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      A Guide to Investigating Suspected Outbreaks of Mucormycosis in Healthcare

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          Abstract

          This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control.

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          Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007.

          A Skiada, L. Pagano, A. Groll … (2011)
          Zygomycosis is an important emerging fungal infection, associated with high morbidity and mortality. The Working Group on Zygomycosis of the European Confederation of Medical Mycology (ECMM) prospectively collected cases of proven and probable zygomycosis in 13 European countries occurring between 2005 and 2007. Cases were recorded by a standardized case report form, entered into an electronic database and analysed descriptively and by logistic regression analysis. During the study period, 230 cases fulfilled pre-set criteria for eligibility. The median age of the patients was 50 years (range, 1 month to 87 years); 60% were men. Underlying conditions included haematological malignancies (44%), trauma (15%), haematopoietic stem cell transplantation (9%) and diabetes mellitus (9%). The most common manifestations of zygomycosis were pulmonary (30%), rhinocerebral (27%), soft tissue (26%) and disseminated disease (15%). Diagnosis was made by both histology and culture in 108 cases (44%). Among 172 cases with cultures, Rhizopus spp. (34%), Mucor spp. (19%) and Lichtheimia (formerly Absidia) spp. (19%) were most commonly identified. Thirty-nine per cent of patients received amphotericin B formulations, 7% posaconazole and 21% received both agents; 15% of patients received no antifungal therapy. Total mortality in the entire cohort was 47%. On multivariate analysis, factors associated with survival were trauma as an underlying condition (p 0.019), treatment with amphotericin B (p 0.006) and surgery (p <0.001); factors associated with death were higher age (p 0.005) and the administration of caspofungin prior to diagnosis (p 0.011). In conclusion, zygomycosis remains a highly lethal disease. Administration of amphotericin B and surgery, where feasible, significantly improve survival. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
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            Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients.

            Kieren A. Marr, Rachel Carter, Fulvio Crippa … (2002)
            Reports have focused on the emergence of moulds as pathogens in recipients of hematopoietic stem cell transplants. To review the incidence of and risks for mould infections, we examined the records of 5589 patients who underwent hematopoietic stem cell transplantation at the Fred Hutchinson Cancer Research Center (Seattle) from 1985 through 1999. After 1992, the incidence of invasive aspergillosis increased in allograft recipients and remained high through the 1990s. Infections with non-fumigatus Aspergillus species, Fusarium species, and Zygomycetes increased during the late 1990s, especially in patients who received multiple transplants. Although infection caused by Scedosporium species was common in patients who had neutropenia, infection caused by Zygomycetes typically occurred later after transplantation, when patients had graft-versus-host disease. The overall 1-year survival rate was equally poor (similar20%) for all patients with mould infections. The results of the present study demonstrate the changing epidemiology of mould infections, emphasizing the increasing importance of amphotericin B--resistant organisms and the differences in risks and outcome of infection with different filamentous fungi.
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              Estimation of direct healthcare costs of fungal diseases in the United States

              Kaitlin Benedict, Brendan R. Jackson, Tom Chiller … (2018)
              Fungal diseases range from relatively-minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of fungal diseases in the United States is challenging to quantify, because they are likely substantially underdiagnosed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Fungi (Basel)
                Journal ID (iso-abbrev): J Fungi (Basel)
                Journal ID (publisher-id): jof
                Title: Journal of Fungi
                Publisher: MDPI
                ISSN (Electronic): 2309-608X
                Publication date (Electronic): 24 July 2019
                Publication date Collection: September 2019
                Volume: 5
                Issue: 3
                Electronic Location Identifier: 69
                Affiliations
                [1 ]Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
                [2 ]Epidemic Intelligence Service, CDC, Atlanta, GA 30333, USA
                [3 ]Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, CDC, Atlanta, GA 30333, USA
                [4 ]Chicago Department of Public Health, Chicago, IL 60604, USA
                Author notes
                [* ]Correspondence: kbeer@ 123456cdc.gov
                Article
                Publisher ID: jof-05-00069
                DOI: 10.3390/jof5030069
                PMC ID: 6787571
                PubMed ID: 31344775
                SO-VID: a500eb47-1ab6-450b-86c3-ea42335b2e55
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 31 May 2019
                Date accepted : 17 July 2019
                Categories
                Subject: Review

                Keywords: mucormycosis,mucormycetes,mold,cluster,outbreak,infections,hospital,healthcare
                Data availability:
                Keywords: mucormycosis, mucormycetes, mold, cluster, outbreak, infections, hospital, healthcare

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