title: Evaluation of invasive aspergillosis risk of immunocompromised patients alternatively hospitalized in hematology intensive care unit and at home.
abstract: Contrary to hospital exposure, little is known about the indoor fungal exposure of hematology patients at home. The aim of our study was to investigate the mold exposure of hematology patients both at home and at hospital to assess their invasive aspergillosis (IA) risk. Fungal exposure was assessed by quantifying opportunistic molds at hospital during hospitalization and in homes of 53 hematology patients. IA was diagnosed in 13 of 53 patients and invasive fungal infection (IFI) in one patient. In hospital, no opportunistic species, or low levels of opportunistic species, were found in 98% of weekly controls. Only 2% of hematology intensive care unit (ICU) controls showed a high level of Aspergillus fumigatus spores in corridor air. Five patients IA were hospitalized during these periods. Seven dwellings of 53 (5/14 dwellings of patients with IA/IFI and 2/39 dwellings of non-IA patients) had a percentage of A. fumigatus and Aspergillus flavus to total mold (significant predictor variable of IA/IFI in our study, general linear model, P-value = 0.02) as high as 15%. Maintaining a 'zero Aspergillus' goal at hospital is essential, and establishing specific and individually opportunistic mold monitoring at home could help to further reduce the IA risk through continuous surveillance.
  
  
  CONCLUSIONS
  This study emphasizes the fact that preventive measures should not be aimed only at the hospital setting: among patients diagnosed with invasive aspergillosis/invasive fungal infection (IA/IFI), 5 of 14 (36%) were exposed to opportunistic fungal species at home exclusively. Moreover, four of these five patients were living in homes having the highest percentage of Aspergillus fumigatus and Aspergillus flavus (>15%), one of which had 48% of A. fumigatus. Therefore, our work supports the need for a counselor to carry out an environmental survey in patients’ homes.
authors.affiliation: Chrono-Environnement UMR 6249 Research Team, Franche-Comté University, Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Rocchi
authors.forename: G
authors.initials: G
authors.lastname: Reboux
authors.forename: F
authors.initials: F
authors.lastname: Larosa
authors.forename: E
authors.initials: E
authors.lastname: Scherer
authors.forename: E
authors.initials: E
authors.lastname: Daguindeau
authors.forename: A
authors.initials: A
authors.lastname: Berceanu
authors.forename: E
authors.initials: E
authors.lastname: Deconinck
authors.forename: L
authors.initials: L
authors.lastname: Millon
authors.forename: A-P
authors.initials: AP
authors.lastname: Bellanger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000391:Air Microbiology; D016902:Air Pollution, Indoor / Q000517:prevention & control; D001230:Aspergillus / Q000302:isolation & purification / Q000472:pathogenicity; D002675:Child, Preschool; D004784:Environmental Monitoring; D005260:Female; D006405:Hematology; D006798:Housing; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D055744:Invasive Pulmonary Aspergillosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D055815:Young Adult
keywords: At-risk patients; Chronically immunocompromised outpatient; Indoor environment; Invasive aspergillosis; Mold exposure; Prevention