Invasive aspergillosis: epidemiology and environmental study in haematology patients (Sfax, Tunisia) I. Hadrich, 1 F. Makni, 1 H. Sellami, 1 F. Cheikhrouhou, 1 A. Sellami, 1 H. Bouaziz, 2 S. Hdiji, 2 M. Elloumi 2 and A. Ayadi 1 1 Fungal and Parasitic Molecular Biology Laboratory, School of Medicine Sfax, Sfax, Tunisia and 2 Onco-Hematolgy Department, Hedi-Chaker UH, Sfax, Tunisia Summary Invasive aspergillosis (IA) is a major opportunistic infection in haematology patients. Preventive measures are important to control IA because diagnosis is difficult and the outcome of treatment is poor. We prospectively examined the environmental contamination by Aspergillus and other fungal species and evaluated the prevalence of invasive aspergillosis in the protect unit of haematology. A three-year prospective study (December 2004–September 2007) was carried out in the department of haematology of Hedi Chaker Hospital. Suspected invasive aspergillosis cases were reviewed and classified as proven, probable and possible invasive aspergillosis using the EORTC criteria. During the study period, we collected weekly environmental samples (patientÕs rooms, tables and acclimatisers) and clinical samples from each patient (nasal, expectoration and auricular). Among 105 neutropenic patients, 16 had probable and 13 had possible IA. A total of 1680 clinical samples were collected and A. flavus was most frequently isolated (79.2%). Analysis of 690 environmental samples revealed that Penicillium (44%) was the most frequent followed by Cladosporium (20%), Aspergillus spp. (18%) and Alternaria (13%). The PCR-sequencing of 30 A. flavus isolates detected from clinical and environmental samples confirmed the mycological identification. Our findings underline the importance of environmental surveillance and strict application of preventive measures. Key words: Department of haematology, invasive aspergillosis, Aspergillus flavus, environment, Sfax, Tunisia. Introduction The incidence rates of invasive aspergillosis have increased dramatically during the last two decades, and despite all diagnosis and therapeutic efforts, out- come is often fatal. 1 Therefore, preventive measures are of major importance to control invasive aspergillosis, and require full understanding of the epidemiology of this devastating disease. The environment has been suggested to play a crucial role in the epidemiology of invasive aspergillosis. 2 The aims of our study were to prospectively examine the filamentous fungal flora of patients and the environmental contamination by Aspergillus and other fungal species. Materials and methods Patients The study was conducted between December 2004 and September 2007 on patients hospitalised in the depart- ment of haematology of Hedi Chaker Hospital. The follow-up population was restricted to patients con- sidered at a high risk of invasive aspergillosis, i.e. all neutropenic patients who had febrile episode (temper- ature >38.5 °C) and neutrophiles per ll <500 more than 10 days. A total of 105 patients were included in this study: 45 with acute myeloid leukaemia, 35 with acute lymphoblastic leukaemia, 15 with medullar aplasia and 10 with other diseases. The department of haematology is a seven-bed capacity. The monitored Correspondence: Prof. Ali Ayadi, Fungal and Parasitic Molecular Biology Laboratory, School of Medicine Sfax, Tunisia. Tel.: +216 7424 7130. Fax: +216 7424 7130. E-mail: ali.ayadi@rns.tn Accepted for publication 4 February 2009 Original article Ó 2009 Blackwell Verlag GmbH • Mycoses 53, 443–447 doi:10.1111/j.1439-0507.2009.01710.x mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases