Alternaria species are the 2nd cause of invasive fungal infections among oncohematological patients at one institution: possible role of high environmental exposure.
Introduction: During the last decades, the prevalence of candidiasis has been decreasing and molds have become the major cause of IFI among immunocompromissed patients. While Aspergillus spp. are the most prevalent opportunistic molds, Fusarium spp, Zygomycetes, and Scedosporium spp, are also frequently reported. In our institution, Alternaria spp. are the second fungal pathogen following Aspergillus spp. Since Alternaria spp. have not been reported with such a high prevalence, we decided to conduct an investigation. Objective: To analyze the clinical characteristics of patients with invasive alternariosis and to evaluate the prevalence of Alternaria spp. in the hospital air. Material and methods: From 3/97 to 2/03, the charts of patients with probable or documented alternariosis were reviewed. Demographic and clinical data was obtained from each case. In the spring of 2004, the hospital air was studied for detection of fungi by using two methods: sedimentation plate (SP) and a portable volumetric method (SAS super 90Â®, pbi, Milan, Italy). (PVM). Sampling was done simultaneously with the 2 methods in 44 indoor and 5 outdoor sites, 3 /day. Results: Patients: Nine patients with alternariosis were found. The mean age was 48 , and 6/9 were males. The underlying diseases were non Hodgkin lymphoma (3), acute (2) and chronic myeloid leukemia (2), acute lymphoblastic leucemia (1) and multiple myeloma (1). Five patients had relapsed disease, 8 patients were neutropenic (ANC <500/uL) and 3 had received prophylaxis with azoles at the time of the fungal infection. Among 7 patients, the mean hospital stay prior to alternariosis was 16 days (0-35). The site most commonly involved was the respiratory tract (pneumonia, sinusitis or nasal invasion) (5), followed by disseminated disease (skin lesions + pneumonia or sinusitis; bone marrow culture positive + empyema) (4). Eight patients were treated with Amphotericin B. 3 of 8 were switched to oral Itraconazol. At this time, 7/9 (80%) patients died. In 3/7 (43%), the alternariosis could have contributed to the patientâ€™s death. Air sampling: 297 air simples were obtained, 146 by SP and 147 by PVM. 4,453 of 5,239 UFC, (85%) could be identified at this time. The mean UFC/m3 of air in hospital rooms was 91 (5-267), in bathrooms 63 (3-283), and in common areas 112 (8-450). Outside air had a mean of CFU/m3 of 259 (217-298). Genero distribution is shown in the table. Conclusions: Alternaria spp. are the 2nd cause of opportunistic IFI among our oncohematological patients, and is associated with a high mortality. The high prevalence of these fungi in the outside and in the hospital air could explain this finding. Although hospital reservoirs of Alternaria spp. may exist, a geographical factor cannot be ruled out.
Full conference title:
15th Annual Focus on Fungal Infections