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Article: Outbreak of intestinal infection due to Rhizopus microsporus

TitleOutbreak of intestinal infection due to Rhizopus microsporus
Authors
KeywordsSpecies Index: Fungi
Rhizopus Microsporus
Issue Date2009
PublisherAmerican Society for Microbiology
Citation
Journal Of Clinical Microbiology, 2009, v. 47 n. 9, p. 2834-2843 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/91711
ISSN
2014 Impact Factor: 3.993
PubMed Central ID
ISI Accession Number ID
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.

References

 

DC FieldValueLanguage
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorChan, JFWen_HK
dc.contributor.authorNgan, AHYen_HK
dc.contributor.authorTo, KKWen_HK
dc.contributor.authorLeung, SYen_HK
dc.contributor.authorTsoi, HWen_HK
dc.contributor.authorYam, WCen_HK
dc.contributor.authorTai, JWMen_HK
dc.contributor.authorWong, SSYen_HK
dc.contributor.authorTse, Hen_HK
dc.contributor.authorLi, IWSen_HK
dc.contributor.authorLau, SKPen_HK
dc.contributor.authorWoo, PCYen_HK
dc.contributor.authorLeung, AYHen_HK
dc.contributor.authorLie, AKWen_HK
dc.contributor.authorLiang, RHSen_HK
dc.contributor.authorQue, TLen_HK
dc.contributor.authorHo, PLen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2010-09-17T10:24:03Z-
dc.date.available2010-09-17T10:24:03Z-
dc.date.issued2009en_HK
dc.identifier.citationJournal Of Clinical Microbiology, 2009, v. 47 n. 9, p. 2834-2843en_HK
dc.identifier.issn0095-1137en_HK
dc.identifier.urihttp://hdl.handle.net/10722/91711-
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.en_HK
dc.languageengen_HK
dc.publisherAmerican Society for Microbiologyen_HK
dc.relation.ispartofJournal of Clinical Microbiologyen_HK
dc.rightsJournal of Clinical Microbiology. Copyright © American Society for Microbiology.-
dc.subjectSpecies Index: Fungien_HK
dc.subjectRhizopus Microsporusen_HK
dc.titleOutbreak of intestinal infection due to Rhizopus microsporusen_HK
dc.typeArticleen_HK
dc.identifier.emailChan, JFW: jfwchan@hku.hken_HK
dc.identifier.emailTo, KKW: kelvinto@hkucc.hku.hken_HK
dc.identifier.emailLeung, SY: suetyi@hku.hken_HK
dc.identifier.emailTsoi, HW: hwtsoi@hkucc.hku.hken_HK
dc.identifier.emailYam, WC: wcyam@hkucc.hku.hken_HK
dc.identifier.emailWong, SSY: samsonsy@hkucc.hku.hken_HK
dc.identifier.emailTse, H: htse@hkucc.hku.hken_HK
dc.identifier.emailLau, SKP: skplau@hkucc.hku.hken_HK
dc.identifier.emailWoo, PCY: pcywoo@hkucc.hku.hken_HK
dc.identifier.emailLeung, AYH: ayhleung@hku.hken_HK
dc.identifier.emailLiang, RHS: rliang@hku.hken_HK
dc.identifier.emailHo, PL: plho@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY: kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityChan, JFW=rp01736en_HK
dc.identifier.authorityTo, KKW=rp01384en_HK
dc.identifier.authorityLeung, SY=rp00359en_HK
dc.identifier.authorityTsoi, HW=rp00439en_HK
dc.identifier.authorityYam, WC=rp00313en_HK
dc.identifier.authorityWong, SSY=rp00395en_HK
dc.identifier.authorityTse, H=rp00519en_HK
dc.identifier.authorityLau, SKP=rp00486en_HK
dc.identifier.authorityWoo, PCY=rp00430en_HK
dc.identifier.authorityLeung, AYH=rp00265en_HK
dc.identifier.authorityLiang, RHS=rp00345en_HK
dc.identifier.authorityHo, PL=rp00406en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1128/JCM.00908-09en_HK
dc.identifier.pmid19641069en_HK
dc.identifier.pmcidPMC2738128-
dc.identifier.scopuseid_2-s2.0-70149115839en_HK
dc.identifier.hkuros165298-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70149115839&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume47en_HK
dc.identifier.issue9en_HK
dc.identifier.spage2834en_HK
dc.identifier.epage2843en_HK
dc.identifier.isiWOS:000269439600020-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridCheng, VCC=23670479400en_HK
dc.identifier.scopusauthoridChan, JFW=24278817900en_HK
dc.identifier.scopusauthoridNgan, AHY=14037517900en_HK
dc.identifier.scopusauthoridTo, KKW=14323807300en_HK
dc.identifier.scopusauthoridLeung, SY=7202044886en_HK
dc.identifier.scopusauthoridTsoi, HW=6603822102en_HK
dc.identifier.scopusauthoridYam, WC=7004281720en_HK
dc.identifier.scopusauthoridTai, JWM=7101993154en_HK
dc.identifier.scopusauthoridWong, SSY=13310021400en_HK
dc.identifier.scopusauthoridTse, H=7006070596en_HK
dc.identifier.scopusauthoridLi, IWS=24464179500en_HK
dc.identifier.scopusauthoridLau, SKP=7401596211en_HK
dc.identifier.scopusauthoridWoo, PCY=7201801340en_HK
dc.identifier.scopusauthoridLeung, AYH=7403012668en_HK
dc.identifier.scopusauthoridLie, AKW=24284842400en_HK
dc.identifier.scopusauthoridLiang, RHS=26643224900en_HK
dc.identifier.scopusauthoridQue, TL=7003786628en_HK
dc.identifier.scopusauthoridHo, PL=7402211363en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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