From the breeze or from the bucket

Invasive aspergillosis is the greatest infec-tious threat to the survival of bone marrow transplant recipients and certain solid-organ transplantation patients. Mortality, which can exceed 80%, is so high for doc-umented disease that attention has fo-cused increasingly on prevention. Preven-tion includes both antifungal prophylax-is and the separation of patients from sources of infection. We have traditionally used early prophylaxis while the patient is hospitalized, but recent studies have shown that development of invasive as-pergillosis after bone marrow transplanta-tion may be delayed until a time long after patients have returned home [1]. Also, the sources of Aspergillus infection may be broader than we think. In this issue of Clinical Infectious Diseases, Anaissie and Costa [2] present evidence that implicates the water supply as a major source of my-celial fungal infection. Hajjeh and War-nock [3] support the more traditional view that there is greater risk of airborne transmission of infection. When to use an-tifungal prophylaxis and how to shelter patients from Aspergillus infection may be more complicated than we once thought