Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review

Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hemato-oncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Resultados de profilaxis con itraconazol 800 mg/día vía oral en adultos con leucemia aguda y neutropenia de alto riesgo: Hospital del Salvador 2006-2008 / Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia

Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25 percent in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17 percent). According to diagnostic criteria, 5 percent of episodes corresponded to persistent fever , 1 percent and 11 percent of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18 percent. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.

Profilaxia de infecçöes em pacientes neutropênicos: Parte 2: infecçöes fúngicas / Infections prophylaxis in neutropenic patients: Part 2: fungal infections

Nos últimos 15 anos, as infecçöes fúngicas vêm aumentando de frequência em pacientes neutropênicos, constituindo-se atualmente a principal causa de óbito por infecçäo nesta populaçäo de pacientes. A associaçäo entre aumento na prevalência, diagnóstico difícil e alta letalidade fez profilaxia uma estratégia mais que justificável. As principais estratégicas de prevençäo de infecçöes fúngicas em pacientes neutropênicos sao voltadas à reduçäo da colonizaçäo por fungos e, consequentemente, das infecçöes sistêmicas, ou à melhoria das defesas do hospedeiro. Para a profilaxia de candidíase, o agente mais eficaz é o fluconazol, especialmente em pacientes submetidos a transplante de medula óssea. Para a profilaxia das infecçöes por Aspergillus, o itraconazol é um agente promissor, embora ainda nao haja estudos clínicos comprovando sua eficácia. Os fatores de crescimento hematopoiético usados em pacientes neutropênicos, ou para estimular a medula óssea de doadores de leucócitos, podem vir a constituir um recurso útil na prevençäo de infecçöes em pacientes neutropênicos.

Aislamiento de diversas especies del género aspergillus de la tierra de plantas ornamentales intrahospitalarias / Isolation of different aspergillus strains fron the soil of ornamental plants located at hospital

The earth of ornamental plants is one of the main reservoirs of Aspergillus type of fungi in hospital areas. We studied 174 ornamental interior plants from a hospital at Santiago. Samples were obtained from the soil surface and sowed in Sabouraud-glucose agar, adding streptomycin and G-penicillin. After 72 h of culture, at least one strain of Aspergillus was isolated from 140 samples (80.5 percent). The most frequently isolated strain was A fumigatus (129 samples), followed by A miger (75 samples). A fumigatus and A niger were the only isolated strains in 65 and 11 samples respectively. These findings confirm that ornamental plants can be important reservoirs of Aspergillus strains, a potential infectious agent for immunocompromised patients in hospital areas