Bloodstream yeast infections: a 15-month survey.

A 15-month survey of 412 bloodstream yeast isolates from 54 Belgian hospitals was undertaken. Candida albicans was the most common species (47.3%) followed by C. glabrata (25.7%), C. parapsilosis (8.0%), C. tropicalis (6.8%) and Saccharomyces cerevisiae (5.1%). Common predisposing factors were antibacterial therapy (45%), hospitalization in intensive care units (34%), presence of in-dwelling catheters (32%), underlying cancer (23%) and major surgery (11%). Most patients had more than one predisposing factor. Fluconazole alone or in combination with another antifungal agent was the treatment of choice for 86.6% of the cases. Susceptibility testing revealed that 93.5% were susceptible to amphotericin B, 39.6% to itraconazole, 42.8% to fluconazole and 87% to voriconazole. Resistance to azoles was more common among C. glabrata isolates.

Trichophyton mentagrophytes of rabbit origin causing family incidence of kerion: an environmental study.

Our laboratory was contacted by a family living directly above a rabbit farm. Both their children had developed a kerion, in consequence of a misdiagnosed superficial mycosis. This study was designed to demonstrate a link between the two kerion cases and the environmental contamination. The degree of contamination was estimated and factors favourising the spread of infection were determined. Dermatophytes were isolated from various environmental sites using Rodac plates. For direct sampling of scalp and fur the brushing technique was used. The farm and home environment initially showed a severe contamination by Trichophyton mentagrophytes. At the farm, cages and surfaces covered with rabbit hair were strongly contaminated. As for the home environment, the dog's basket and clothes from the mother carried a large number of spores. Trichophyton mentagrophytes was identified as responsible agent for the children's kerions and the lesions of the rabbits. Mother, eldest child and dog seemed to be excellent carriers. Cleaning and disinfection measures resulted in a reduction of the overall contamination. The home environment was no longer a source of contamination. Nevertheless, on the farm a fair number of dermatophytes could still be isolated from the wire meshes and roof beams covered with fluff.

Chrysosporium chiropterorum sp. nov., isolated in France, resembling Chrysosporium state of Ajellomyces capsulatus (Histoplasma capsulatum).

A fungus isolated in France from the fur of a bat, which produces characterized large tuberculate conidia (aleurioconidia) similar to those produced by the mycelial form of Histoplasma capsulatum (Ajellomyces capsulatus) is described. Colonies are white at first, but then become rosy buff from the centre outwards. Sectoring, resulting in the appearance of patches or areas of dark green mycelium, occurs spontaneously. Single-celled conidia are formed on undifferentiated hyphae, and may be sessile, or borne laterally on short stalks or producing in an intercalary position as it is the case in the genus Chrysosporium. This fungus is clearly distinguishable from any described species and is described as Chrysosporium chiropterorum sp. nov. C. chiropterorum, like H. capsulatum, produces gelatinase, and is non-keratinolytic but strongly ureolytic. Both species are associated with bat dwellings. C. chiropterorum differs from H. capsulatum by faster growth, pink or green colonies, and failure to produce microconidia as well as lack of conversion to a yeast phase in vitro at 37 degrees C.

[Moulds asthma]. / Asthme bronchique d'origine fongique.

Mould allergy revealed by skin prick tests or by measuring specific IgE (RAST), is frequently diagnosed throughout the world. It is associated to clinical asthma, sometimes severe. Thanks to the know how of teams of specialists, surveys are carried out in home-, work- and school environments, and calendars of moulds found in our country are regularly updated. This allows practitioners to determine specific sensitisation tests (selection of skin prick tests, and RAS tests), and helps them play a role in the diagnosis strategy and the recommendations for necessary eviction and building sanitation measures. These measures are all the more important as until now standardised extracts for specific hyposensitisation to moulds are not yet available.

In vitro activities of voriconazole (UK-109, 496), fluconazole, itraconazole and amphotericin B against 132 non-albicans bloodstream yeast isolates (CANARI study).

The aim was to evaluate the in vitro activity of voriconazole compared with those of amphotericin B, itraconazole and fluconazole against 132 bloodstream isolates of Candida non-albicans and Saccharomyces cerevisiae species. The minimal inhibitory concentrations (MICs) were determined by an adapted National Committee for Clinical Laboratory Standards (NCCLS) M27-A method using RPMI 1640 as test medium supplemented with 2% glucose. MIC end-points were determined with a spectrophotometer after incubation for 48 h at 35 degrees C. Optical density data were used for the calculation of the MIC end-points. For amphotericin B, the end-point was defined as the minimal antifungal concentration that exerts 90% inhibition compared with the control well growth. For the azoles, the end-points were determined at 50% inhibition of growth. Amphotericin B is highly active with 97% of isolates inhibited by < or =1 microg ml(-1). Decreased susceptibility or resistance to fluconazole was the rule among C. krusei, which is intrinsically resistant to fluconazole. For C. glabrata isolates, resistance to fluconazole and itraconazole was measured in 13% and 17% of the isolates respectively. Voriconazole was quite active in vitro against all the isolates with a MIC90% of < or =1 microg ml(-1) and we conclude that it may be useful in the treatment of non-albicans bloodstream infections.

Environmental investigations and molecular typing of Aspergillus flavus during an outbreak of postoperative infections.

After an outbreak of sternal surgical-site infections (SSSI) with Aspergillus flavus following cardiac surgery, a mycological survey of air and surfaces (41 and 149 samples, respectively) was performed throughout the surgical ward (SW) and in other areas of the hospital. Results showed massive contamination by A. flavus: more than 100 cfu per contact plate were frequently observed in some areas of the SW. The distribution of the A. flavus spores in the building, and especially in the SW, enabled the location of a possible source within the non-medical part of the SW, but the true source could not be identified. Four other surveys were made to follow up the decontamination process; the contamination level did not fall rapidly, needing repetitive cleaning operations. Strains from patients and from the hospital environment selected all over the SW were typed by random amplification of polymorphic DNA (RAPD), using two different primers (ERIC-1, BG-2). All these strains showed the same genotype, proving the clonal single-source of the environmental contamination and the intra-operative acquisition of A. flavus in the SSSI outbreak.

A one-year survey of candidemia in Belgium in 2002.

A total of 211 episodes of bloodstream yeast infections in 207 patients, hospitalized in 28 Belgian hospitals participating in a National Surveillance Program, were evaluated. A total of 81% of the patients were more than 50 years of age. Candida albicans was the cause of infections in 55% of patients, 22% were due to C. glabrata and 13% to C. parapsilosis. The most common predisposing factors were antibacterial therapy (42%), residence in an intensive care unit (32.9%) and presence of an intravascular catheter (29.7%). Most patients had more than one predisposing factor. Fluconazole alone or in association with another antifungal agent was the treatment of choice for 89.7% of the cases. In vitro susceptibility testing of the isolates revealed that 99% were susceptible to amphotericin B, 95% to 5-fluorocytosine, 82% to fluconazole and 69% to itraconazole. Resistance to azoles was more common among C. glabrata isolates in the elderly. We conclude that the frequency of C. albicans infection is decreasing in Belgium and this is associated with the emergence of other species, most notably, C. glabrata.

[Evaluation of the health inpact of the floods in the Gard on respiratory health of disaster victims]. / Evaluation de l'impact sanitaire des inondations dans le Gard sur la santé respiratoire des sinistrés.

In 2002 the Gard was subjected to exceptional flooding, as much by their size as by the number of affected community victims, more than the Nimes floods in October 1988. No community was spared and more than 800 families had to be rapidly re-located. As the medical bibliography of the impact of the floods on respiratory heath was not conclusive we have proposed to the CHU of Nimes a hospital clinical research project undertaken by the members of RNSA, the Institute of Public Health of Brussels and the European Centre for Medical Bioclimate Research and Teaching, who have accepted to share their knowledge with the Gard. It seems to us to be indispensable, considering the certifications made by the professionals on the health on the department, to validate the study methods for the evaluation of the health impact of the floods, with regard to the development of moulds in the environment, so as to recognise the risk to health, in the very special circumstances, and so allow the mobilisabion of useful resources more rapidly than previously. The new floods to which the department was subjected in December 2003 made us regret that we had not developed this project more quickly.

Hospital-acquired Aspergillus fumigatus infection: can molecular typing methods identify an environmental source?

Aspergillus fumigatus infection in hospitalized immunocompromised patients often raises suspicion regarding the potential for hospital acquisition. Hospital staff have an important responsibility in implementing preventive measures, especially since the advent of current legislation concerning hospital-acquired infections. There have been high expectations that molecular typing methods might determine the source of Aspergillus fumigatus, a ubiquitous mould. The aim of the present epidemiological study, was therefore, to identify the origin(s) of Aspergillus infection in six well-documented patients. All the clinical strains (N=33), and those from hospital (N=14) and home environments (N=34) were isolated according to a standardized protocol and typed by sequence-specific DNA primer analysis. The results confirmed the huge biodiversity of the A. fumigatus population, and consequently the difficulty in ascertaining a hospital source of the infection, as opposed to infections due to other Aspergillus species less frequently encountered.

Responses in the start of Betula (birch) pollen seasons to recent changes in spring temperatures across Europe.

A shift in the timing of birch pollen seasons is important because it is well known to be a significant aeroallergen, especially in NW Europe where it is a notable cause of hay fever and pollen-related asthma. The research reported in this paper aims to investigate temporal patterns in the start dates of Betula (birch) pollen seasons at selected sites across Europe. In particular it investigates relationships between the changes in start dates and changes in spring temperatures over approximately the last 20 years. Daily birch pollen counts were used from Kevo, Turku, London, Brussels, Zurich and Vienna, for the core period from 1982 to 1999 and, in some cases, from 1970 to 2000. The sites represent a range of biogeographical situations from just within the Arctic Circle through to North West Maritime and Continental Europe. Pollen samples were taken with Hirst-type volumetric spore traps. Weather data were obtained from the sites nearest to the pollen traps. The timing of birch pollen seasons is known to depend mostly on a non-linear balance between the winter chilling required to break dormancy, and spring temperatures. Pollen start dates and monthly mean temperatures for January through to May were compiled to 5-year running means to examine trends. The start dates for the next 10 years were calculated from regression equations for each site, on the speculative basis that the current trends would continue. The analyses show regional contrasts. Kevo shows a marked trend towards cooler springs and later starts. If this continues the mean start date will become about 6 days later over the next 10 years. Turku exhibits cyclic patterns in start dates. A current trend towards earlier starts is expected to continue until 2007, followed by another fluctuation. London, Brussels, Zurich and Vienna show very similar patterns in the trends towards earlier start dates. If the trend continues the mean start dates at these sites will advance by about 6 days over the next 10 years. Following this work, amendments will be needed to pollen calendars and local predictive models. It will also be important to assess the implications of earlier seasons for allergy sufferers.

Prevalence of Candida dubliniensis in the BCCM/IHEM Biomedical Fungi/Yeasts culture collection (isolates before 1990).

The BCCM/IHEM Biomedical Fungi/Yeasts collection hosts 1200 Candida albicans strains of the Vanbreuseghem mycotheque isolated between 1951 and 1997. From this collection, 469 freeze-dried C. albicans strains, producing chlamydospores, germ tubes and forming green colonies on CHROMagar, all isolated before 1990, were screened to identify the Candida dubliniensis isolates. Screening was performed in different steps using the growth at 45 degrees C, the assimilation of xylose, the intracellular beta-glucosidase activity test and C. dubliniensis-specific polymerase chain reaction (PCR) with primers from ACT1 intron sequence. Five isolates (1%) were identified as C. dubliniensis: one isolate was not documented, the others were of oropharyngeal origin of which two (1987 and 1990) were from proven human immunodeficiency virus patients.

A longitudinal study of lung transplant recipients infected with Aspergillus: genetic polymorphism of A fumigatus.

BACKGROUND: Aspergillus infection is a well-known complication of lung transplantation and remains associated with high mortality rates. Molecular typing methods are required to elucidate the complex epidemiology of Aspergillus disease in lung transplant recipients. METHODS: Eight lung transplant recipients from one hospital were followed for A fumigatus colonization or infection. Forty-four sequential isolates from these patients were selected and typed by three molecular methods (random amplified polymorphic DNA, sequence-specific DNA primer and multi-locus enzyme electrophoresis). RESULTS: Sixteen different types were identified of which 14 were specific to 1 patient. A factorial correspondence analysis showed that variability between sequential isolates from a single patient was as high as between isolates from the other patients. Lung transplant recipients presented many different genotypes, reflecting the environmental diversity of A fumigatus. Nevertheless, throughout their follow-up, 2 of the 8 lung transplant recipients harbored a common genotype that was not replaced by others. CONCLUSIONS: These results confirm the important genetic polymorphism of the A fumigatus population. The observed genotypes were not related to the type of Aspergillus disease or anti-fungal treatment used nor to the outcome of the patient. These data confirm that all A fumigatus molecular types present the same pathogenic risk.

A 4-year study of the mycological aspects of Kashin-Beck disease in Tibet.

In order to clarify the association between mycotoxin-producing fungi in food and Kashin-Beck disease (KBD), we examined the occurrence and contamination levels of fungi in samples of barley grain, from KBD-affected families and from unaffected families in endemic areas. A control area without the occurrence of KBD served as reference. The first results obtained in 1995 showed that total mesophilic fungal contamination of barley grain was consistently higher in families with KBD. Trichothecium roseum (Pers) Link ex gray, Dreschlera Ito and Alternaria Nees ex Fr. were the three most common fungi significantly associated with KBD. In 1996 we again observed a significant difference between affected and non-affected families, especially with Trichothecium roseum and Ulocladium Preuss. On this basis, measures to prevent KBD were suggested and a preventive program has been set up since 1998 in 20 new villages.

The prevalence of mycotoxins in Kashin-Beck disease.

Mycotoxins are naturally occurring toxic chemical compounds produced by fungi infesting agricultural crops both during their growth and storage. Such secondary metabolites, when ingested, can produce toxic syndromes in humans. As it has been suggested that mycotoxins might be involved in the development of Kashin-Beck disease (KBD), we undertook a survey of barley grains of KBD-affected families and non-affected families in that country. We found, by thin layer chromatography, a hitherto unknown metabolite of Alternaria sp. This was especially common on the barley grains of KBD-affected families.

Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology.

Migrating pulmonary infiltrates present a difficult diagnostic and therapeutic challenge. We report on eight patients (mean age 51 years, range 32-78 years, with a prolonged history of migrating pulmonary infiltrates of unknown aetiology despite a very elaborate search for infectious causes, hypersensitivity pneumonitis or inhalation fever due to occupational or domestic exposure to fungi, or to other environmental causes, and for humoral or cellular immunological incompetence. These patients (one male, seven females) presented with recurrent episodes (mean 6, range 2-13) of a flu-like illness, often with cough, wheezing and pleuritic chest pain, but without systemic involvement. Previous medical histories were unremarkable. There was no relation with smoking habits, occupation, drug use or other possible exposures. Biochemical data were non-specific. There was no peripheral nor pulmonary eosinophilia; total IgE was normal, with negative RASTs and precipitins to a variety of antigens. Cultures and serological tests for bacteria, viruses, fungi, etc were non-contributory. Chest X-ray and computed tomography (CT) scan showed bilateral migratory pulmonary infiltrates, with a predilection for the middle and lower lung zones, often with a minor-to-moderate pleural effusion. Lung function tests were usually normal; at the most a slight decrease in diffusing capacity was noted in some patients. There was no or only a slight response to antimicrobials; systemic corticosteroids were not given. Further evolution was benign with patients being asymptomatic between the episodes. Despite elaborate investigations, the cause of these 'pneumonias' remains frustratingly unknown.

[Mold allergy: 25 years of indoor and outdoor studies in Belgium]. / Allergie aux moisissures: 25 années d'études "indoor" et "outdoor" en Belgique.

Collecting atmospheric fungal spores in Brussels for 25 years revealed significant quantitative differences at three different levels: the total number of spores collected every year, the annual frequency rate of some species e.g. Cladosporium and Alternaria, the proliferation of some rare species according to weather conditions.