Fungal outbreak investigations

Abstract

This chapter on fungal outbreak investigation deals with the common and rare fungi of medical importance causing outbreaks among humans. It has been known that fungal outbreaks have multiple possible sources such as human (Pichia outbreak), environment (Aspergillus outbreak as during hospital construction, especially in the setting of immunocompromised patients), iatrogenic sources (as in the case of contaminated methyl prednisolone outbreak seen in the USA), water (Fusarium outbreak), and food (Mucor from yogurt, etc.). The array of sources and transmission epidemiology-person to person, construction and demolition, ventilation, cleaning activities, waste container, plant, and water system-makes prevention and containment of fungal infections a formidable challenge in the medical management. This chapter brings out the story associated with some fungal outbreaks, focusing mainly on Asia, and elaborates how these outbreaks were controlled, along with some lessons learnt. Although MALDI-TOF and DNA sequencing are extensively used in apex centers and mycology reference laboratories for fungal identification, for outbreak investigation molecular typing needs to be done for source identification. Fungal outbreaks may be prevented and controlled by improvement of patient care including hand hygiene, air, and ventilation quality control, following recommended guidelines during hospital demolition and construction, use of sterile water for immunocompromised patients (especially those who are neutropenic and undergone transplantation), appropriate outbreak investigation for source identification and its containment, and finally training of relevant staff. CUSUM (cumulative sum test) can be used to monitor and identify early evidence of outbreak.