title: An outbreak of invasive fusariosis in a children's cancer hospital.
abstract: Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 μm were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-μm filters in all tap faucets and showers.
authors: Instituto de Tratamento de Cancer Infantil (ITACI), Children's Institute, Hospital das Clínicas, University of São Paulo, Brazil; Department of Pediatrics, University of São Paulo, Brazil.
authors: Nadia
authors: N
authors: Litvinov
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, Brazil.
authors: Mariama Tomaz N
authors: MT
authors: da Silva
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, Brazil.
authors: Inneke M
authors: IM
authors: van der Heijden
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo, Brazil.
authors: Mariana G
authors: MG
authors: Graça
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo, Brazil.
authors: Larissa
authors: L
authors: Marques de Oliveira
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo, Brazil.
authors: Liang
authors: L
authors: Fu
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, Brazil.
authors: Mauro
authors: M
authors: Giudice
authors: Instituto de Tratamento de Cancer Infantil (ITACI), Children's Institute, Hospital das Clínicas, University of São Paulo, Brazil.
authors: Maria
authors: M
authors: Zilda de Aquino
authors: Instituto de Tratamento de Cancer Infantil (ITACI), Children's Institute, Hospital das Clínicas, University of São Paulo, Brazil; Department of Pediatrics, University of São Paulo, Brazil.
authors: Vicente
authors: V
authors: Odone-Filho
authors: Department of Pediatrics, University of São Paulo, Brazil.
authors: Heloisa Helena
authors: HH
authors: Marques
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo, Brazil.
authors: Silvia F
authors: SF
authors: Costa
authors: Infection Control Department and LIM -54, Hospital das Clínicas, University of São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo, Brazil. Electronic address: gcih.adm@hc.fm.usp.br.
authors: Anna S
authors: AS
authors: Levin
mesh_terms: D000293:Adolescent; D002173:Cancer Care Facilities; D002648:Child; D003428:Cross Infection; D004196:Disease Outbreaks; D005260:Female; D060585:Fusariosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D005670:Fusarium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006776:Hospitals, Pediatric; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008297:Male; D058889:Molecular Typing; D009894:Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D010802:Phylogeny
keywords: Fusarium infection; oncohaematologic disease; paediatric infections; water; water filter