Aspergillus monitoring project in a large educational hospital using molecular assay

Background: It is important to find reliable and accessible methods for the diagnosis and identification of fungal species causing hospital acquired infections. Our main objective was using a rapid and accessible molecular method for the monitoring of Aspergillus infections and identification of causing agents in the level of species. Material and Methods: The study subjects were primarily clinical specimens collected from suspected HAI patients with clinical symptoms after hospitalization. Also some environmental specimens were collected from air and instruments of health care facilities for the investigation of Aspergillus sources in a university hospital of UMSU, Urmia. All specimens were transported to Medical Mycology Center for the detection and identification of Aspergillus species using morphological methods. Also molecular method, PCR-RFLP using single restriction enzyme as a rapid and available method was performed to investigate environmental sources of Aspergillus infections. Results: Total of 110 clinical fungal isolates included Candida and Aspergillus species and some other opportunistic fungi. Among the clinical Aspergillus findings, Aspergillus flavus (47%), Aspergillus fumigatus (29.4%) and Aspergillus niger (23.6%) were the most frequent species respectively and also Aspergillus niger (43.7%), Aspergillus flavus (41.8%), Aspergillus fumigatus (14.7%) were isolated as the most frequent species from environmental sources. Conclusion: Because of accessibility, speed and high sensitivity of diagnosis, the PCR-RFLP was very useful for the identification of medically important Aspergillus species and epidemiological approaches

Aspergilloma of the Lungs: Operative Experience from Tikur Anbessa Hospital; Ethiopia

Background: Pulmonary aspergilloma represents a potentially life-threatening disease caused by saprophytic growth of Aspergillus fumigates in pulmonary cavities. This is the first report of its operative treatment from Ethiopia.The aim of this study was to determine the clinical presentations; operative treatments and post operative outcome of patients with pulmonary aspergilloma. Methods: This was a retrospective review of patients' record with post operative diagnosis of pulmonary aspergilloma treated over a period of three years between April 2005-March 2008 at The Tikur Anbessa hospital which is a teaching and referral hospital in Addis Ababa. Results: Eleven patients were included; 81.8of whom were males. Cough and hemoptysis were the two most common presenting symptoms; occurring in 11(100) and 10(90.9). The chest x-ray features typical for aspergilloma was seen in only 4(36.4). The left lung was involved in 8(72.75) and the upper lobes were the most commonly affected lobes occurring in 10 (90.9). The most frequent clinical indication for surgery was severe hemoptysis in 8 (72.75). Left upper lobectomy was the most frequently performed surgery in 4(36.4) and left pneumonectomy in 3(27.3). Four significant complications occurred in the postoperative period and one patient died; making the postoperative mortality 9.1. Histopathologic confirmation of the fungal ball was possible in 10 patients and the most common underlying cavitary disease was tuberculosis in 9(90). Conclusion: Aspergilloma is not an uncommon disease in Ethiopia and the diagnosis should be considered in patients who present with hemoptysis or chronic non-resolving cough. Surgery for pulmonary aspergilloma accounted for 5.8of all thoracotomies done at the hospital and we have adopted the policy of early surgical treatment for all cases. In our series; the commonest lung pathology behind the aspergillus lesions was cavitary pulmonary tuberculosis; similar to many reports. Since the typical x/ray finding is not present in all patients; we believe that a supportive x/ray finding is sufficient enough an investigation to decide on early surgery in patients who present with suggestive symptoms