Monday, 25 February 2008

Salford Royal detects Aspergillus in baby ward

Last week reports appeared that tests of the air in the ward showed no problems - eliminating a major potential source of the fungus getting onto the ward.

Other sources would included dust, clothing, pot plants(!), hands, hair, food, water and so on. A significant tightening of standard practices of hygiene for everyone entering the ward would also be helpful and have no doubt been in place since the cases were discovered.

Latest reports states that Aspergillus has been detected in several areas of the ward - presumably after swabbing surfaces open to the air (though the exact details are not stated). Specialist cleaners are being brought in to remove all traces of the fungus, so that suggests that was the only detected source of the infections. Equally importantly continuing efforts are being made to monitor the situation in an ongoing manner.

Aspergillus toy in big demand


On a slightly more light hearted note - purchasers of a computer game in Japan known as 'Moyashimon' are also getting a toy in the shape of an Aspergillus oryzae conidial head! The toy is flying off the shelves apparently.

The link underpinning the concept is the Aspergillus Oryzae is the organism used for the brewing of Sake - an alchoholic drink originating in Japan.

After a little research we found that Moyashimon is a comedy cartoon based on a character that can see and speak to bacteria and fungi, though obviously much larger than they appear to us!

Who knows, it may be the next big thing in the UK by Christmas.

Friday, 22 February 2008

Aspergillosis and Leukemia - a deadly combination

Aspergillus fungus invading lung tissue
In the news this week is a story from New Zealand of a young girl suffering from leukemia who has also become infected with aspergillus.

This is a dreadful 'catch 22' situation where in order to treat the cancer the patient has to have their natural immune system completely wiped out. Of course as soon as the patient has no immune system then they have no resistance to infection, resulting in a wide variety of infections including one of the most deadly - aspergillosis.

Many of these infections are serious but are treatable using antibiotics, but even when antibiotics are used a lot of the 'work' needed to kill off an infection is still done by a healthy immune system. If there is no immune system then treatment becomes very difficult with a high chance of failure (90% in this case according to the news article).

If the infecting organism is the aspergillus fungus then things are very bad indeed as this can be far more resistant to treatment with antifungal 'antibiotics' than bacteria.

This becomes a deadly race between the fungal enemy and the recovering immune system. Leukemia patients have virtually no immune system for a fairly short period of time after treatment for the cancer. After treatment (e.g. transplant of bone marrow) the patients immune system gradually recovers - every day the immune system becomes better at fighting off infection. Past a certain point of recovery the patient can fight off even the worst infections (e.g. aspergillus) as long as the fungus has not got too great a foothold in the patients body.

All is not gloom and doom however. A few years ago there was only one drug to treat aspergillus infections, and that was very toxic. A weak patient could find the drug itself to be intolerable so it would not be possible to fight the infection aggressively. Nowadays there are several drugs available, most of which being far less toxic so treatment is less inhibited.

The Fungal Research Trust funds a lot of research into these drugs and their best use. Aspergillus infections are still very rare but as we have seen they are very deadly - much more research is needed as more and more transplants are carried out to treat a variety of illnesses.

Friday, 15 February 2008

Two cases of aspergillosis in premature babies

Mouldy air conditioning unit
No doubting the news of the week - this broke yesterday morning (Thursday 14th Feb)

Infection closes baby unit
BBC ITN news

Aspergillus website and Fungal Research Trust staff contributed expertise to the story and many of the pictures and short movies of growing aspergillus were provided by the Trust (though one or two movies originated here at the Fungal Cell Biology Group in Edinburgh).

One striking feature of this incident is that major building work started at the Salford Royal in September 2007. Any disturbance of the ground causes large amounts of dust to be released into the air, including large amounts of Aspergillus. Building work of this size at Salford Royal would release very large amounts of fungal spores into the air.
Building works adjacent to hospitals have been noted several times to coincide with outbreaks of aspergillus infections - see Barnes et al and a study in France showing the need for increased precautions during building work here.

There is absolutely no suggestion here that Salford Royal or any other UK hospital have failed in their duty to protect vulnerable patients as their precautions are in line with current best practice and even though buildings work is widespread in our hospitals cases of neonatal aspergillosis are thankfully still very rare.

There are several other groups of vulnerable patients e.g. very recent transplant patients, patients being treated for leukemia and other highly immunocompromised patients. These are also at increased risk and cases of aspergillosis in these people are more common - building works having the potential to contribute.

Oddly, there is no UK wide standard protocol or advice to protect vulnerable patients from this increased risk - things as simple as being aware of the risk from building dust and not allowing open windows in wards containing vulnerable patients to the amount of wind on any given day. This is a complex problem.
For the most part it appears in practice that protection is adequate because if it were not there would be many more cases. However there are isolated outbreaks that carry a high risk of having a fatal conclusion.

Head of Estates at Newcastle General Hospital Andrew Poplett has been attempting to push the relevant authorities to establish a standard practice under these circumstances, and many of his suggestions are found here on the Aspergillus Trust website. Perhaps now is the time to take this issue more seriously??

Friday, 8 February 2008

Aspergillus contamination of buildings - no small problem

Moldy wall - Aspergillus Website
This news story is of the rehabilitation of a 300 bed hospital in Canada (The Honore-Mercier Hospital in Saint-Hyacinthe, Quebec). The hospital had to be closed and completely gutted in 2003 following discovery of widespread aspergillus growing in its walls!!!

The mention of aspergillus growing like 'mildew' suggests that the problem was uncontrolled damp and humidity with condensation on walls thrown in for good measure. Aspergillus, like most fungi, needs moisture above all else to grow in this way.

This mouldy mess was cleaned up professionally and expensively, but what does a private householder do?
I recently contacted the Environmental Protection Agency (EPA) in USA for details on how a householder would go about getting a mouldy house diagnoses and treated and got the followign answer:

There is no list of approved mold remediation companies endorsed by the
USEPA. EPA has a published guideline titled "Mold Remediation in
Schools and Commercial Buildings" and recommends that when outsourcing
mold remediation work to "make sure they have experience cleaning up
mold, check their references, and have them follow the recommendations
presented in this document, the guidelines of the American Conference
of Government Industrial Hygienists (ACGIH) (see Resources List),
and/or guidelines from other professional organizations."

You can access the "Mold Remediation in Schools and Commercial
Buildlings" on the EPA website at http://www.epa.gov/mold

The IICRC and the Association of Specialists in Cleaning and
Restoration (ASCR) are two associations of cleaning and restoration
professionals that can help to provide referrals to experienced
contractors.


I thought that link above was good for people within and outside the US.
I am still looking for help in the UK - watch this space!

Friday, 1 February 2008

Keeping track of infections that happen while in hospital

An example of how minuscule particles can be caught between dermal ridges in the hand, yet remain unseen by the naked eye. Washing one's hands removes such contaminants.
Infections acquire while in hospital (nosocomial infections) are quite common. Aspergillus infections can be extremely serious especially if a patient is severely immune-compromised, for example patients being treated for leukemia or transplant recipients.
It has been extremely difficult to obtain information on these outbreaks, but now there is an initiative to address that problem.

The Outbreak Worldwide database aims to collect details of all reported nosocomial outbreaks and allows free access to all information collected. Doctors can contribute and get important information and contact details to study the risk factors involved in each type of infection - potentially an important step forward to understanding this problem.

Originally set up with details of 1000 outbreaks reported in the scientific literature but it already contains records of more than 2100 incidents, 23 involving aspergillus.

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