RESUMO
Most cases of invasive aspergillosis are caused by Aspergillus fumigatus, whose conidia are ubiquitous in the environment. Additionally, in indoor environments, such as houses or hospitals, conidia are frequently detected too. Hospital-acquired aspergillosis is usually associated with airborne fungal contamination of the hospital air, especially after building construction events. A. fumigatus strain typing can fulfill many needs both in clinical settings and otherwise. The high incidence of aspergillosis in COVID patients from our hospital, made us wonder if they were hospital-acquired aspergillosis. The purpose of this study was to evaluate whether the hospital environment was the source of aspergillosis infection in CAPA patients, admitted to the Hospital Universitario Central de Asturias, during the first and second wave of the COVID-19 pandemic, or whether it was community-acquired aspergillosis before admission. During 2020, sixty-nine A. fumigatus strains were collected for this study: 59 were clinical isolates from 28 COVID-19 patients, and 10 strains were environmentally isolated from seven hospital rooms and intensive care units. A diagnosis of pulmonary aspergillosis was based on the ECCM/ISHAM criteria. Strains were genotyped by PCR amplification and sequencing of a panel of four hypervariable tandem repeats within exons of surface protein coding genes (TRESPERG). A total of seven genotypes among the 10 environmental strains and 28 genotypes among the 59 clinical strains were identified. Genotyping revealed that only one environmental A. fumigatus from UCI 5 (box 54) isolated in October (30 October 2020) and one A. fumigatus isolated from a COVID-19 patient admitted in Pneumology (Room 532-B) in November (24 November 2020) had the same genotype, but there was a significant difference in time and location. There was also no relationship in time and location between similar A. fumigatus genotypes of patients. The global A. fumigatus, environmental and clinical isolates, showed a wide diversity of genotypes. To our knowledge, this is the first study monitoring and genotyping A. fumigatus isolates obtained from hospital air and COVID-19 patients, admitted with aspergillosis, during one year. Our work shows that patients do not acquire A. fumigatus in the hospital. This proves that COVID-associated aspergillosis in our hospital is not a nosocomial infection, but supports the hypothesis of "community aspergillosis" acquisition outside the hospital, having the home environment (pandemic period at home) as the main suspected focus of infection.
Assuntos
Infecções por Bartonella/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
AIM: The epidemiologic and clinical characteristics, presence of HIV coinfection, and sensitivity to tuberculostatic drugs were analyzed in a series of tuberculosis patients attended in our center. PATIENTS AND METHODS: Retrospective study of tuberculosis cases attended in a third- level hospital from 1993 to 1998. RESULTS: During the study period, 268 cases of tuberculosis were diagnosed in our center. A progressive decrease in the incidence of this disease has occurred since 1995. Among the jailed population, we also found a decrease in cases of tuberculosis and there were no cases of resistance. In the total population, only 8 isolates (3.27%) showed resistance to some of the antituberculosis drugs studied (isoniazid, rifampicin, ethambutol, streptomycin). A tendency toward a decrease in resistance was also observed starting from 1995, with no new cases detected in the last two years. There was a 1.3% rate of primary resistance to isoniazid. Multiresistance was detected in only 4 patients, two of whom died. The rate of HIV coinfection was 38.8%. In 39% of cases the form of presentation was exclusively pulmonary and in 25% it was disseminated. CONCLUSIONS: There was a 50% decrease in tuberculosis cases during the period studied. The rate of HIV coinfection was 38.8%, one of the highest in the literature, indicating that HIV serology should be included in the protocol for studying tuberculosis in our setting. Given the low rate of resistance detected, we recommend a three-drug regimen for antituberculosis treatment.