OUTBREAK OF INVASIVE MYCOSES CAUSED BY PAECILOMYCES-LILACINUS FROM A CONTAMINATED SKIN LOTION

Background: Invasive mycoses are an important cause of illness and dea th in immunocompromised patients. Infections with molds other than asp ergilli have been increasingly seen in patients with hematologic cance rs, but epidemics of these infections have not yet been reported. Obje ctive: To describe an outbreak of invasive mycoses with Paecilomyces l ilacinus in severely neutropenic patients. Design: An outbreak investi gation. Setting: The hematology-oncology isolation and bone marrow tra nsplantation unit of the University Hospital, Basel, Switzerland. Pati ents: 25 consecutive patients admitted between 17 August 1993 (the dat e of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed). Measurements: Clinical and microbiol ogical data, including histologic findings; cultures from several pati ent sites; and environmental examinations of potential airborne, paren teral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions. Results: 12 of the 25 patients (48%) were infected or colo nized. Nine patients (36%), including all bone marrow transplant recip ients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patie nts with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and k idney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did n ot respond clinically to these agents. The outbreak was ultimately tra ced to a contaminated, commercially available, pharmaceutically prepar ed skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years. Conclusion: Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a com mon saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.