Article: Outbreak of intestinal infection due to Rhizopus microsporus
| Title | Outbreak of intestinal infection due to Rhizopus microsporus | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Authors | Cheng, VCC Chan, JFW Ngan, AHY To, KKW Leung, SY Tsoi, HW Yam, WC Tai, JWM Wong, SSY Tse, H Li, IWS Lau, SKP Woo, PCY Leung, AYH Lie, AKW Liang, RHS Que, TL Ho, PL Yuen, KY | ||||||||
| Keywords | Species Index: Fungi Rhizopus Microsporus | ||||||||
| Issue Date | 2009 | ||||||||
| Publisher | American Society for Microbiology | ||||||||
| Citation | Journal Of Clinical Microbiology, 2009, v. 47 n. 9, p. 2834-2843 [How to Cite?] DOI: http://dx.doi.org/10.1128/JCM.00908-09 | ||||||||
| Abstract | Sinopulmonary and rhinocerebral zygomycosis has been increasingly found in patients with hematological malignancies and bone marrow transplantation, but intestinal zygomycosis remains very rare in the literature. We investigated an outbreak of intestinal infection due to Rhizopus microsporus in 12 patients on treatment for hematological malignancies over a period of 6 months in a teaching hospital. The intake of allopurinol during hospitalization (P < 0.001) and that of commercially packaged ready-to-eat food items in the preceding 2 weeks (P < 0.001) were found to be independently significant risk factors for the development of intestinal zygomycosis. A total of 709 specimens, including 378 environmental and air samples, 181 food samples, and 150 drug samples, were taken for fungal culture. Among them, 16 samples of allopurinol tablets, 3 prepackaged ready-to-eat food items, and 1 pair of wooden chopsticks were positive for Rhizopus microsporus, which was confirmed by ITS1-5.8S-ITS2 rRNA gene cluster (internal transcribed spacer [ITS]) sequencing. The mean viable fungal counts of allopurinol obtained from wards and pharmacy were 4.22 × 10 3 CFU/g of tablet (range, 3.07 × 10 3 to 5.48 × 10 3) and 3.24 × 10 3 CFU/g of tablet (range, 2.68 × 10 3 to 3.72 × 10 3), respectively, which were much higher than the mean count of 2 × 10 2 CFU/g of food. Phylogenetic analysis by ITS sequencing showed multiple clones from isolates of contaminated allopurinol tablets and ready-to-eat food, of which some were identical to patients' isolates, and with one isolate in the cornstarch used as an excipient for manufacture of this drug. We attempted to type the isolates by random amplification of polymorphic DNA analysis, with limited evidence of clonal distribution. The primary source of the contaminating fungus was likely to be the cornstarch used in the manufacturing of allopurinol tablets or ready-to-eat food. Rhizopus microsporus is thermotolerant and can multiply even at 50°C. The long holding time of the intermediates during the manufacturing process of allopurinol amplified the fungal load. Microbiological monitoring of drugs manufactured for highly immunosuppressed patients should be considered. Copyright © 2009, American Society for Microbiology. All Rights Reserved. | ||||||||
| ISSN | 0095-1137 2011 Impact Factor: 4.153 2011 SCImago Journal Rankings: 0.397 | ||||||||
| DOI | http://dx.doi.org/10.1128/JCM.00908-09 | ||||||||
| ISI Accession Number ID | WOS:000269439600020
Funding Information: This work was partly funded by the HKSAR Research Fund commissioned block grant for the control of infectious diseases and the Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the Department of Health, the Health, Welfare, and Food Bureau of the Hong Kong Special Administrative Region of China. | ||||||||
| PubMed Central ID | PMC2738128 | ||||||||
| References | References in Scopus |
| dc.contributor.author | Cheng, VCC | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| dc.contributor.author | Chan, JFW | ||||||||
| dc.contributor.author | Ngan, AHY | ||||||||
| dc.contributor.author | To, KKW | ||||||||
| dc.contributor.author | Leung, SY | ||||||||
| dc.contributor.author | Tsoi, HW | ||||||||
| dc.contributor.author | Yam, WC | ||||||||
| dc.contributor.author | Tai, JWM | ||||||||
| dc.contributor.author | Wong, SSY | ||||||||
| dc.contributor.author | Tse, H | ||||||||
| dc.contributor.author | Li, IWS | ||||||||
| dc.contributor.author | Lau, SKP | ||||||||
| dc.contributor.author | Woo, PCY | ||||||||
| dc.contributor.author | Leung, AYH | ||||||||
| dc.contributor.author | Lie, AKW | ||||||||
| dc.contributor.author | Liang, RHS | ||||||||
| dc.contributor.author | Que, TL | ||||||||
| dc.contributor.author | Ho, PL | ||||||||
| dc.contributor.author | Yuen, KY | ||||||||
| dc.date.accessioned | 2010-09-17T10:24:03Z | ||||||||
| dc.date.available | 2010-09-17T10:24:03Z | ||||||||
| dc.date.issued | 2009 | ||||||||
| dc.description.abstract | Sinopulmonary and rhinocerebral zygomycosis has been increasingly found in patients with hematological malignancies and bone marrow transplantation, but intestinal zygomycosis remains very rare in the literature. We investigated an outbreak of intestinal infection due to Rhizopus microsporus in 12 patients on treatment for hematological malignancies over a period of 6 months in a teaching hospital. The intake of allopurinol during hospitalization (P < 0.001) and that of commercially packaged ready-to-eat food items in the preceding 2 weeks (P < 0.001) were found to be independently significant risk factors for the development of intestinal zygomycosis. A total of 709 specimens, including 378 environmental and air samples, 181 food samples, and 150 drug samples, were taken for fungal culture. Among them, 16 samples of allopurinol tablets, 3 prepackaged ready-to-eat food items, and 1 pair of wooden chopsticks were positive for Rhizopus microsporus, which was confirmed by ITS1-5.8S-ITS2 rRNA gene cluster (internal transcribed spacer [ITS]) sequencing. The mean viable fungal counts of allopurinol obtained from wards and pharmacy were 4.22 × 10 3 CFU/g of tablet (range, 3.07 × 10 3 to 5.48 × 10 3) and 3.24 × 10 3 CFU/g of tablet (range, 2.68 × 10 3 to 3.72 × 10 3), respectively, which were much higher than the mean count of 2 × 10 2 CFU/g of food. Phylogenetic analysis by ITS sequencing showed multiple clones from isolates of contaminated allopurinol tablets and ready-to-eat food, of which some were identical to patients' isolates, and with one isolate in the cornstarch used as an excipient for manufacture of this drug. We attempted to type the isolates by random amplification of polymorphic DNA analysis, with limited evidence of clonal distribution. The primary source of the contaminating fungus was likely to be the cornstarch used in the manufacturing of allopurinol tablets or ready-to-eat food. Rhizopus microsporus is thermotolerant and can multiply even at 50°C. The long holding time of the intermediates during the manufacturing process of allopurinol amplified the fungal load. Microbiological monitoring of drugs manufactured for highly immunosuppressed patients should be considered. Copyright © 2009, American Society for Microbiology. All Rights Reserved. | ||||||||
| dc.description.nature | link_to_subscribed_fulltext | ||||||||
| dc.identifier.citation | Journal Of Clinical Microbiology, 2009, v. 47 n. 9, p. 2834-2843 [How to Cite?] DOI: http://dx.doi.org/10.1128/JCM.00908-09 | ||||||||
| dc.identifier.doi | http://dx.doi.org/10.1128/JCM.00908-09 | ||||||||
| dc.identifier.epage | 2843 | ||||||||
| dc.identifier.hkuros | 165298 | ||||||||
| dc.identifier.isi | WOS:000269439600020
Funding Information: This work was partly funded by the HKSAR Research Fund commissioned block grant for the control of infectious diseases and the Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the Department of Health, the Health, Welfare, and Food Bureau of the Hong Kong Special Administrative Region of China. | ||||||||
| dc.identifier.issn | 0095-1137 2011 Impact Factor: 4.153 2011 SCImago Journal Rankings: 0.397 | ||||||||
| dc.identifier.issue | 9 | ||||||||
| dc.identifier.pmcid | PMC2738128 | ||||||||
| dc.identifier.pmid | 19641069 | ||||||||
| dc.identifier.scopus | eid_2-s2.0-70149115839 | ||||||||
| dc.identifier.spage | 2834 | ||||||||
| dc.identifier.uri | http://hdl.handle.net/10722/91711 | ||||||||
| dc.identifier.volume | 47 | ||||||||
| dc.language | eng | ||||||||
| dc.publisher | American Society for Microbiology | ||||||||
| dc.publisher.place | United States | ||||||||
| dc.relation.ispartof | Journal of Clinical Microbiology | ||||||||
| dc.relation.references | References in Scopus | ||||||||
| dc.rights | Journal of Clinical Microbiology. Copyright © American Society for Microbiology. | ||||||||
| dc.subject | Species Index: Fungi | ||||||||
| dc.subject | Rhizopus Microsporus | ||||||||
| dc.title | Outbreak of intestinal infection due to Rhizopus microsporus | ||||||||
| dc.type | Article |
Author Affiliations
- The University of Hong Kong
- Queen Mary Hospital Hong Kong