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Open Access Research article

Molecular analyses of Fusarium isolates recovered from a cluster of invasive mold infections in a Brazilian hospital

Christina M Scheel1*, Steven F Hurst1, Gloria Barreiros2, Tiyomi Akiti2, Marcio Nucci2 and S Arunmozhi Balajee3

  • * Corresponding author: Christina M Scheel zsr3@cdc.gov

  • † Equal contributors

Author Affiliations

1 Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

2 University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

3 Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

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BMC Infectious Diseases 2013, 13:49  doi:10.1186/1471-2334-13-49

Published: 30 January 2013

Abstract

Background

Invasive fusariosis (IF) is a rare but often fatal fungal infection in immunosuppressed patients. In 2007, cases of IF above the expected epidemiologic baseline were detected in the hematology ward of a hospital in Rio de Janeiro, Brazil. Possible sources of infection were investigated by performing environmental sampling and patient isolate collection, followed by molecular typing. Isolates from dermatology patients with superficial fusariosis were included in the study for comparison to molecular types found in the community.

Methods

Environmental sampling focused on water-related sources in and around the hematology ward. Initially, we characterized 166 clinical and environmental isolates using the Fusarium translation elongation factor 1α (EF-1α) genetic locus. Isolates included 68 collected from water-related sources in the hospital environment, 55 from 18 hematology patients, and 43 from the skin/nails of 40 outpatients seen at the hospital dermatology clinic. Multi-locus sequence typing was performed on Fusarium solani species complex (FSSC) species 1 and 2 isolates to investigate their relatedness further.

Results

Most of the hematology samples were FSSC species 2, with species type FSSC 2-d the most commonly isolated from these patients. Most of the outpatient dermatology samples were also FSSC 2, with type 2-d again predominating. In contrast, environmental isolates from water sources were mostly Fusarium oxysporum species complex (FOSC) and those from air samples mostly Fusarium incarnatum-equiseti species complex (FIESC). A third of the environmental samples were FSSC, with species types FSSC 1-a and FSSC 1-b predominating.

Conclusions

Fusarium isolate species types from hematology patient infections were highly similar to those recovered from dermatology patients in the community. Four species types (FSSC 1-a, 1-b, 2-d and 2-f) were shared between hematology patients and the environment. Limitations in environmental sampling do not allow for nosocomial sources of infection to be ruled out. Future studies will focus on environmental factors that may have influenced the prevalence of FSSC fusariosis in this hematology ward.

Keywords:
Fusarium; Invasive fusariosis; Molecular epidemiology; Multi-locus sequence typing; Invasive fungal infection; Bone marrow transplant; Hospital-associated infection; Community acquired disease; Brazil