Summary In this study, researchers document a phenomenon that occurred in a hospital renal unit regarding the airborne spores of Aspergillus fumigatus. They postulated the spores were released into the ventilation of the unit from nearby construction efforts in the building. Inhalation of the species of the spores into the lungs of immunodepressed people can cause severe lung infections that lead to death. Two patients died as a result of the outbreak, and one was barely saved with invasive doses of liposomal amphotericin B.
The first fatality was that of an 85-year-old female who had been admitted was admitted to the hospital in January 1995 for complications associated with chronic renal failure due to nephrosclerosis. Once the infection was discovered in her lungs, the patient’s condition declined rapidly despite antibiotic regimen. A postmortem exam revealed Aspergillus hyphae in both sides of the lungs.
The next fatality was that of a 49-year-old female suffering with Wegener granulomatosis who was admitted in February 1995 for cough and fever. Once the infection was discovered in her lungs, the patient’s condition declined rapidly even though immunosuppressive treatments were reduced and antituberculotic therapy instituted. A postmortem exam revealed the Aspergillus infection had spread through the lungs to the heart and into the brain.
The near-fatality was that of a 65-year-old male admitted in February 1995 with chronic renal failure due to renal vascular disease for severe malnutrition. The infection was never discovered in the patient’s septum but his condition improved with liposomal amphotericin therapy. The patient achieved nearly complete regression in 10 weeks.
The study shows certain strengths. The investigators admit the findings are inconclusive especially since they did not test air. They warn that hospital construction or renovation work near immunodepressed patients should alert physicians to the possible presence of A. fumigatus.
Likewise, the study showed certain weaknesses. The final case was presumptive. Cultures of sputum never revealed a presence of A. fumigatus. It did not suggest ways to prevent infiltration into ventilation systems, and it did not suggest methods for clearing air once infiltration has occurred.
Nevertheless, we are left with certain questions. How quickly does in spread from the lungs to the central nervous system What effect does gender have on its aggressiveness It is a recommendation for future study that immunodeficient rats be given controlled exposure to Aspergillus infections to develop ways of preventing it altogether or stopping it as progresses into the body.
Sessa A, Meroni M, Battini G, Pitingolo F, Giordano F, Marks M, Casella P. (1996) Nosocomial outbreak of Aspergillus fumigatus infection among patients in a renal unit Nephrol Dial Transplant 11(7):1322-4.