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Prepublished online as a Blood First Edition Paper on December 5, 2002; DOI 10.1182/blood-2002-02-0530.
Submitted May 2, 2002
Accepted November 22, 2002
Pathogenic moulds (including Aspergillus spp.) in hospital water distribution systems: A three-year prospective study and clinical implications for patients with hematological malignancies
Elias J Anaissie*, Shawna L Stratton, Cecilia Dignani, Choon-Kee Lee, Richard C Summerbell, John H Rex, Thomas P Monson, and Thomas J Walsh
Myeloma Institute for Research and Treatment, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Centraalbureau voor Schimmelcultures, Baarn, The Netherlands
Center for Infectious Diseases, University of Texas Medical School, Houston, TX, USA
Memorial Veterans Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Immunocompromised Host Section, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
* Corresponding author; email: elias114{at}aol.com.
The incidence of mould infections in patients with hematological malignancies continues to increase despite the widespread use of air filtration systems, suggesting the presence of other hospital sources for these moulds. Water sources are known to harbor pathogenic moulds. We examined samples from water, water surfaces, air, and other environment sources from a bone marrow transplantation unit with optimal air precautions. Moulds (Aspergillus spp, others) were recovered in 70% of 398 water samples, in 22% of 1,311 swabs from plumbing structures and environmental surfaces, and in 83% of 274 indoor air samples. Microscopic examination of the water plumbing lines revealed hyphal forms compatible with moulds. Four findings suggest that indoor airborne moulds were aerosolized from the water 1) higher mean airborne concentrations of moulds in bathrooms (16.1 CFU/m3) than in patient rooms (7 CFU/m3) and hallways (8.6 CFU/m3) (p= 0.00005); 2) a strong type and rank correlation between moulds isolated from hospital water and those recovered from indoor hospital; 3) lack of seasonal correlation between the airborne mould concentration in outdoor and indoor air; and 4) molecular relatedness between a clinical strain and a water-related strain (previously reported). Hospital water distribution systems may serve as a potential indoor reservoir of Aspergillus and other moulds leading to aerosolization of fungal spores and potential patient exposure.
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