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Article: Outbreak of intestinal infection due to Rhizopus microsporus
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TitleOutbreak of intestinal infection due to Rhizopus microsporus
 
AuthorsCheng, VCC1 2
Chan, JFW1
Ngan, AHY1
To, KKW1
Leung, SY1
Tsoi, HW1
Yam, WC1
Tai, JWM2
Wong, SSY1
Tse, H1
Li, IWS1
Lau, SKP1
Woo, PCY1
Leung, AYH2
Lie, AKW2
Liang, RHS2
Que, TL
Ho, PL1
Yuen, KY1
 
KeywordsSpecies Index: Fungi
Rhizopus Microsporus
 
Issue Date2009
 
PublisherAmerican Society for Microbiology
 
CitationJournal Of Clinical Microbiology, 2009, v. 47 n. 9, p. 2834-2843 [How to Cite?]
DOI: http://dx.doi.org/10.1128/JCM.00908-09
 
AbstractSinopulmonary 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.
 
ISSN0095-1137
2012 Impact Factor: 4.068
2012 SCImago Journal Rankings: 1.785
 
DOIhttp://dx.doi.org/10.1128/JCM.00908-09
 
PubMed Central IDPMC2738128
 
ISI Accession Number IDWOS:000269439600020
Funding AgencyGrant Number
HKSAR Research Fund
Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the Department of Health
Health, Welfare, and Food Bureau of the Hong Kong Special Administrative Region of China
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.

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorCheng, VCC
 
dc.contributor.authorChan, JFW
 
dc.contributor.authorNgan, AHY
 
dc.contributor.authorTo, KKW
 
dc.contributor.authorLeung, SY
 
dc.contributor.authorTsoi, HW
 
dc.contributor.authorYam, WC
 
dc.contributor.authorTai, JWM
 
dc.contributor.authorWong, SSY
 
dc.contributor.authorTse, H
 
dc.contributor.authorLi, IWS
 
dc.contributor.authorLau, SKP
 
dc.contributor.authorWoo, PCY
 
dc.contributor.authorLeung, AYH
 
dc.contributor.authorLie, AKW
 
dc.contributor.authorLiang, RHS
 
dc.contributor.authorQue, TL
 
dc.contributor.authorHo, PL
 
dc.contributor.authorYuen, KY
 
dc.date.accessioned2010-09-17T10:24:03Z
 
dc.date.available2010-09-17T10:24:03Z
 
dc.date.issued2009
 
dc.description.abstractSinopulmonary 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.naturelink_to_subscribed_fulltext
 
dc.identifier.citationJournal 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.doihttp://dx.doi.org/10.1128/JCM.00908-09
 
dc.identifier.epage2843
 
dc.identifier.hkuros165298
 
dc.identifier.isiWOS:000269439600020
Funding AgencyGrant Number
HKSAR Research Fund
Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the Department of Health
Health, Welfare, and Food Bureau of the Hong Kong Special Administrative Region of China
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.issn0095-1137
2012 Impact Factor: 4.068
2012 SCImago Journal Rankings: 1.785
 
dc.identifier.issue9
 
dc.identifier.pmcidPMC2738128
 
dc.identifier.pmid19641069
 
dc.identifier.scopuseid_2-s2.0-70149115839
 
dc.identifier.spage2834
 
dc.identifier.urihttp://hdl.handle.net/10722/91711
 
dc.identifier.volume47
 
dc.languageeng
 
dc.publisherAmerican Society for Microbiology
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of Clinical Microbiology
 
dc.relation.referencesReferences in Scopus
 
dc.rightsJournal of Clinical Microbiology. Copyright © American Society for Microbiology.
 
dc.subjectSpecies Index: Fungi
 
dc.subjectRhizopus Microsporus
 
dc.titleOutbreak of intestinal infection due to Rhizopus microsporus
 
dc.typeArticle
 
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<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 &lt; 0.001) and that of commercially packaged ready-to-eat food items in the preceding 2 weeks (P &lt; 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 &#215; 10 3 CFU/g of tablet (range, 3.07 &#215; 10 3 to 5.48 &#215; 10 3) and 3.24 &#215; 10 3 CFU/g of tablet (range, 2.68 &#215; 10 3 to 3.72 &#215; 10 3), respectively, which were much higher than the mean count of 2 &#215; 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&apos; 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&#176;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 &#169; 2009, American Society for Microbiology. All Rights Reserved.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong