Abstract
BackgroundInvasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. The role of season and climatic conditions in case clustering of IMI remain poorly understood.MethodsFollowing detection of a cluster of sinopulmonary IMIs in patients with hematologic malignancies, we reviewed center-based medical records of all patients with IMIs and other invasive fungal infections (IFIs) between January of 2012 and August of 2015 to assess for case clustering in relation to seasonality.ResultsA cluster of 7 patients were identified with sinopulmonary IMIs (Rhizopus microsporus/azygosporus, 6; Rhizomucor pusillus, 1) during a 3 month period between June and August of 2014. All patients died or were discharged to hospice. The cluster was managed with institution of standardized posaconazole prophylaxis to high-risk patients and patient use of N-95 masks when outside of protected areas on the inpatient service. Review of an earlier study period identified 11 patients with IMIs of varying species over the preceding 29 months without evidence of clustering. There were 9 total IMIs in the later study period (12 month post-initial cluster) with 5 additional cases in the summer months, again suggesting seasonal clustering. Extensive environmental sampling did not reveal a source of mold. Using local climatological data abstracted from National Centers for Environmental Information the clusters appeared to be associated with high temperatures and low precipitation.ConclusionsSinopulmonary Mucorales clusters at our center had a seasonal variation which appeared to be related to temperature and precipitation. Given the significant mortality associated with IMIs, local climatic conditions may need to be considered when considering center specific fungal prevention and prophylaxis strategies for high-risk patients.
Highlights
Invasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts
The patient with multiple myeloma had a history of autologous hematopoietic cell transplant (HCT); no other HCT recipients were identified within this cluster of IMIs
A total of 7402 hematology/oncology patients were admitted over this period, of whom 11 patients had IMIs classified as proven, probable or possible with a positive Polymerase chain reaction (PCR) within the University of Washington Medical Center (UWMC) system
Summary
Invasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. First we review a cluster of Mucorales sinopulmonary infections that occurred in summer of 2014 in patients with HM, and report steps implemented to limit the development of additional cases. We retrospectively reviewed other IMIs in the 2 years prior to this cluster to assess overall infection rate among these high-risk patients and their association with climatic changes. We compared these data to patients in the subsequent year that included a time period during which the cluster occurred and report an additional, separate cluster of IMI cases that occurred during the summer of that year. We hypothesized that seasonal variation of Mucorales infections, during the elevated temperatures and limited precipitation of summer months, were associated with these clusters
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