title: Geoclimatic influences on invasive aspergillosis after hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Aspergillus species are ubiquitous. We hypothesized that climatic variables that affect airborne mold counts affect the incidence of invasive aspergillosis (IA).
  
  
  METHODS
  Patients who received hematopoietic stem cell transplants (HSCTs) in geographically and climatically diverse regions (Seattle, WA, and Houston, TX) were examined. Cumulative incidence function, Kaplan-Meier analysis, and Cox proportional hazards regression were performed to examine the association between IA and season. Poisson regression analysis was performed to evaluate the seasonal patterns in IA rates and association with spore counts and climate.
  
  
  RESULTS
  In Seattle, the 3-month incidence of IA was 4.6% (5.7% in allograft recipients and 0.8% in autograft recipients). During the 10-year study period, there was a decrease in the incidence of IA among allogeneic HSCT recipients, corresponding to decreased risks during the nonsummer months; receipt of HSCTs during the summer months was associated with an increased hazard for IA (hazard ratio, 1.87; 95% confidence interval, 1.25-2.81) after adjustment for other known risks. The person-month IA rate in Seattle was positively associated with environmental spore counts, which increased with high temperature and low precipitation. No seasonal effect on IA was observed in Houston, where total spore counts were lower and not variable by climate.
  
  
  CONCLUSIONS
  Climatic variables differentially affect airborne spore counts and IA risk in geographically disparate centers.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Anil A
authors.initials: AA
authors.lastname: Panackal
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Motomi
authors.initials: M
authors.lastname: Mori
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Perego
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
mesh_terms: D000293:Adolescent; D000328:Adult; D000391:Air Microbiology; D001228:Aspergillosis / Q000453:epidemiology*; D001230:Aspergillus / Q000302:isolation & purification; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012621:Seasons; D013170:Spores / Q000302:isolation & purification; D013781:Texas / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology; D014887:Weather; D055815:Young Adult
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