Mucormycosis outbreak associated with hospital linens

Pediatr Infect Dis J. 2014 May;33(5):472-6. doi: 10.1097/INF.0000000000000261.


Background: Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections.

Methods: A case was defined as a hospital-onset illness consistent with mucormycosis, confirmed by culture or histopathology. Case-patient medical records were reviewed for clinical course and exposure to items and locations within the hospital. Environmental samples were collected from air and surfaces. Fungal isolates collected from case-patients and the environmental samples were identified using DNA sequencing.

Results: Five case-patients had hospital-associated cutaneous mucormycosis over an 11-month period; all subsequently died. Three case-patients had conditions known to be associated with susceptibility to mucormycosis, while 2 had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas and from 1 (4%) of 25 samples from nonlinen-related items. Case-patients were infected with Rhizopus delemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility.

Conclusions: Hospital linens were identified as a vehicle that carried R. delemar into contact with susceptible patients. Fungal species identification using DNA-based methods is useful for corroborating epidemiologic links in hospital outbreak investigations. Hospital linens should be laundered, packaged, shipped and stored in a manner that minimizes exposure to environmental contaminants.

MeSH terms

  • Adolescent
  • Animals
  • Bedding and Linens / microbiology*
  • Child
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / transmission
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • Disease Outbreaks*
  • Female
  • Histocytochemistry
  • Hospitals, Pediatric
  • Humans
  • Infant, Newborn
  • Male
  • Microbiological Techniques
  • Mucormycosis / epidemiology*
  • Mucormycosis / microbiology
  • Mucormycosis / transmission
  • Rhizopus / classification
  • Rhizopus / genetics
  • Rhizopus / isolation & purification*
  • Sequence Analysis, DNA


  • DNA, Fungal