Instituto de Tratamento de Cancer Infantil (ITACI), Children's Institute, Hospital das Clínicas, University of São Paulo, Brazil; Department of Pediatrics, University of São Paulo, Brazil.
Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, Brazil.
Clin Microbiol Infect. 2015 Mar;21(3):268.e1-7. doi: 10.1016/j.cmi.2014.09.004. Epub 2014 Oct 12.
Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 μm were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-μm filters in all tap faucets and showers.
镰刀菌被认为是一种新兴的病原体，儿童中镰刀菌病的报道很少。本研究的目的是描述一家儿童医院侵袭性镰刀菌病的暴发。一名 17 岁的中性粒细胞减少症男性患者因急性髓细胞性白血病复发，接受化疗，住院 10 天，出现发热，无其他症状；胸部计算机断层扫描显示双侧肺结节。在伏立康唑治疗期间，手臂和腿部出现 1 厘米红肿疼痛的皮下结节，皮肤活检培养出 F. solani。11 天后又发生了另一个病例，开始了暴发调查。从水龙头、淋浴器和水箱中采集用于培养的水样。采集所有患者房间的空气样本。擦拭水龙头和水槽及淋浴器的排水管并进行培养。对环境和临床分离株进行了分型。有 10 例确诊为 Fusarium spp.感染。从水、棉签和患者房间空气中分离出 F. oxysporum 和 F. solani。采取了许多控制措施，但在首例病例发生 1 年后才控制住暴发，当时在所有患者房间的所有水龙头和淋浴器出口（使用点）安装了过滤 0.2μm 的水过滤器。分型表明，临床分离的 F. oxysporum 与环境中的相似。总之，据我们所知，这是首例报道的儿童血液肿瘤疾病侵袭性镰刀菌病暴发。通过在所有水龙头和淋浴器上安装 0.2μm 的过滤器控制了暴发。
