14-MAR-2007 -- The Preventive Medicine Service in Principe de Asturias at Alcala de
Henares Hospital in Madrid, together with the General Directorate for
Public Health is currently investigating the origin of 11 cases of
_Aspergillus_ infection in elderly patients, of whom 4 died in the
last 2 months.

In a press conference, Dr. Alfonso Diaz-Canete, stated that "until we
have the final results of the investigation, we still have not found
a concrete cause" of what he described as "a condition that occurred
for a shorter than usual time in a certain group of patients."

Dr. Diaz-Canete stated that 4 elderly and chronic patients who had
severe respiratory conditions and who were infected by _Aspergillus_
died. However, the chief of the Internal Medicine service, Dr.
Joaquin Lopez-Alvarez, pointed out that "it is very difficult to
determine" that the aforementioned microorganism was the cause of
these deaths, "since we do not have evidence for this," but he
recognized that the fungus "contributes [to] the severity of the
condition" in patients who are already ill.

Dr. Almudena Perez, head of the Madrid Health Service, said "the
situation is under control," and the Sanitation Council and Alcala
hospital have taken "every available measure" for this infectious
outbreak, and that "every effort has been made" for controlling its
dissemination. Consequently, she also said that patients at the
Principe de Asturias Hospital and Madrid citizens "can have every
guarantee that every safety measure has been taken and that every
effort has been done" for controlling this outbreak.

On the other hand, the "Defensor del Paciente" Association (a NGO for
preserving the rights of patients) requested the Madrid Attorney to
open an investigation about these 4 deaths and to establish all
responsibilities for this occurrence, according to a press release.

[Aspergillosis is caused by the fungus _ Aspergillus _ sp. This
particular fungus is often found in decaying material, such as piles
of dead leaves, rotting vegetation, as might be found in compost
heaps, and stored commodities such as grain.

_Aspergillus_ can cause invasive lung disease and may form fungal
balls in the lungs, particularly if there are previous tuberculosis
scars or abscesses, whether old or active. Invasive aspergillosis may
appear with clinical symptoms initially similar to the flu, such as
fever, aches, chills, headaches, and include shortness of breath,
vision difficulties, and bloody sputum.

It may cause allergic symptoms similar to asthma conditions,
frequently resulting in fever, wheezing, coughing and weight loss.

Diagnosis may be based upon history, clinical signs and symptoms and
a radiograph (x-ray) of the chest, sputum culture, or even a tissue
biopsy [for a chest x-ray image see:
<http://www4.umdnj.edu/cswaweb/rad_teach/images/pri_asp_04.jpg> -
Mod.JW].  Fungus balls may require surgery if they cause bleeding
into the lung tissue.

The invasive form may require antifungal medications such as
Itraconazole or voriconasol. Amphotericin B may also be used.
Endocarditis may occur with the invasive form and may be treated with
amphotericin B. These drugs have their own set of problems and should
be monitored carefully by a physician, as kidney failure may be a
severe consequence of use of the drug.

Generally, with proper treatment and a responsive immune system,
patients make a gradual recovery.

In this particular case, we are not told how the patients acquired
the disease or what their immune status is. We are told they were
elderly and the ability to respond immunologically tends to decrease
with age. While investigating the occurrences of this disease, it
would be helpful to know the circumstances of exposure and if the
patients were close to each other. - Mod.TG]

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