title: Healthcare-associated outbreaks due to Mucorales and other uncommon fungi.
abstract: BACKGROUND
  Healthcare-associated outbreaks of fungal infections, especially with uncommon and emerging fungi, have become more frequent in the past decade.
  
  
  METHODS
  Here, we reviewed the history and definition of healthcare-associated outbreaks of uncommon fungal infections and discussed the principles of investigating, containing and treatment of these outbreaks.
  
  
  RESULTS
  In case of these uncommon diseases, occurrence of two or more cases in a short period is considered as an outbreak. Contaminated medical devices and hospital environment are the major sources of these outbreaks. Care must be taken to differentiate a real infection from colonization or contamination. Defining and identifying cases, describing epidemiologic feature of cases, finding and controlling the source of the outbreak, treating patients, and managing asymptomatic exposed patients are main steps for outbreak elimination. These fungal outbreaks are not only difficult to detect but also hard to treat. Early initiation of appropriate antifungal therapy is strongly associated with improved outcomes in infected patients. Choice of antifungal drugs should be made based on spectrum, pharmacodynamic and pharmacokinetic characteristics and adverse effects of available drugs. Combination antifungal therapy and surgical intervention may be also helpful in selected cases.
  
  
  CONCLUSIONS
  A multidisciplinary approach and close collaboration between all key partners are necessary for successful control of fungal outbreaks.
authors.affiliation: Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Setareh
authors.initials: S
authors.lastname: Davoudi
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Graviss
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000266:history / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000266:history / Q000517:prevention & control*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D017053:Infection Control / Q000379:methods; D009091:Mucormycosis / Q000266:history / Q000517:prevention & control; D009181:Mycoses / Q000266:history / Q000517:prevention & control*; D035583:Rare Diseases / Q000266:history / Q000517:prevention & control
chemical_list: D000935:Antifungal Agents
keywords: Healthcare-associated; Mucorales; outbreak; uncommon fungi