An outbreak of invasive fusariosis in a children’s cancer hospital

Abstract

Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 μm were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-μm filters in all tap faucets and showers.

Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

“…These factors may be related to the disease itself (disease duration, lymphopenia, leukopenia, neutropenia, disease activity, functional asplenia, and primary immunodeficiencies) and its treatment (glucocorticoid and immunosuppressant agents). 13,15,16,18,23,24 Endocrinology, Nephrology, Renal Transplantation, Pediatric Surgery, and Liver Transplantation were also frequent subspecialties in patients followed by more than three concomitant specialties. This fact results from a specific situation of our tertiary hospital, which is a reference center for the most common and severe endocrine, kidney, liver, and congenital diseases in Brazil.…”

“…29 Pediatric care systems and multidisciplinary health teams should develop evidence-based solutions to the challenges of caring for and treating PCD patients with a medically complex disease. 23 Strategies should be devised focusing on reducing hospital admission rates, thus improving hospital care for these patients.…”

Importance of Fungal Histopathology in Immunocompromised Pediatric Patients

“…IFIs are associated with high morbidity and mortality in immunocompromised pediatric patients. [2][3][4] Thus, rapid and accurate laboratory diagnosis is of the utmost importance. 5,6 This is one of few reports of histologic examination in pediatric immunocompromised patients, and the results of this study emphasize the important diagnostic role of histology in providing clinically actionable information.…”

A Clonal Lineage of Fusarium oxysporum Circulates in the Tap Water of Different French Hospitals

“…Fusaria in water may be aerosolized into the air when the water passes through taps and showers and then inhaled by immunocompromised patients (14). In two previous studies, we detected F. oxysporum in the water distribution systems of different French hospitals, with high concentrations of up to 10 5 propagules liter Ϫ1 in some units (19,20). Heterogeneous distributions according to building and variability over time were explained by episodic detachments of parts of colonies from biofilms in the pipes.…”

“…can also cause life-threatening disseminated infections in immunocompromised patients (3). The Fusarium species most often involved are the morphological species Fusarium solani and Fusarium oxysporum (4,5). These morphological species are now recognized as species complexes due to their high level of phylogenetic diversity (6,7).…”