DOI: 10.1016/j.jhin.2013.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/19/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fungal contamination of dialysis fluids may be a serious problem in therapy, particularly due to the debilitated immune system of haemodialysis patients. AIM To investigate the occurrence, distribution, and diversity of fungi in dialysis water and dialysis solution of eight haemodialysis units in a region of central Italy. METHODS Samples were collected over a one-year period from different points of the haemodialysis circuits in accordance with the guidelines of the Italian Society of Nephrology. Isolation and identification of fungi was performed according to the ISTISAN method Reports (2007/05 and 2008/10). FINDINGS Of the 976 samples analysed, 96 grew filamentous fungi, 28 were positive for yeast, and six samples contained both mould and yeast. A wide variety of filamentous fungi (26 genera, of which 15 identified at species level, and 'mycelia sterilia') were recovered, many of which are known as opportunistic pathogens. Cladosporium spp. were most frequently found (39%), followed by Alternaria spp. and Tricophyton spp. Fungal counts in treated water and standard dialysate solution were always below the threshold (<10 cfu/mL), and thus are in agreement with the Italian guidelines for dialysis fluid quality, whereas 10.9% of the samples of ultrapure dialysate solution were contaminated by one or several fungi types, in contravention of the guidelines. CONCLUSION The large variety of opportunistic fungi recovered in the haemodialysis circuits proves the importance of including an analysis of fungi to check the microbial quality of dialysis water and dialysate.
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Affiliation(s)
- G F Schiavano
- Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy
| | - L Parlani
- Laboratory of Public Health and Hygiene, Department of Prevention, Area Vasta n. 1 - AZUR Marche, Italy
| | - M Sisti
- Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy
| | - G Sebastianelli
- Laboratory of Public Health and Hygiene, Department of Prevention, Area Vasta n. 1 - AZUR Marche, Italy
| | - G Brandi
- Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy.
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Al-gabr HM, Zheng T, Yu X. Occurrence and quantification of fungi and detection of mycotoxigenic fungi in drinking water in Xiamen City, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 466-467:1103-11. [PMID: 23391452 DOI: 10.1016/j.scitotenv.2012.12.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/20/2012] [Accepted: 12/20/2012] [Indexed: 05/25/2023]
Abstract
Fungi are known to play an important role in nutrient and carbon cycling, and the occurrence of fungi in the water supply may result in a variety of human health problems. This study aimed to investigate the occurrence and frequency of various fungi in drinking water over a one-year period. The study also aimed to quantify the fungal presence using real-time PCR, and to effectively detect mycotoxigenic fungi in a variety of water sources. Water samples were collected from different water systems (surface water, public system water, house water, and tank water), from different sites (n=15) in Xiamen, China. Each month from February 2011 to January 2012, 22 water samples were collected and analyzed. The results showed that surface water samples possessed a higher frequency of fungi than did the other water samples. Identification of fungal species was conducted using morphological and molecular methods. The most dominant fungi found were Aspergillus spp., Fusarium spp., Pencillium spp., Trichoderma spp., Mucor sp., and Rhizopus sp. Notably, the more-frequency observed fungi in the tap water of houses and public systems were Fusarium sp., Exophiala sp., and Phialophora sp. Meanwhile, mycotoxigenic fungi were detected in some water samples at different times. The strains isolated from samples collected in September to November had the aflatoxigenic fungi, and for fumonisin and trichothecenes, the fungi strains were re-isolated from water in November and December.
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Affiliation(s)
- Hamid Moh Al-gabr
- Key Laboratory of Ministry of Education for Coast and Wetland Ecosystems, School of Life Sciences, Xiamen University, Xiamen 361005, China; Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
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20
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Mesquita-Rocha S, Godoy-Martinez PC, Gonçalves SS, Urrutia MD, Carlesse F, Seber A, Silva MAA, Petrilli AS, Colombo AL. The water supply system as a potential source of fungal infection in paediatric haematopoietic stem cell units. BMC Infect Dis 2013; 13:289. [PMID: 23802862 PMCID: PMC3708769 DOI: 10.1186/1471-2334-13-289] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022] Open
Abstract
Background We conducted a prospective study to investigate the presence of microfungal contamination in the water supply system of the Oncology Paediatric Institute, São Paulo – Brazil after the occurrence of one invasive Fusarium solani infection in a patient after Haematopoietic Stem Cell Transplantation (HSCT). During a twelve-month period, we investigated the water supply system of the HSCT unit by monitoring a total of fourteen different collection sites. Methods One litre of water was collected in each location, filtered through a 0.45 μm membrane and cultured on SDA to detect the presence of filamentous fungi. Physicochemical analyses of samples were performed to evaluate the temperature, turbidity, pH, and the concentration of free residual chlorine. Results Over the 12 months of the study, 164 samples were collected from the water supply system of the HSCT unit, and 139 of the samples tested positive for filamentous fungi (84.8%), generating a total of 2,362 colonies. Cladosporium spp., Penicillium spp., Purpureocillium spp. and Aspergillus spp. were ranked as the most commonly found genera of mould in the collected samples. Of note, Fusarium solani complex isolates were obtained from 14 out of the 106 samples that were collected from tap water (mean of 20 CFU/L). There was a positive correlation between the total number of fungal CFU obtained in all cultures and both water turbidity and temperature parameters. Our findings emphasise the need for the establishment of strict measures to limit the exposure of high-risk patients to waterborne fungal propagules. Conclusions We were able to isolate a wide variety of filamentous fungi from the water of the HSCT unit where several immunocompromised patients are assisted.
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21
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Figel IC, Marangoni PRD, Tralamazza SM, Vicente VA, Dalzoto PDR, do Nascimento MMF, de Hoog GS, Pimentel IC. Black yeasts-like fungi isolated from dialysis water in hemodialysis units. Mycopathologia 2013; 175:413-20. [PMID: 23467974 DOI: 10.1007/s11046-013-9633-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
Hemodialysis in patients with chronic renal failure promotes the removal of toxic substances, water, and minerals from the body and often takes place in specialized clinics. Microbial contamination of dialysis fluid is a serious problem in therapy. One of the sources of contamination is the water used to prepare the dialysate. In Brazil, legislation regulating the microbiological quality of water for dialysis does not cover waterborne microbes such as Pseudomonas, mycobacteria, and fungi. The aim of the present study was to quantify, isolate, and identify fungi present in water systems in six hemodialysis units in Curitiba, Paraná state, Brazil. Fungi were analyzed by surface plating and membrane filtration. Isolates were identified by morphology, while the dematiaceous fungi were identified by sequencing the rDNA ITS region. It was found that 66 % of the samples presented fungi, while black fungi were present in 46 % of all samples. Twenty-eight isolates from treated water for dialysis and dialysate were identified by sequencing and were found to be Exophiala pisciphila, E. cancerae, E. equina, and Rhinocladiella similis. The presence of dematiaceous fungi may pose a risk for debilitated hospitalized patients.
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Affiliation(s)
- Izabel Cristina Figel
- Microbiology, Parasitology and Pathology Post-Graduation Program, Basic Pathology Department, Federal University of Paraná State, Curitiba, Brazil
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Short DPG, O'Donnell K, Zhang N, Juba JH, Geiser DM. Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains. J Clin Microbiol 2011; 49:4264-72. [PMID: 21976755 PMCID: PMC3232942 DOI: 10.1128/jcm.05468-11] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 09/23/2011] [Indexed: 12/31/2022] Open
Abstract
It has been proposed that plumbing systems might serve as a significant environmental reservoir of human-pathogenic isolates of Fusarium. We tested this hypothesis by performing the first extensive multilocus sequence typing (MLST) survey of plumbing drain-associated Fusarium isolates and comparing the diversity observed to the known diversity of clinical Fusarium isolates. We sampled 471 drains, mostly in bathroom sinks, from 131 buildings in the United States using a swabbing method. We found that 66% of sinks and 80% of buildings surveyed yielded at least one Fusarium culture. A total of 297 isolates of Fusarium collected were subjected to MLST to identify the phylogenetic species and sequence types (STs) of these isolates. Our survey revealed that the six most common STs in sinks were identical to the six most frequently associated with human infections. We speculate that the most prevalent STs, by virtue of their ability to form and grow in biofilms, are well adapted to plumbing systems. Six major Fusarium STs were frequently isolated from plumbing drains within a broad geographic area and were identical to STs frequently associated with human infections.
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Affiliation(s)
- Dylan P G Short
- Department of Plant Pathology, Pennsylvania State University, University Park, PA 16802, USA.
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Filamentous fungi in drinking water, particularly in relation to biofilm formation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:456-69. [PMID: 21556196 PMCID: PMC3084471 DOI: 10.3390/ijerph8020456] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 01/02/2023]
Abstract
The presence of filamentous fungi in drinking water has become an area worthy of investigation with various studies now being published. The problems associated with fungi include blockage of water pipes, organoleptic deterioration, pathogenic fungi and mycotoxins. Fungal biofilm formation is a less developed field of study. This paper updates the topic and introduces novel methods on fungal biofilm analysis, particularly from work based in Brazil. Further recommendations for standard methodology are provided.
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Hedayati MT, Mayahi S, Movahedi M, Shokohi T. Study on fungal flora of tap water as a potential reservoir of fungi in hospitals in Sari city, Iran. J Mycol Med 2011; 21:10-4. [PMID: 24451496 DOI: 10.1016/j.mycmed.2010.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 11/23/2010] [Accepted: 12/02/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present investigation was to evaluate the fungal flora of tap water from university hospitals of Sari city, Iran. MATERIALS AND METHODS During a 1-year period, 240 water samples were collected from four university hospitals. All water samples were collected in sterile polystyrene bottles. A volume of 100ml of the samples passed through sterile 0.45-micrometer filters. The filters were placed directly on malt extract agar and incubated at 27°C for 3 to 7 days. Routine mycological techniques were applied to identification of grown fungi. RESULTS Out of 240 plates, 77.5% were positive for fungal growth. Twelve different genera were identified. Aspergillus (29.7%), Cladosporium (26.7%) and Penicillium (23.9%) were the most common isolated. Among Aspergillus species, A. flavus had the highest frequency. Highest colony counts were found in autumn. Aspergillus predominated in autumn, Cladosporium in winter and spring and Penicillium in summer. CONCLUSION The results of our study showed that hospital water should be considered as a potential reservoir of fungi particularly Aspergillus.
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Affiliation(s)
- M T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, P.O. Box: 48175-1665, Sari, Iran
| | - S Mayahi
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, P.O. Box: 48175-1665, Sari, Iran
| | - M Movahedi
- Department of Environmental Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - T Shokohi
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, P.O. Box: 48175-1665, Sari, Iran
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Hayette MP, Christiaens G, Mutsers J, Barbier C, Huynen P, Melin P, de Mol P. Filamentous fungi recovered from the water distribution system of a Belgian university hospital. Med Mycol 2010; 48:969-74. [DOI: 10.3109/13693781003639601] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hageskal G, Lima N, Skaar I. The study of fungi in drinking water. ACTA ACUST UNITED AC 2008; 113:165-72. [PMID: 19010414 DOI: 10.1016/j.mycres.2008.10.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 10/10/2008] [Indexed: 12/23/2022]
Abstract
The occurrence of fungi in drinking water has received increased attention in the last decades, and fungi are now generally accepted as drinking water contaminants. The knowledge about the occurrence and diversity of fungi in water has increased considerably from a low knowledge base. However, the relevance of waterborne fungi for water quality and human health is poorly understood and still conflicting. Scientific reports on effective treatment against fungi in water are also few. This article presents a review of the literature on fungal water studies, including some general results, and considerations of significance, limits, contradictions, precautions, and practical consequences.
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Affiliation(s)
- Gunhild Hageskal
- National Veterinary Institute, Section of Mycology, P.O. Box 750 Centrum, 0106 Oslo, Norway.
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Kanzler D, Buzina W, Paulitsch A, Haas D, Platzer S, Marth E, Mascher F. Occurrence and hygienic relevance of fungi in drinking water. Mycoses 2008; 51:165-9. [PMID: 18254755 DOI: 10.1111/j.1439-0507.2007.01454.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fungi, above all filamentous fungi, can occur almost everywhere, even in water. They can grow in such a quantity in water that they can affect the health of the population or have negative effects on food production. There are several reports of fungal growth in water from different countries, but to our knowledge none from Austria so far. The aim of this study was to gain an overview of the spectrum of filamentous fungi and yeasts in drinking water systems. Thirty-eight water samples from drinking water and groundwater were analysed. Fungi were isolated by using membrane filtration and plating method with subsequent cultivation on agar plates. The different taxa of fungi were identified using routine techniques as well as molecular methods. Fungi were isolated in all water samples examined. The mean value for drinking water was 9.1 CFU per 100 ml and for groundwater 5400 CFU per 100 ml. Altogether 32 different taxa of fungi were found. The taxa which occurred most frequently were Cladosporium spp., Basidiomycetes and Penicillium spp. (74.6%, 56.4% and 48.7%, respectively). This study shows that drinking water can be a reservoir for fungi, among them opportunists, which can cause infections in immunosuppressed patients.
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Affiliation(s)
- D Kanzler
- Institute of Hygiene, Medical University Graz, Graz, Austria
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28
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Pires-Gonçalves RH, Sartori FG, Montanari LB, Zaia JE, Melhem MSC, Mendes-Giannini MJS, Martins CHG. Occurrence of fungi in water used at a haemodialysis centre. Lett Appl Microbiol 2008; 46:542-7. [PMID: 18363650 DOI: 10.1111/j.1472-765x.2008.02349.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to identify and determine the diversity, occurrence and distribution of fungi in water used at a haemodialysis centre. METHODS AND RESULTS Samples in the hydraulic circuit for the distribution of the water, dialysate samples and samples of sterilization solution from dialysers were collected over a 3-month period, and 500 ml of each sample was filtered through membranes. All together 116 isolates of fungi were recovered from 89% of all water samples collected inside the haemodialysis unit, with prevalence of moulds in tap water samples and of yeasts in dialysate samples. Fusarium spp. was the most abundant genus found, whereas Candida parapsilosis was the predominant yeast species. CONCLUSIONS This study demonstrated that various fungi were present in the water system. These data suggest the inclusion of the detection and quantification of fungi in the water of haemodialysis. SIGNIFICANCE AND IMPACT OF THE STUDY The recovery of fungi from aqueous haemodialysis environments implies a potential risk for haemodialysis patients and indicates the need for continuous maintenance and monitoring. Further studies on fungi in haemodialysis water systems are required to investigate the organism ability to persist, their role in biofilm formation and their clinical significance.
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Affiliation(s)
- R H Pires-Gonçalves
- Laboratory of Research in Applied Microbiology, University of Franca, Franca, Brazil
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29
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Varo SD, Martins CHG, Cardoso MJDO, Sartori FG, Montanari LB, Pires-Gonçalves RH. [Isolation of filamentous fungi from water used in a hemodialysis unit]. Rev Soc Bras Med Trop 2007; 40:326-31. [PMID: 17653470 DOI: 10.1590/s0037-86822007000300015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 05/04/2007] [Indexed: 11/22/2022] Open
Abstract
Despite the relative frequency of opportunistic fungal infections among hemodialysis patients, the reservoirs for these microorganisms in the environment remain unknown, although some recent studies have made correlations with the water supply as their source. The objective of the present study was to monitor the mycological quality of the water system of a hemodialysis unit in the interior of the State of São Paulo, Brazil, over the period from April to July 2006. Fifteen samples of 1000 ml were collected from seven water distribution points using the membrane filtration technique (0.45 microm). A total of 116 filamentous fungus specimens were isolated, including 47 Trichoderma sp (40.5%), 29 Cladosporium sp (25%), 16 Aspergillus sp (13.8%) and 11 Fusarium sp (9.5%). The results suggest that the water supply for hemodialysis units should also be monitored for mycological contamination, and that effective prophylactic measures should be adopted for minimizing the exposure of these immunodeficient patients to contaminated water sources in the environment.
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Affiliation(s)
- Samuel Dutra Varo
- Laboratório de Pesquisa em Microbiologia Aplicada, Universidade de Franca, Franca, SP
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30
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Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis: epidemiology, diagnosis and management in immunocompromised patients. Drugs 2007; 67:1567-601. [PMID: 17661528 DOI: 10.2165/00003495-200767110-00004] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Morbidity and mortality caused by invasive Aspergillus infections are increasing. This is because of the higher number of patients with malignancies treated with intensive immunosuppressive therapy regimens as well as their improved survival from formerly fatal bacterial infections, and the rising number of patients undergoing allogeneic haematopoietic stem cell or organ transplantation. Early initiation of effective systemic antifungal treatment is essential for a successful clinical outcome in these patients; however, clinical clues for diagnosis are sparse and early microbiological proof of invasive aspergillosis (IA) is rare. Clinical diagnosis is based on pulmonary CT scan findings and non-culture based diagnostic techniques such as galactomannan or DNA detection in blood or bronchoalveolar lavage samples. Most promising outcomes can be expected in patients at high risk for aspergillosis in whom antifungal treatment has been started pre-emptively, backed up by laboratory and imaging findings. The gold standard of systemic antifungal treatment is voriconazole, which has been proven to be significantly superior to conventional amphotericin B and has led to a profound improvement of survival rates in patients with cerebral aspergillosis. Liposomal amphotericin B at standard dosages appears to be a suitable alternative for primary treatment, while caspofungin, amphotericin B lipid complex or posaconazole have shown partial or complete response in patients who had been refractory to or intolerant of primary antifungal therapy. Combination therapy with two antifungal compounds may be a promising future strategy for first-line treatment. Lung resection helps to prevent fatal haemorrhage in single patients with pulmonary lesions located in close proximity to larger blood vessels, but is primarily considered for reducing the risk of relapse during subsequent periods of severe immunosuppression. Strict reverse isolation appears to reduce the incidence of aspergillosis in allogeneic stem cell transplant recipients and patients with acute myeloid leukaemia undergoing aggressive anticancer therapy. Well designed, prospective randomised studies on infection control measures effective to prevent aspergillosis are lacking. Prophylactic systemic antifungal treatment with posaconazole significantly improves survival and reduces IA in acute myeloid leukaemia patients and reduces aspergillosis incidence rates in patients with intermediate-to-severe graft-versus-host reaction emerging after allogeneic haematopoietic stem cell transplantation. Voriconazole prophylaxis may be suitable for prevention of IA as well; however, the results of large clinical trials are still awaited.
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Affiliation(s)
- Georg Maschmeyer
- Department of Internal Medicine, Hematology and Oncology, Klinikum Ernst von Bergmann, Potsdam, Germany.
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31
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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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32
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De Vos MM, Nelis HJ. An improved method for the selective detection of fungi in hospital waters by solid phase cytometry. J Microbiol Methods 2006; 67:557-65. [PMID: 16884797 DOI: 10.1016/j.mimet.2006.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 05/01/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
Yeast cells and mould spores can be fluorescently labelled with the viability stain carboxyfluorescein diacetate (CFDA) and detected on a membrane filter by laser scanning (solid phase cytometry, SPC). Although the selectivity of an existing commercial SPC procedure for fungi is ensured by using a 2 microm pore size membrane filter and a pre-incubation on a proprietary spore swelling/activation medium, some bacteria are still co-detected. In the present study, the selectivity for fungi has been enhanced by combining the green fluorescent CFDA with a second red fluorescent label, i.e. TRITC-concanavalin A, targetting fungal but not commonly bacterial cells. Additional improvements resulted from the prolongation of the pre-incubation and from the extra-rinsing of the membrane filter. The improved method was applied to detect fungi in hospital waters, dialysis fluids and endoscopic rinse waters. In general, SPC detected more fungi in water than plate methods. The occurrence of fungi in dialysis fluid and endoscopic rinse water was rare. Evidence for the presence of fungal viable but non-culturable (VBNC) cells in water was weak.
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Affiliation(s)
- Muriel M De Vos
- Laboratory for Pharmaceutical Microbiology, Ghent University, Harelbekestraat 72, B-9000 Ghent, Belgium
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33
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Hageskal G, Knutsen AK, Gaustad P, de Hoog GS, Skaar I. Diversity and significance of mold species in Norwegian drinking water. Appl Environ Microbiol 2006; 72:7586-93. [PMID: 17028226 PMCID: PMC1694246 DOI: 10.1128/aem.01628-06] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to determine the occurrence, distribution, and significance of mold species in groundwater- and surface water-derived drinking water in Norway, molds isolated from 273 water samples were identified. Samples of raw water, treated water, and water from private homes and hospital installations were analyzed by incubation of 100-ml membrane-filtered samples on dichloran-18% glycerol agar. The total count (number of CFU per 100 ml) of fungal species and the species diversity within each sample were determined. The identification of mold species was based on morphological and molecular methods. In total, 94 mold species belonging to 30 genera were identified. The mycobiota was dominated by species of Penicillium, Trichoderma, and Aspergillus, with some of them occurring throughout the drinking water system. Several of the same species as isolated from water may have the potential to cause allergic reactions or disease in humans. Other species are common contaminants of food and beverages, and some may cause unwanted changes in the taste or smell of water. The present results indicate that the mycobiota of water should be considered when the microbiological safety and quality of drinking water are assessed. In fact, molds in drinking water should possibly be included in the Norwegian water supply and drinking water regulations.
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Affiliation(s)
- Gunhild Hageskal
- National Veterinary Institute, Section for Food and Feed Microbiology, P.O. Box 8156 Dep., 0033 Oslo, Norway
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34
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Chaberny IF, Kaiser P, Sonntag HG. Can soda fountains be recommended in hospitals? Int J Hyg Environ Health 2006; 209:471-5. [PMID: 16740412 DOI: 10.1016/j.ijheh.2006.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Revised: 04/05/2006] [Accepted: 04/09/2006] [Indexed: 11/17/2022]
Abstract
Mineral water (soda water) is very popular in Germany. Therefore, soda fountains were developed as alternatives to the traditional deposit bottle system. Nowadays, different systems of these devices are commercially available. For several years, soda fountains produced by different companies have been examined at the University Hospital of Heidelberg. In 1998, it was possible for the first time to observe and evaluate one of these systems over a period of 320 days in a series of microbiological examinations. The evaluation was implemented on the basis of the German drinking water regulation (Anonymous, 1990. Gesetz über Trinkwasser und Wasser für Lebensmittelbetriebe (Trinkwasserverordnung - TrinkwV) vom 12. Dezember 1990. Bundesgesetzblatt 66, 2613ff). Initially, the bacteria counts exceeded the reference values imposed by the German drinking water regulation in almost 50% of the analyses. Pseudomonas aeruginosa was also detected in almost 38% of the samples. After a re-arrangement of the disinfection procedure and the removal of the charcoal filter, Pseudomonas aeruginosa was not detectable any more. However, the bacteria counts still frequently exceeded the reference values of the German drinking water regulation. Following our long-term analysis, we would not recommend soda fountains in high-risk areas of hospitals. If these devices are to be used in hospitals, the disinfection procedures should be executed in weekly or fortnightly intervals and the water quality should be examined periodically.
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Affiliation(s)
- Iris F Chaberny
- Department of Medical Microbiology and Hygiene, Institute of Hygiene at the University Hospital of Heidelberg, Germany.
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35
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Abstract
Invasive aspergillosis presents a formidable problem for both diagnosis and therapy. Therefore, prevention is a very important strategy in controlling this disease. Preventing invasive aspergillosis demands a clear understanding of the environmental sources of Aspergillus spp. and how this mould is transmitted to patients. Insight into the sources of exposure, mechanisms of transmission, and host susceptibility to infection are vital to appropriately direct preventive strategies to those settings where the risk of infection is the highest and consequently the impact of prevention the greatest.
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Affiliation(s)
- A Warris
- Department of Paediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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36
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El-Hamamsy I, Dürrleman N, Stevens LM, Perrault LP, Carrier M. Aspergillus Endocarditis After Cardiac Surgery. Ann Thorac Surg 2005; 80:359-64. [PMID: 15975413 DOI: 10.1016/j.athoracsur.2004.08.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 08/28/2004] [Accepted: 08/30/2004] [Indexed: 10/25/2022]
Abstract
Aspergillus species infections are an increasingly common occurrence in hospital wards. Aspergillus endocarditis constitutes one of the manifestations of the disease, which bears a poor prognosis in cardiac surgery patients. A review of the literature on fungal and Aspergillus endocarditis was undertaken. Valvular risk factors, indwelling intravenous catheters, prolonged antibiotics, malignancy, and intravenous drug use increase the risk. Clinical presentation is insidious, with embolic complications often representing the first manifestation of the disease. Blood cultures are typically negative. The mortality rate is almost 100%. Amphotericin B represents the mainstay of medical therapy with several possible adjuncts. Surgery is an essential part of therapy in Aspergillus endocarditis after cardiac surgery and should be undertaken as soon as the diagnosis is made. Aspergillus endocarditis is an ominous complication after cardiac surgery. A high suspicion index, early administration of appropriate antibiotics, and prompt surgical intervention should improve the prognosis, which remains dismal.
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Affiliation(s)
- Ismaïl El-Hamamsy
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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37
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Exner M, Kramer A, Lajoie L, Gebel J, Engelhart S, Hartemann P. Prevention and control of health care-associated waterborne infections in health care facilities. Am J Infect Control 2005; 33:S26-40. [PMID: 15940114 DOI: 10.1016/j.ajic.2005.04.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current article is a review of the public health risks attributable to waterborne pathogens in health care. The consequences of health care-associated infections (HAIs) are discussed. Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, and amoeba-associated bacteria. This is particularly noteworthy among immunocompromised patients. New prevention strategies and control measures brought about through advanced planning, facility remodelling and reconstruction, disinfection, and filtration have resulted in a significant reduction of the incidence of waterborne HAIs. The positive consequences of a comprehensive multibarrier approach including prevention and control programs in health care facilities are discussed. Environmental cultures are now integrated within the infection control program of some European countries. In high-risk areas, the application of disposable sterile point-of-use filters for faucets and shower heads appears to be the practice of choice to efficiently control waterborne pathogens and to prevent infections.
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Affiliation(s)
- M Exner
- Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany.
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Warris A, Klaassen CHW, Meis JFGM, De Ruiter MT, De Valk HA, Abrahamsen TG, Gaustad P, Verweij PE. Molecular epidemiology of Aspergillus fumigatus isolates recovered from water, air, and patients shows two clusters of genetically distinct strains. J Clin Microbiol 2003; 41:4101-6. [PMID: 12958232 PMCID: PMC193792 DOI: 10.1128/jcm.41.9.4101-4106.2003] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There has been an increase in data suggesting that besides air, hospital water is a potential source of transmission of filamentous fungi, and in particular Aspergillus fumigatus. Molecular characterization of environmental and clinical A. fumigatus isolates, collected prospectively during an 18-month period, was performed to establish if waterborne fungi play a role in the pathogenesis of invasive aspergillosis. Isolates recovered from water (n = 54) and air (n = 21) at various locations inside and outside the hospital and from 15 patients (n = 21) with proven, probable, or possible invasive aspergillosis were genotyped by amplified fragment length polymorphism analysis. Based on genomic fingerprints, the environmental A. fumigatus isolates could be grouped into two major clusters primarily containing isolates recovered from either air or water. The genotypic relatedness between clinical and environmental isolates suggests that patients with invasive aspergillosis can be infected by strains originating from water or from air. In addition, 12 clusters with genetically indistinguishable or highly related strains were differentiated, each containing two to three isolates. In two clusters, clinical isolates recovered from patients matched those recovered from water sources, while in another cluster the clinical isolate was indistinguishable from one cultured from air. This observation might open new perspectives in the development of infection control measures to prevent invasive aspergillosis in high-risk patients. The genetic variability found between airborne and waterborne A. fumigatus strains might prove to be a powerful tool in understanding the transmission of invasive aspergillosis and in outbreak control.
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Affiliation(s)
- Adilia Warris
- Department of Pediatrics, University Medical Center St. Radboud, Nijmegen, The Netherlands.
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39
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Brinkman NE, Haugland RA, Wymer LJ, Byappanahalli M, Whitman RL, Vesper SJ. Evaluation of a rapid, quantitative real-time PCR method for enumeration of pathogenic Candida cells in water. Appl Environ Microbiol 2003; 69:1775-82. [PMID: 12620869 PMCID: PMC150045 DOI: 10.1128/aem.69.3.1775-1782.2003] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Quantitative PCR (QPCR) technology, incorporating fluorigenic 5' nuclease (TaqMan) chemistry, was utilized for the specific detection and quantification of six pathogenic species of Candida (C. albicans, C. tropicalis, C. krusei, C. parapsilosis, C. glabrata and C. lusitaniae) in water. Known numbers of target cells were added to distilled and tap water samples, filtered, and disrupted directly on the membranes for recovery of DNA for QPCR analysis. The assay's sensitivities were between one and three cells per filter. The accuracy of the cell estimates was between 50 and 200% of their true value (95% confidence level). In similar tests with surface water samples, the presence of PCR inhibitory compounds necessitated further purification and/or dilution of the DNA extracts, with resultant reductions in sensitivity but generally not in quantitative accuracy. Analyses of a series of freshwater samples collected from a recreational beach showed positive correlations between the QPCR results and colony counts of the corresponding target species. Positive correlations were also seen between the cell quantities of the target Candida species detected in these analyses and colony counts of Enterococcus organisms. With a combined sample processing and analysis time of less than 4 h, this method shows great promise as a tool for rapidly assessing potential exposures to waterborne pathogenic Candida species from drinking and recreational waters and may have applications in the detection of fecal pollution.
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Affiliation(s)
- Nichole E Brinkman
- National Exposure Research Laboratory, U.S. Environmental Protection Agency, 26 West Martin Luther King Drive, Cincinnati, OH 45268, USA
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40
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Panagopoulou P, Filioti J, Petrikkos G, Giakouppi P, Anatoliotaki M, Farmaki E, Kanta A, Apostolakou H, Avlami A, Samonis G, Roilides E. Environmental surveillance of filamentous fungi in three tertiary care hospitals in Greece. J Hosp Infect 2002; 52:185-91. [PMID: 12419271 DOI: 10.1053/jhin.2002.1298] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The environmental fungal load (FL) of three hospitals was studied in representative regions in Greece (Thessalonika, Northern Greece, Athens, Central Greece and Heraklion, Southern Greece). Air, surfaces and tap water from high-risk departments were sampled monthly during one year. Air FL was [median (range)] 10.6 (1.2-37), 5.5 (3-28.8) and 7.7 (3.1-12.1) cfu/m(3) at Thessalonika, Athens and Heraklion, respectively. Air FL was lower in winter and higher in summer and autumn but seldom above acceptable levels. Aspergillus spp. constituted 70.5% of the filamentous fungi isolated. Aspergillus niger was the most prevalent species in the air of all the hospitals followed by Aspergillus flavus and Aspergillus fumigatus. The least contaminated departments were the intensive care units, whilst most contaminated were the solid organ transplantation in Athens and haematology departments in Thessalonika. No correlation between fungal species, season, hospital or departments was observed. Sixty per cent of all surfaces examined yielded filamentous fungi and/or blastomycetes. While no fungi were recovered from water in Thessalonika and Athens, one-third of the samples in Heraklion (apart from those of ICU) yielded multiple fungal species. The higher air FL in Thessalonika and Athens was recorded in departments located close to renovation works. These findings suggest that the air and surface FL fluctuates over the year, is due to varying fungal species, but does not differ greatly among hospitals. The variation among hospitals, as well as the role of hospital water fungal contamination and appropriate measures to eliminate it, need further study.
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Affiliation(s)
- P Panagopoulou
- 3rd Department Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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41
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Gangneux JP, Bretagne S, Cordonnier C, Datry A, Derouin F, Grillot R, Kauffmann-Lacroix C, Lebeau B, Morin O, Nicolle MC, Piens MA, Poirot JL. Prevention of nosocomial fungal infection: the French approach. Clin Infect Dis 2002; 35:343-6. [PMID: 12115106 DOI: 10.1086/341318] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abbott KC, Hypolite I, Tveit DJ, Hshieh P, Cruess D, Agodoa LY. Hospitalizations for fungal infections after initiation of chronic dialysis in the United States. Nephron Clin Pract 2001; 89:426-32. [PMID: 11721161 DOI: 10.1159/000046115] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS Hospitalized fungal infections are reported frequently in renal transplant recipients and peritoneal dialysis patients, but the frequency of hospitalized fungal infections in dialysis patients has not been studied in a national population. METHODS 327,993 dialysis patients in the United States Renal Data System initiated from January 1, 1992 to June 30, 1997 were analyzed in a retrospective registry study of fungal infections (based on ICD9 Coding). RESULTS Dialysis patients had an age-adjusted incidence ratio for fungal infections of 9.80 (95% confidence interval (CI) 6.34-15.25)) compared to the general population in 1996 (the National Hospital Discharge Survey). Candidiasis accounted for 79% of all fungal infections, followed by cryptococcosis (6.0%) and coccidioidomycosis (4.1%). In multivariate analysis, fungal infections were associated with earlier year of dialysis, diabetes, female gender, decreased weight and serum creatinine at initiation of dialysis, chronic obstructive lung disease and AIDS. In Cox regression analysis the hazard ratio for mortality of fungal infections was 1.35 (95% CI 1.28-1.42). CONCLUSIONS Dialysis patients were at increased risk for fungal infections compared to the general population, which substantially decreased patient survival. Female and diabetic patients were at increased risk for fungal infections. Although candidiasis was the dominant etiology of fungal infections, the frequency of cryptococcosis and coccidioidomycosis were higher than previously reported.
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Affiliation(s)
- K C Abbott
- Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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Hajjeh RA, Warnock DW. Counterpoint: invasive aspergillosis and the environment--rethinking our approach to prevention. Clin Infect Dis 2001; 33:1549-52. [PMID: 11568854 DOI: 10.1086/322970] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2001] [Revised: 04/17/2001] [Indexed: 11/03/2022] Open
Abstract
Preventive measures are important in the control of invasive aspergillosis (IA) because diagnosis is difficult and the outcome of treatment is poor. If effective strategies are to be devised, it will be essential to have a clearer understanding of the sources and routes of transmission of Aspergillus species. Nosocomial outbreaks of IA highlight the fact that Aspergillus spores are common in the hospital environment. However, in general, such outbreaks are uncommon. Most cases of IA are sporadic in nature, and many of them are now being acquired outside of the hospital setting. Housing patients in high-energy particulate air-filtered hospital rooms helps prevent IA, but it is feasible and cost-effective only for the highest-risk groups and for limited periods. Control measures, which are designed to protect patients from exposure to spores outside the hospital, are even more difficult. Nevertheless, now that high-risk patients are spending more time outside of the hospital, the cost benefits of antifungal prophylaxis and other preventive measures require careful evaluation.
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Affiliation(s)
- R A Hajjeh
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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