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Investigating fungal outbreaks in the 21st century.

Litvintseva AP, Brandt ME, Mody RK, Lockhart SR - PLoS Pathog. (2015)

View Article: PubMed Central - PubMed

Affiliation: Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

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Public attention has been drawn to recent high-profile outbreaks of mycotic diseases, such as those of fungal meningitis and other infections linked to contaminated steroids and an outbreak of necrotizing cutaneous mucormycosis linked to a tornado... In 2012, two medications produced by a single compounding pharmacy in Florida were contaminated with Fusarium sp. and Bipolaris sp., respectively, shipped to 15 states, and injected into the eyes of patients undergoing vitrectomies... As a result, 47 patients developed endophthalmitis, and most lost vision... For example, a recent cluster of Rhizopus delemar infections in a children’s hospital in New Orleans was linked to contaminated linens... This method has recently been applied to investigate several fungal outbreaks: (i) to confirm molecular identity of Coccidioides immitis from three organ recipients who shared the same donor, (ii) to investigate genetic relationships among isolates of E. rostratum from patients and contaminated methylprednisolone, (iii) to confirm genetic identity between isolates of C. immitis from soil in Washington state and a case patient with coccidioidomycosis acquired in that state, (iv) to demonstrate multiple origins of the rare mold A. trapeziformis in the tornado-associated cluster of necrotizing cutaneous mucormycosis, and (v) to demonstrate genetic identity among strains of Saprochaete clavata, a highly unusual fungal pathogen, associated with a multicenter outbreak in France... Conversely, genetically identical isolates of A. trapeziformis as well as isolates separated by thousands of SNPs were identified when WGST was used to investigate the etiology of necrotizing cutaneous mucormycosis, which was consistent with environmentally acquired infections... Although the results of WGST can significantly enhance epidemiological investigations, this method is still unacceptably slow for most real-time investigations... For example, WGST results for the Exserohilum outbreak were generated 6 months after the initial investigation was completed and therefore provided mostly confirmatory data... In order for WGST to become applicable for real-time investigations, time and cost of generating and analyzing WGST data need to be reduced... As vulnerable patient populations increase and exposure to pathogenic fungi continues, the number of fungal outbreaks is also likely to increase... We anticipate that novel molecular tools coupled with thorough epidemiological investigation will continue to assume greater importance in recognizing, stopping, understanding, and preventing fungal outbreaks in the future.

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CDC epidemiologists are collecting environmental samples in a histoplasmosis outbreak investigation.
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ppat.1004804.g001: CDC epidemiologists are collecting environmental samples in a histoplasmosis outbreak investigation.

Mentions: Descriptive epidemiology (i.e., detailed assessment of patients’ demographic characteristics, clinical histories, and the geographic and temporal distribution of cases) is essential for generating hypotheses about the potential source of infection. For example, cases occurring over several weeks to months and scattered geographically suggest a common source outbreak that involves a widely distributed product, especially when case patients have undergone similar medical treatments [1,3]. Conversely, cases occurring among persons with exposure to a common location suggest environmental transmission. Specifically, environmental transmission may be likely among patients with invasive mold infections cared for in the same hospital [4,9,10] or among people with dimorphic fungal infections who participated together in outdoor activities [6,8]. Hypotheses generated through descriptive epidemiology can be tested through analytical epidemiological studies and by microbiological testing of suspected sources (Fig 1).


Investigating fungal outbreaks in the 21st century.

Litvintseva AP, Brandt ME, Mody RK, Lockhart SR - PLoS Pathog. (2015)

CDC epidemiologists are collecting environmental samples in a histoplasmosis outbreak investigation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440772&req=5

ppat.1004804.g001: CDC epidemiologists are collecting environmental samples in a histoplasmosis outbreak investigation.
Mentions: Descriptive epidemiology (i.e., detailed assessment of patients’ demographic characteristics, clinical histories, and the geographic and temporal distribution of cases) is essential for generating hypotheses about the potential source of infection. For example, cases occurring over several weeks to months and scattered geographically suggest a common source outbreak that involves a widely distributed product, especially when case patients have undergone similar medical treatments [1,3]. Conversely, cases occurring among persons with exposure to a common location suggest environmental transmission. Specifically, environmental transmission may be likely among patients with invasive mold infections cared for in the same hospital [4,9,10] or among people with dimorphic fungal infections who participated together in outdoor activities [6,8]. Hypotheses generated through descriptive epidemiology can be tested through analytical epidemiological studies and by microbiological testing of suspected sources (Fig 1).

View Article: PubMed Central - PubMed

Affiliation: Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Public attention has been drawn to recent high-profile outbreaks of mycotic diseases, such as those of fungal meningitis and other infections linked to contaminated steroids and an outbreak of necrotizing cutaneous mucormycosis linked to a tornado... In 2012, two medications produced by a single compounding pharmacy in Florida were contaminated with Fusarium sp. and Bipolaris sp., respectively, shipped to 15 states, and injected into the eyes of patients undergoing vitrectomies... As a result, 47 patients developed endophthalmitis, and most lost vision... For example, a recent cluster of Rhizopus delemar infections in a children’s hospital in New Orleans was linked to contaminated linens... This method has recently been applied to investigate several fungal outbreaks: (i) to confirm molecular identity of Coccidioides immitis from three organ recipients who shared the same donor, (ii) to investigate genetic relationships among isolates of E. rostratum from patients and contaminated methylprednisolone, (iii) to confirm genetic identity between isolates of C. immitis from soil in Washington state and a case patient with coccidioidomycosis acquired in that state, (iv) to demonstrate multiple origins of the rare mold A. trapeziformis in the tornado-associated cluster of necrotizing cutaneous mucormycosis, and (v) to demonstrate genetic identity among strains of Saprochaete clavata, a highly unusual fungal pathogen, associated with a multicenter outbreak in France... Conversely, genetically identical isolates of A. trapeziformis as well as isolates separated by thousands of SNPs were identified when WGST was used to investigate the etiology of necrotizing cutaneous mucormycosis, which was consistent with environmentally acquired infections... Although the results of WGST can significantly enhance epidemiological investigations, this method is still unacceptably slow for most real-time investigations... For example, WGST results for the Exserohilum outbreak were generated 6 months after the initial investigation was completed and therefore provided mostly confirmatory data... In order for WGST to become applicable for real-time investigations, time and cost of generating and analyzing WGST data need to be reduced... As vulnerable patient populations increase and exposure to pathogenic fungi continues, the number of fungal outbreaks is also likely to increase... We anticipate that novel molecular tools coupled with thorough epidemiological investigation will continue to assume greater importance in recognizing, stopping, understanding, and preventing fungal outbreaks in the future.

No MeSH data available.


Related in: MedlinePlus