PEARLS Investigating Fungal Outbreaks in the 21st Century

Public attention has been drawn to recent high-profile outbreaks of mycotic diseases, such as those of fungal meningitis and other infections linked to contaminated steroids [1] and an out-break of necrotizing cutaneous mucormycosis linked to a tornado [2]. However, fungal out-breaks are more common than most people appreciate, and reports of outbreaks caused by unusual fungal pathogens are increasing. The Mycotic Diseases Branch at the Centers for Dis-ease Control and Prevention (CDC) investigates 3–6 fungal outbreaks per year, many of which are caused by rare fungi with limited diagnostic and treatment options. This is a considerable increase from the 1990s, when the Branch investigated 1–2 hospital-based outbreaks per year, generally caused by yeast and traced to a single source. Although the exact reasons for this in-crease are unknown, the increased number of patients with impaired immune system may have contributed to this trend. The majority of fungal outbreaks can be attributed to either environmental exposure or a contaminated product (Table 1). For example, two recent outbreaks were linked to contaminat-ed medications. In 2012, two medications produced by a single compounding pharmacy in Flor-ida were contaminated with Fusarium sp. and Bipolaris sp., respectively, shipped to 15 states