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. 2018 Apr 26;13(4):e0196426.
doi: 10.1371/journal.pone.0196426. eCollection 2018.

Airborne transmission of invasive fusariosis in patients with hematologic malignancies

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Airborne transmission of invasive fusariosis in patients with hematologic malignancies

Maria Luiza Moretti et al. PLoS One. .

Abstract

From 2006 to 2013, an increasing incidence of fusariosis was observed in the hematologic patients of our University Hospital. We suspected of an environmental source, and the indoor hospital air was investigated as a potential source of the fungemia. Air samplings were performed in the hematology and bone marrow transplant (BMT) wards using an air sampler with pre-defined air volumes. To study the molecular relationship among environmental and clinical isolates, 18 Fusarium spp. recovered from blood cultures were included in the study. DNA sequencing of a partial portion of TEF1α gene was performed for molecular identification. Molecular typing was carried out by multi-locus sequence typing (MLST) using a four-gene scheme: TEF1α, rDNA, RPB1 and RPB2. One hundred four isolates were recovered from the air of the hematology (n = 76) and the BMT (n = 28) wards. Fusarium isolates from the air were from five species complexes: Fusarium fujikuroi (FFSC, n = 56), Fusarium incarnatum-equiseti (FIESC, n = 24), Fusarium solani (FSSC, n = 13), Fusarium chlamydosporum (FCSC, n = 10), and Fusarium oxysporum (FOSC, n = 1). Fifteen Fusarium isolates recovered from blood belonged to FSSC, and three to FFSC. MLST identified the same sequence type (ST) in clinical and environmental isolates. ST1 was found in 5 isolates from blood and in 7 from the air, both identified as FSSC (Fusarium petroliphilum). STn1 was found in one isolate from blood and in one from the air, both identified as FFSC (Fusarium napiforme). F. napiforme was isolated from the air of the hospital room of the patient with fungemia due to F. napiforme. These findings suggested a possible clonal origin of the Fusarium spp. recovered from air and bloodcultures. In conclusion, our study found a diversity of Fusarium species in the air of our hospital, and a possible role of the air as source of systemic fusariosis in our immunocompromised patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Molecular identification of Fusarium species isolated from hospital air samplings.
(A) and (B) shows TEF1α DNA sequencing classification in species complex and species, respectively. The number of isolates is shown above each bar. FCSC: F. chlamydosporum species complex; FFSC: F. fujikuroi species complex; FIESC: F. incarnatum-equiseti species complex; FOSC: F. oxysporum species complex; FSSC: F. solani species complex.
Fig 2
Fig 2. Distribution of Fusarium species isolated from hospital air.
The frequency of each species complex in the hematology (A, n = 76) and BMT (B, n = 28) wards is shown. The species identified for each complex is presented outside the graphs. The species found exclusively in hematology unit are marked with (*). FCSC: F. chlamydosporum species complex; FFSC: F. fujikuroi species complex; FIESC: F. incarnatum-equiseti species complex; FOSC: F. oxysporum species complex; FSSC: F. solani species complex.
Fig 3
Fig 3. Sequence types (ST) determined by sequencing of portions of the genes TEF1α, rDNA, RPB1 and RPB2 for Fusarium species isolated from air and blood.
The number of samples with each ST is shown above the bar. FSSC: F. solani species complex. FFSC: F. fujikuroi species complex. ST: sequence type.

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