Invasive pulmonary aspergillosis in immunocompetent patients acquired during renovation in a chest institute

Abstract

Background: Invasive aspergillosis (IA) is now recognized in immunocompetent patients too with outbreaks known to occur in hospitals during civil work Aims: To identify characteristics and outcomes of patients who developed IA and correlate aerial spore counts and molecular types of Aspergillus isolates with possible role of civil work in nosocomial infection Methods: Patients diagnosed in 2010-16 were enrolled. Clinical data and outcome were noted. Those with nosocomial infection, defined as IA diagnosed 2days after admission served as cases. Annual incidence of IA and spore counts were calculated. Environmental and clinical Aspergillus isolates were characterized by microsatellite typing (STR) to determine possible source of infection Results: IA was observed in 50cases. Civil work was done in 2011,2014-16. Incidence of IA correlated with greater spore counts (r=0.942). COPD was commonest risk factor. None were immunocompromised. Further, 77% of those admitted required ICU care. Cases stayed longer in wards than controls(12.4±9.4vs0.8±0.8days, p=0.000) before diagnosing IA and received therapy later(7.8±7.8vs3.3±3.5days, p=0.011). 64.4% patients succumbed to IA. Both groups were similar in terms of age, sex, risk factors, serology, radiology, treatment outcomes Although no environmental A. Fumigatus isolate shared the same STR type as patient isolates, similar STR types were observed among patients suggesting common source of infection Conclusion: Civil work in augments Aspergillus spore count, increasing the incidence of IA in admitted immunocompetent patients with prolonged fungal exposure. No difference is seen in the natural history of IA with respect to source of infection.