[What should we know about Aspergillus?]

[Prevention of nosocomial infection of fungal origin: verification of the environmental biosafety in surgery rooms]

The biodiversity and concentration of environmental fungi in the hospital surgical area was monitored for 36 months. A total of 120 measures were made, 70% of which had fungal growth, a single genus being identified in 62%. Nine different genus were isolated (Penicillium, Aspergillus, Acremonium, Dactylaria, Fusarium, Cladophialophora, Alternaria, Candida and Rodothorula) with a clear predominance of Cladophialophora. Aspects that still must be resolved are discussed. These are: periodicity of the sample obtention, definition of the area of risk, interpretation of the counts and species considered pathogenic. At present, in spite of the large gaps in knowledge, the maintenance of continuous registry system of the environmental biosafety levels is fundamental, since the cause cannot be identified in most of the times when elevated fungal count is detected.

Aspergilosis pulmonar. Papel de los corticoides como factor de riesgo asociado en el bronquítico crónico

BASIS

Description of a situation of incidence increase of bronchial secretions with positive cultures for Aspergillus fumigatus, and analysis of the related risk factors in the invasive aspergillosis.

METHODS

Between January 1999 and February 2000, a prospective study of the patients was conducted with culture of bronchial secretions and with positive result for A. fumigatus.

VARIABLES STUDIED

age, sex, primary diagnosis, type of cultivated sample, clinical interpretation (colonization/infection), probable source (community/nosocomial), situation of the patient after discharge, and risk factors for opportunistic infection. The results were compared among the colonized and infected patients.

RESULTS

Fifty-two patients showed positive cultures of bronchial secretions to A. fumigatus, 43 (82.6%) colonized and 9 (17.3%) infected. Cultivated sputum sample on 30 occasions (57.6%) and bronchial aspiration in 22 (42.3%). Median age: 70 years (31-84). Sex: 40 men (76.9%). Probable source of infection/colonization: nosocomial in 18 cases (34.6%), community in 3 (5.7%) and unknown in 31 (59.6%). Mortality: 15 patient colonized (34.8%) and 8 infected (88.8%). Risk factors with statistical significance for invasive infection by A. fumigatus: diagnosis of chronic bronchopathy (COPD) (p=0.007) and treatment with prednisone in dose higher than 60 mg/day (p=0.0005).

CONCLUSIONS

The patients with positive culture of bronchial secretions to A. fumigatus with COPD and treatment with prednisone in dose higher than 60 mg/day should be considered with a greater risk for infection by this pathogen. A more restricted use and adequate of the corticoids in these patients, and an early diagnosis and treatment in light of the suspicion of infection by A. fumigatus in patients with COPD, it could imply a reduction of morbidity and mortality.