Table 3.
Nosocomial outbreaks of non-Aspergillus moulds, typing methods employed, and results.
| Country, Year Published (Ref) | Setting and Infection Site(s) where Known | Pathogen | No. Isolates/No. Patients | Typing Method(s) | Results | Outbreak Caused by Clonal Strain (Yes/No) | Source of Outbreak | Mortality |
|---|---|---|---|---|---|---|---|---|
| Scedosporium and Lomentospora species | ||||||||
| Spain 1997 [250] | Haematology/oncology, single centre | Lomentopsora prolificans | 14/4 | RAPD, PCR fingerprinting | Four outbreak isolates consisted of three molecular types with two patients sharing a similar strain | No | Unknown | 100% |
| Spain 2001 [248] | Haematology/oncology, single centre | L. prolificans | 6/6 | PCR fingerprinting | Clinical and environmental isolates had identical M13 fingerprint patterns | Yes; but may not be adequately discriminatory | Unknown | 100% |
| Germany 2015 [252] | Surgical patients, single centre | Scedosporium boydii | 5/5 | MLST | Identical MLST type was found in 5 patients | Yes | Unknown | 50% |
| Fusarium species complex | ||||||||
| Brazil 2017 [253] | Paediatric haematology/oncology, single centre | Fusarium oxysporum | 16/7 | AFLP | All 7 strains from blood and catheter tips were genetically similar | Yes | Unknown | 0% |
| South Korea 2022 [254] | Eye surgery patients, multiple centres | F. oxysporum | 39/39 | MLST | 12 clinical F. oxysporum isolates and 2 isolates from contaminated ocular device were of the same MLST type | Yes | Ocular viscoelastic device | Not specified |
| Mucorales | ||||||||
| Germany 2000 and 2019 [255,256] | Haematology/oncology, single centre | Cunninghamella bertholletiae | 4/4 | Rep-PCR, RAPD, microsatellite typing | Probable epidemiological association of the cluster isolates demonstrated by microsatellite genotyping (all were clonally related) | Yes | Possible hospital construction | 75% |
| France 2018 [257] | Burn unit, single centre, wound infection | Mucor circinelloides f. circinelloides | 14/7 | WGS | Four clades amongst outbreak isolates with each clade separated by >290,000 SNPs; isolates within each clade varied by <20,000 SNPs; seven “control” isolates also fell within these four clades | No multiple genetically diverse strains caused outbreak |
Unknown; no point source | 83% |
| Argentina 2018 [258] | Post-arthroscopic anterior cruciate ligament repair, bone infection |
Rhizopus microsporus | 3/3 | RAPD and MALDI-TOF MS | All three strains fell within one cluster using both methods; three “control” strains fell into a separate cluster | Yes; however, resolution of RAPD and MALDI-TOF MS likely insufficient | Unknown | 0% |
| Canada 2019 [259] | Heart/lung transplantation, single centre, various sites | Rhizomucor pusillus (n = 2); Lichtheimia ramosa (n = 1) | 3/3 | WGS | The 2 R. pusillus genomes differed by >5900 core SNPs. | No, and no common source | Unknown | 33% |
| USA 2020 [260] | Solid-organ transplantation, single centre | R. microsporus (n = 2), Rhizopus arrhizus (n = 1), Lichtheimia corymbifera (n = 1) | 4/4 | WGS | 4 case isolates and 68 “control” clinical and environmental isolates showed high genetic diversity overall. Pan-genome analysis showed two patient R. microsporus isolates were similar, but no link between cases with environmental isolates or with other “control” isolates | No support for point source or patient-to-patient transmission for Rhizopus infections | Unknown | Unknown |
| Miscellaneous species | ||||||||
| USA 2014 [261] | Patients receiving steroid injections, multiple centres |
Exserohilum rostratum | 28/19 | WGS | All 28 isolates had nearly identical genomes and were separated by </= 8 SNPs | Yes | Methylprednisolone acetate medication produced by single compounding pharmacy | Not specified |
| Chile and Colombia 2016 [262] | Oncology, multiple centres |
Sarocladium kiliense | 25/18 (18 clinical isolates, 7 environmental isolates) |
WGS | All 18 outbreak isolates were separated by <5 SNPs) as they were from 7 strains from anti-nausea medication vials | Yes | Contaminated anti-nausea medication | Not specified |
Abbreviations: AFLP, amplified fragment length polymorphism; MLST, multilocus sequence typing; RAPD, random amplification of polymorphic DNA; rep-PCR, repetitive sequence-based PCR; SNPs, single-nucleotide polymorphisms; WGS, whole genome sequencing.