Preventing Fungal Disease in Chronically Immunosuppressed Outpatients: Time for Action?
Authors: Dimitrios P. Kontoyiannis
Journal: Annals of Internal Medicine (2013)

Ideas and Opinions2 April 2013Preventing Fungal Disease in Chronically Immunosuppressed Outpatients: Time for Action?Dimitrios P. Kontoyiannis, MD, ScDDimitrios P. Kontoyiannis, MD, ScDFrom The University of Texas MD Anderson Cancer Center, Houston, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-7-201304020-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The issues of infection control and avoiding exposure to environmental fungi in outpatients with chronic immunosuppression are unique and timely, especially for transplant recipients or those with hematologic cancer. The increasing use of chemotherapy and stem cell transplantation in the outpatient setting and the increased mobility of these patients, including long-distance travel, create complex and variable scenarios of exposure to various fungi and late infectious complications (1). Typically, these patients have a lower net state of immunosuppression than acutely hospitalized patients and have differing patterns and degrees of immune reconstitution. The safety of patients' residences is not regulated, because the ...References1. Bieri S, Roosnek E, Ozsahin H, Huguet S, Ansari M, Trombetti A, et al. Outcome and risk factors for late-onset complications 24 months beyond allogeneic hematopoietic stem cell transplantation. Eur J Haematol. 2011;87:138-47. [PMID: 21535161] CrossrefMedlineGoogle Scholar2. Kontoyiannis DP. Antifungal prophylaxis in hematopoietic stem cell transplant recipients: the unfinished tale of imperfect success. Bone Marrow Transplant. 2011;46:165-73. [PMID: 21042306] CrossrefMedlineGoogle Scholar3. Partridge-Hinckley K, Liddell GM, Almyroudis NG, Segal BH. Infection control measures to prevent invasive mould diseases in hematopoietic stem cell transplant recipients. Mycopathologia. 2009;168:329-37. [PMID: 19859825] CrossrefMedlineGoogle Scholar4. Centers for Disease Control and Prevention (CDC). Healthcare-associated infections: guidelines and recommendations. Accessed at www.cdc.gov/HAI/prevent/prevent_pubs.html on 2 January 2013. Google Scholar5. Centers for Disease Control and Prevention (CDC). Healthcare-associated infections: basic infection control and prevention plan for outpatient oncology settings. Accessed at www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-2011/ on 5 February 2013. Google Scholar6. Sipsas NV, Kontoyiannis DP. Occupation, lifestyle, diet, and invasive fungal infections. Infection. 2008;36:515-25. [PMID: 18998051] CrossrefMedlineGoogle Scholar7. Lass-Flörl C, Grif K, Kontoyiannis DP. Molecular typing of Aspergillus terreus isolates collected in Houston, Texas, and Innsbruck, Austria: evidence of great genetic diversity. J Clin Microbiol. 2007;45:2686-90. [PMID: 17581930] CrossrefMedlineGoogle Scholar8. Raad I, Tarrand J, Hanna H, Albitar M, Janssen E, Boktour M, et al. Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer. Infect Control Hosp Epidemiol. 2002;23:532-7. [PMID: 12269452] CrossrefMedlineGoogle Scholar9. Panackal AA, Li H, Kontoyiannis DP, Mori M, Perego CA, Boeckh M, et al. Geoclimatic influences on invasive aspergillosis after hematopoietic stem cell transplantation. Clin Infect Dis. 2010;50:1588-97. [PMID: 20450414] CrossrefMedlineGoogle Scholar10. Warris A, Onken A, Gaustad P, Janssen W, van der Lee H, Verweij PE, et al. Point-of-use filtration method for the prevention of fungal contamination of hospital water. J Hosp Infect. 2010;76:56-9. [PMID: 20542590] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Dimitrios P. Kontoyiannis, MD, ScDAffiliations: From The University of Texas MD Anderson Cancer Center, Houston, Texas.Grant Support: This research is supported in part by the MD Anderson Cancer Center (grant CA016672). Dr. Kontoyiannis is the recipient of the Frances King Black Endowed Professorship for Cancer Research.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2735.Corresponding Author: Dimitrios P. Kontoyiannis, MD, ScD, Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; e-mail, dkontoyi@mdanderson.org.Author Contributions: Conception and design: D. Kontoyiannis.Analysis and interpretation of the data: D. Kontoyiannis.Drafting of the article: D. Kontoyiannis.Critical revision of the article for important intellectual content: D. Kontoyiannis.Final approval of the article: D. Kontoyiannis. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInfection Control Strategies in Transplant PopulationsInfections in Hematopoietic Stem Cell Transplant RecipientsEmerging Issues With Diagnosis and Management of Fungal Infections in Solid Organ Transplant RecipientsEvaluation of mold exposure in cystic fibrosis patients' dwellings and allergic bronchopulmonary riskEvaluation of invasive aspergillosis risk of immunocompromised patients alternatively hospitalized in hematology intensive care unit and at homeSurveillance of patients identified with fungal mold at a public academic medical centerOur recommendations for avoiding exposure to fungi outside the hospital for patients with haematological cancers 2 April 2013Volume 158, Issue 7Page: 555-556KeywordsFungal diseasesHematologic malignanciesHygieneImmunosuppressivesInhalationOutpatient clinicsOutpatientsProphylaxisSafetyStem cell transplantation ePublished: 2 April 2013 Issue Published: 2 April 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...