title: Outbreak of invasive mycoses caused by Paecilomyces lilacinus from a contaminated skin lotion.
abstract: BACKGROUND
  Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported.
  
  
  OBJECTIVE
  To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients.
  
  
  METHODS
  An outbreak investigation.
  
  
  METHODS
  The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland.
  
  
  METHODS
  25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed).
  
  
  METHODS
  Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, 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 colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney 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 not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years.
  
  
  CONCLUSIONS
  Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.
authors.affiliation: University Hospital, Basel, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Orth
authors.forename: R
authors.initials: R
authors.lastname: Frei
authors.forename: P H
authors.initials: PH
authors.lastname: Itin
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: B
authors.initials: B
authors.lastname: Speck
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.forename: A F
authors.initials: AF
authors.lastname: Widmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000276:immunology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D003881:Dermatomycoses / Q000453:epidemiology / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000635:transmission; D009369:Neoplasms / Q000276:immunology; D009503:Neutropenia / Q000276:immunology; D009824:Ointments; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000635:transmission; D010143:Paecilomyces; D013557:Switzerland / Q000453:epidemiology
chemical_list: D009824:Ointments