Outbreak of invasive wound mucormycosis in a burn unit due to multiple strains of <i>Mucor circinelloides</i> f. <i>circinelloides</i> resolved by whole genome sequencing

García-Hermoso, Dea; Criscuolo, Alexis; Lee, Soo Chan; Legrand, Matthieu; Chaouat, Marc; Denis, Blandine; Lafaurie, Matthieu; Rouveau, M.; Soler, C.; Schaal, Jean-Vivien; Mimoun, Maurice; Mebazaa, Alexandre; Heitman, Joseph; Dromer, Françoise; Brisse, Sylvain; Bretagne, Stéphane; Alanio, Alexandre

doi:10.1101/233049

Cited by 5 publications

(5 citation statements)

References 48 publications

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“…1,2 In addition to Candida and Aspergillus species as the most common aetiologic agents of nosocomial fungal infections, Candida auris played a significant role in several large outbreaks in different continents. [3][4][5] There is an extensive and expanding list of fungi that have been reported causing healthcare-associated infections, including Pneumocytis jirovecii, 6 Mucor circinelloides, 7 Saprochaete clavata, 8 Exophiala jeanselmei, 9 Sarocladium kiliense 10 and Exserohilum rostratum. 11 Multi-drug resistant yeasts including Candida blankii, 12 Dirkmeia churashimaensis 13 and Candida parapsilosis 14 have also caused outbreaks in intensive care units.…”

Section: Introductionmentioning

confidence: 99%

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

Abdolrasouli

Gibani

Groot

et al. 2020

Mycoses

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Outbreaks of fungal infections due to emerging and rare species are increasingly reported in healthcare settings. We investigated a pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, UK. We aimed to determine route of healthcare‐associated transmission and prevent additional infections. From July 2018 through February 2019, we detected a pseudo‐outbreak of R. similis isolated from bronchoalveolar lavage (BAL) fluid samples collected from nine patients who had undergone bronchoscopy in a multispecialty teaching hospital, during a period of 8 months. Isolates were identified by MALDI‐TOF mass spectrometry. Antifungal susceptibility testing was performed by EUCAST broth microdilution. To determine genetic relatedness among R. similis isolates, we undertook amplified fragment length polymorphism analysis. To determine the potential source of contamination, an epidemiological investigation was carried out. We reviewed patient records retrospectively and audited steps taken during bronchoscopy as well as the subsequent cleaning and decontamination procedures. Fungal cultures were performed on samples collected from bronchoscopes and automated endoscope washer‐disinfector systems. No patient was found to have an infection due to R. similis either before or after bronchoscopy. One bronchoscope was identified to be used among all affected patients with positive fungal cultures. Physical damage was found in the index bronchoscope; however, no fungus was recovered after sampling of the affected scope or the rinse water of automated endoscope washer‐disinfectors. Use of the scope was halted, and, during the following 12‐month period, Rhinocladiella species were not isolated from any BAL specimen. All pseudo‐outbreak isolates were identified as R. similis with high genetic relatedness (>90% similarity) on ALFP analysis. The study emphasises the emergence of a rare and uncommon black yeast R. similis, with reduced susceptibility to echinocandins, in a bronchoscope‐related pseudo‐outbreak with a potential water‐related reservoir. Our findings highlight the importance of prolonged fungal culture and species‐level identification of melanised yeasts isolated from bronchoscopy samples. Possibility of healthcare‐associated transmission should be considered when R. similis is involved in clinical microbiology samples.

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Section: Introductionmentioning

confidence: 99%

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

Abdolrasouli

Gibani

Groot

et al. 2020

Mycoses

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“…Pathogenic fungi are known to spread rapidly worldwide facilitating fast evolution by introgressive hybridization and intragenic recombination amongst lineages in the plant pathogenic ascomycete Fusarium graminearum (O'Donnell et al, 2000). Equally rapidly spreading pathogenicity patterns but in the clinical environment were reported in Mucor circinelloides, one of the major causative agents of mucormycosis (Lee et al, 2014, Garcia-Hermoso et al, 2018. To date, similar studies on the global phylogeographic structure of Lichtheimia are non-existent, although such genetic data are mandatory for preventing the inadvertent intercontinental distribution of highly virulent isolates towards a proper disease management to control outbreaks at a global scale.…”

Section: Discussionmentioning

confidence: 99%

The geographical region of origin determines the phagocytic vulnerability of Lichtheimia strains

Hassan

Cseresnyés

Al-Zaben

et al. 2019

Environmental Microbiology

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Summary Mucormycoses are life‐threatening infections that affect patients suffering from immune deficiencies. We performed phagocytosis assays confronting various strains of Lichtheimia species with alveolar macrophages, which form the first line of defence of the innate immune system. To investigate 17 strains from four different continents in a comparative fashion, transmitted light and confocal fluorescence microscopy was applied in combination with automated image analysis. This interdisciplinary approach enabled the objective and quantitative processing of the big volume of image data. Applying machine‐learning supported methods, a spontaneous clustering of the strains was revealed in the space of phagocytic measures. This clustering was not driven by measures of fungal morphology but rather by the geographical origin of the fungal strains. Our study illustrates the crucial contribution of machine‐learning supported automated image analysis to the qualitative discovery and quantitative comparison of major factors affecting host–pathogen interactions. We found that the phagocytic vulnerability of Lichtheimia species depends on their geographical origin, where strains within each geographic region behaved similarly, but strongly differed amongst the regions. Based on this clustering, we were able to also classify clinical isolates with regard to their potential geographical origin.

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“…Besides the ongoing need for large multi-center evaluation studies and standardization, there are also technical developments and improvements in molecular diagnostics. Costs for whole genome sequencing are currently dropping, allowing intensified usage in applied and basic clinical research [ 69 , 70 , 71 , 72 ] as well as outbreak management. For example, Garcia-Hermoso et al, (2018) demonstrated that an outbreak of Mucor circinelloides in a burn unit of a French hospital was caused by cross-transmissions between patients as well as contaminations with a heterogeneous pool of strains from an unknown environmental reservoir [ 72 ].…”

Section: Dna-based Diagnosismentioning

confidence: 99%

Microbiological and Molecular Diagnosis of Mucormycosis: From Old to New

2021

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Members of the order Mucorales may cause severe invasive fungal infections (mucormycosis) in immune-compromised and otherwise ill patients. Diagnosis of Mucorales infections and discrimination from other filamentous fungi are crucial for correct management. Here, we present an overview of current state-of-the-art mucormycosis diagnoses, with a focus on recent developments in the molecular field. Classical diagnostic methods comprise histology/microscopy as well as culture and are still the gold standard. Newer molecular methods are evolving quickly and display great potential in early diagnosis, although standardization is still missing. Among them, quantitative PCR assays with or without melt curve analysis are most widely used to detect fungal DNA in clinical samples. Depending on the respective assay, sequencing of the resulting PCR product can be necessary for genus or even species identification. Further, DNA-based methods include microarrays and PCR-ESI-MS. However, general laboratory standards are still in development, meaning that molecular methods are currently limited to add-on analytics to culture and microscopy.

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Outbreak of invasive wound mucormycosis in a burn unit due to multiple strains of Mucor circinelloides f. circinelloides resolved by whole genome sequencing

Cited by 5 publications

References 48 publications

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

A pseudo‐outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom

The geographical region of origin determines the phagocytic vulnerability of Lichtheimia strains

Microbiological and Molecular Diagnosis of Mucormycosis: From Old to New

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