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We previously have demonstrated that the hospital water-distribution system could be a reservoir for airborne molds that leads to secondary aerosolization of these molds in patient shower facilities. In this report, we show that cleaning the floors of patient shower facilities in a bone marrow transplantation unit reduced the mean air concentrations of molds, including Aspergillus species (from 12 cfu/m3 to 4 cfu/m3; P=.0047).

Nosocomial aspergillosis, a life-threatening infection in immunocompromised patients, is thought to be caused primarily by Aspergillus organisms in the air. A 3-year prospective study of the air, environmental surfaces, and water distribution system of a hospital in which there were known cases of aspergillosis was conducted to determine other possible sources of infection. Aspergillus species were found in the hospital water system. Significantly higher concentrations of airborne aspergillus propagules were found in bathrooms, where water use was highest (2.95 colony-forming units [cfu]/m(3)) than in patient rooms (0.78 cfu/m(3); P=.05) and in hallways (0.61 cfu/m(3); P=.03). A correlation was found between the rank orders of Aspergillus species recovered from hospital water and air. Water from tanks yielded higher counts of colony-forming units than did municipal water. An isolate of Aspergillus fumigatus recovered from a patient with aspergillosis was genotypically identical to an isolate recovered from the shower wall in the patient's room. In addition to the air, hospital water systems may be a source of nosocomial aspergillosis.

Summary: Objectives: The study investigated the epidemiology and outcome of invasive aspergillosis (IA), an important cause of morbidity and mortality in immunocompromised patients. Methods: Cases of proven/probable IA from the Prospective Antifungal Therapy Alliance (PATH Alliance®) registry – a prospective surveillance network comprising 25 centers in the United States and Canada that collected data on invasive fungal infections from 2004 to 2008 – were analyzed with respect to clinical outcome. Results: Nine hundred and sixty patients with IA were enrolled, the most frequent underlying disease being hematologic malignancy (n =464 [48.3%]). Two hundred and eighty patients (29.2%) received solid organ transplant; 268 patients (27.9%) underwent hematopoietic stem cell transplantation. Identified isolates included Aspergillus fumigatus (72.6%), Aspergillus flavus (9.9%), Aspergillus niger (8.7%) and Aspergillus terreus (4.3%). The lung was most frequently affected. Following diagnosis, 47% patients received monotherapy – voriconazole (70%), an amphotericin B formulation (13.8%), or an echinocandin (10.5%) – while 279 patients (29%) received combination therapy. Twelve-week overall survival was 64.4%. Conclusions: In this series of patients with IA, the lung was the predominant focus of infection, A. fumigatus was the major species isolated, and overall survival appeared slightly improved compared with previous reports. [ABSTRACT FROM AUTHOR]

The article discusses a study concerning the immune reconstitution inflammatory syndrome (IRIS) in cancer patients with pulmonary aspergillosis recovering from neutropenia. Under the study, galactomannan, an Aspergillus-specific polysaccharide released during aspergillosis, was used to determine IRIS responses from progressive aspergillosis. Results show that deterioration corresponded with microbiologic response. It concludes that declining galactomannan values suggest IRIS with an aspergillus response.