Invasive aspergillosis: epidemiology and environmental study in haematology patients (Sfax, Tunisia)

Abstract

Invasive aspergillosis (IA) is a major opportunistic infection in haematology patients. Preventive measures are important to control IA because diagnosis is difficult and the outcome of treatment is poor. We prospectively examined the environmental contamination by Aspergillus and other fungal species and evaluated the prevalence of invasive aspergillosis in the protect unit of haematology. A three-year prospective study (December 2004-September 2007) was carried out in the department of haematology of Hedi Chaker Hospital. Suspected invasive aspergillosis cases were reviewed and classified as proven, probable and possible invasive aspergillosis using the EORTC criteria. During the study period, we collected weekly environmental samples (patient's rooms, tables and acclimatisers) and clinical samples from each patient (nasal, expectoration and auricular). Among 105 neutropenic patients, 16 had probable and 13 had possible IA. A total of 1680 clinical samples were collected and A. flavus was most frequently isolated (79.2%). Analysis of 690 environmental samples revealed that Penicillium (44%) was the most frequent followed by Cladosporium (20%), Aspergillus spp. (18%) and Alternaria (13%). The PCR-sequencing of 30 A. flavus isolates detected from clinical and environmental samples confirmed the mycological identification. Our findings underline the importance of environmental surveillance and strict application of preventive measures.

Microsatellite Typing To Trace Aspergillus flavus Infections in a Hematology Unit

“…The characteristics of the 48 isolates collected from 14 patients with proven and probable invasive aspergillosis hospitalized in the hematology ward of the Hedi Cheker Hospital in Sfax, Tunisia, and their environment over a period of 3 years (2004 to 2007) are summarized in Table 1. This study design has been described elsewhere (12). Briefly, A. flavus infections were diagnosed in high-risk patients hospitalized in one hematology ward where neither high-efficiency particulate air filtration nor an aspergillosis prophylaxis policy was implemented.…”

“…In particular, Aspergillus flavus has been described to be an emerging species second only to the A. fumigatus pathogenic Aspergillus species (17). Furthermore, A. flavus has been described as the main etiological agent of human aspergillosis in Saudi Arabia and in Tunisia, Sudan, and other African countries (10,12). Three molecular methods have been proposed for A. flavus typing: restriction fragment length polymorphism (15,19), randomly amplified polymorphic DNA (20), and random amplified microsatellite polymorphism analysis (11).…”

Aspergilosis invasiva pulmonar: reporte de un caso

“…En una revisión bibliográfica en pacientes con afecciones hematológicas, también se encontró que A. flavus era el agente más frecuente (79,2 %) (9). Las manifestaciones clínicas pulmonares de la infección por este agente, no difieren de las que se presentan con A. fumigatus (7,10).…”

“…En pacientes con leucemia, el riesgo se incrementa en 1 % al día durante las primeras tres semanas y en 4 % al día durante los días siguientes (10,14). La prevalencia de aspergilosis pulmonar invasiva en pacientes con anemia aplásica se encuentra entre 25 y 55 % (9,14). Del mismo modo, cualquier paciente con enfermedad hematológica que curse con neutropenia, tiene mayor riesgo de contraer la enfermedad.…”

Microsatellite typing of Aspergillus flavus from clinical and environmental avian isolates

“…A. flavus can also cause avian infections (Barton et al, 1992;Knudtson & Meinecke, 1972;Okoye et al, 1989;Richard & Thurston, 1983). In fact, A. flavus is the predominant aetiological agent of human invasive aspergillosis in Sfax, Tunisia (Hadrich et al, 2010b). However, the potential health problems in turkeys should not be underestimated, because A. flavus is a toxigenic species.…”