title: Molecular epidemiology of apparent outbreak of invasive aspergillosis in a hematology ward.
abstract: During a 2-month period, five patients suffering from invasive infections caused by Aspergillus flavus or Aspergillus fumigatus were identified in the Hematology Department of the University Hospital Dijkzigt (Rotterdam, The Netherlands). To study the epidemiological aspects of invasive aspergillosis, strains from these patients and from the hospital environment, isolated during extensive microbiological screening, were subjected to genotyping. A novel DNA extraction technique, involving freezing, grinding, and direct lysis in guanidium isothiocyanate-containing buffers of mycelial material, was applied. DNA isolation was followed by typing by random amplification of polymorphic DNA (RAPD) analysis. This showed that strains isolated from all patients infected with the same fungal species were genotypically distinct, thus providing evidence against the possibility of an ongoing, single-source nosocomial outbreak. Strains could also be differentiated from strains of geographically diverse origins. However, an A. flavus strain from one of the patients was also frequently encountered in the hospital environment. As all environmental strains were collected after this patient had been diagnosed with invasive disease, the epidemiological value of this observation could not be ascertained. Intensive investigations showed no single source of A. flavus or other aspergilli. RAPD genotyping proved that the outbreak of invasive aspergillosis in the hematology ward consisted of a series of unrelated events and was not due to a common source within the hospital. RAPD fingerprinting of aspergilli may greatly facilitate future investigations of the epidemiology of invasive disease caused by these pathogens.
authors.affiliation: Department of Bacteriology, University Hospital Dijkzigt, Rotterdam, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Leenders
authors.forename: A
authors.initials: A
authors.lastname: van Belkum
authors.forename: S
authors.initials: S
authors.lastname: Janssen
authors.forename: S
authors.initials: S
authors.lastname: de Marie
authors.forename: J
authors.initials: J
authors.lastname: Kluytmans
authors.forename: J
authors.initials: J
authors.lastname: Wielenga
authors.forename: B
authors.initials: B
authors.lastname: Löwenberg
authors.forename: H
authors.initials: H
authors.lastname: Verbrugh
mesh_terms: D000328:Adult; D000368:Aged; D000389:Air Conditioning; D000391:Air Microbiology; D001228:Aspergillosis / Q000453:epidemiology* / Q000382:microbiology; D001231:Aspergillus flavus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D001232:Aspergillus fumigatus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D001483:Base Sequence; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D017931:DNA Primers / Q000235:genetics; D004271:DNA, Fungal / Q000235:genetics / Q000302:isolation & purification; D004196:Disease Outbreaks; D005260:Female; D006405:Hematology; D006748:Hospital Departments; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D016533:Mycological Typing Techniques; D009426:Netherlands / Q000453:epidemiology; D019105:Random Amplified Polymorphic DNA Technique
chemical_list: D017931:DNA Primers; D004271:DNA, Fungal