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Houston hospital saw no increase in mold infections after Hurricane Harvey
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Houston’s MD Anderson Cancer Center did not see an apparent increase in invasive mold infections in patients treated after Hurricane Harvey, despite concerns that extensive floodwater damage would lead to an excess of cases in immunocompromised patients, researchers said.
Previous study findings showed that, following the 2017 storm, almost 40% of immunocompromised patients in the Houston area participated in cleanup activities that placed them at risk for invasive mold infections, and that most wore either no personal protective equipment or were underprotected.
“Molds are ubiquitous in the environment, and their growth is promoted by warm and humid conditions,” Dimitrios P. Kontoyiannis, MD, ScD, PhD, Texas 4000 Distinguished Endowed Professor for Cancer Research and deputy head of internal medicine at The University of Texas MD Anderson Cancer Center, told Infectious Diseases News. “As these infections are not nationally notifiable nor reportable in the state of Texas, there is a knowledge gap on the prevalence of invasive mold infections (IMIs) following major natural events such as Hurricane Harvey.”
For the current study, Kontoyiannis and colleagues reviewed all mold-positive culture results from the microbiology laboratory at MD Anderson Cancer Center from 12 months before and 12 months after Hurricane Harvey, comparing rates of culture documented invasive mold infections and causative agents pre- and post-storm.
According to the study, rates of inpatient culture-positive IMI (cIMI) per 1,000 patient days were comparable before and after the storm: 0.17 vs. 0.21, respectively. Specifically, 188 cultures were positive for mold pathogens before Harvey and 195 after. Aspergillus species, Fusarium species or Mucorales caused the “vast majority” of cIMI cases during both surveillance periods, and no unusual mold infections were observed, Kontoyiannis and colleagues reported.
Additionally, they said that the amount of mold genera recovered from cultures at the hospital was “largely unaltered.”
They highlighted the increased use of “some” mold-active antifungals following the storm. Specifically, posaconazole use increased significantly, and the use of voriconazole and liposomal amphotericin B “began to increase significantly,” they wrote.
“The results of this small study, although reassuring, need to be viewed with caution as we employed very stringent culture-based case definitions of IMIs according to established criteria (EORTC/MSG definitions), which have a high specificity but limited sensitivity,” Kontoyiannis said. “In the future, we hope to work with public health partners, including Houston, Texas state and CDC and conduct a thorough, patient-level review by using less stringent criteria to look for excess-IMI cases not fitting the traditional diagnostic criteria (eg, biomarker-positive but culture-negative IMIs) or cases of severe pneumonia of unknown pathogen.
“Hopefully, much more complete future data would aid the development of strategies and guidance for the public (including immunosuppressed hosts) by further understanding the trends of IMI in post-hurricane/flood settings, which can be translated to other areas affected by similar events.” – by Marley Ghizzone
Disclosures: Kontoyiannis reports receiving research support from Astellas Pharma and honoraria for lectures from Merck & Co, Gilead Sciences, and United Medical, serving as a consultant for Astellas Pharma, Cidara, Amplyx, Astellas, and Mayne, and being on the advisory board of Merck & Co. Please see the study for all other authors’ relevant financial disclosures.
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Mitsuru Toda, PhD
This article is a helpful, initial look at mold infections following Hurricane Harvey, and we agree with the authors that the case definition criteria they used were stringent and likely missing cases. Also, we agree that more work is needed in this area.
Clinicians should be aware that immunocompromised patients are at risk for invasive mold infections. The CDC and other federal agencies recommend that immunocompromised people stay away from mold-damaged buildings until remediation is complete.
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