NOSOCOMIAL OUTBREAK OF ASPERGILLUS-FUMIGATUS INFECTION AMONG PATIENTSIN A RENAL UNIT

Aspergillus fumigatus is present in the environment worldwide and it i s only able to infect debilitated or immunodepressed subjects. Nosocom ial outbreaks of A. fumigatus infection have been associated with hosp ital reconstruction. Spores are released into the environment and are inhaled by immunodepressed patients housed in nearby Medical Units. Sp ecific clinical syndromes are allergic bronchopulmonary aspergillosis and invasive pulmonary aspergillosis with characteristic radiological features. Invasive A. fumigatus infection is commonly fatal, even if p romptly diagnosed and treated. Three consecutive cases of A. fumigatus infection occurred in debilitated patients housed in our Renal Unit w hile building renovation near the Unit was being performed. Two of the se patients died and pulmonary and diffuse aspergillosis was found on postmortem examination. The third patient, highly suspected to be infe cted with Aspergillus, was aggressively and successfully treated with liposomal amphotericin B. Our experience suggests that fungal infectio ns have gained increasing prominence in clinical medicine and they mus t be considered in chronic debilitated patients including dialysis pat ients, and that liposomal amphotericin B represents an important advan ce in the treatment of aspergillosis.