{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:04:01Z","timestamp":1790352241291,"version":"4.1.0"},"reference-count":29,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              During construction work (2017\u20132019), an increase in\n              <jats:italic>Aspergillus flavus<\/jats:italic>\n              infections was noted among pediatric patients, the majority of whom were receiving amphotericin B prophylaxis. Microsatellite genotyping was used to characterize the outbreak. A total of 153\n              <jats:italic>A<\/jats:italic>\n              .\n              <jats:italic>flavus<\/jats:italic>\n              isolates of clinical and environmental origin were included. Clinical isolates included 140 from 119 patients. Eight patients were outbreak-related patients, whereas 111 were outbreak-unrelated patients from Danish hospitals (1994\u20132023). We further included four control strains. Nine\n              <jats:italic>A. flavus<\/jats:italic>\n              isolates were from subsequent air sampling in the outbreak ward (2022\u20132023). Typing followed Rudramurthy et al.(S. M. Rudramurthy, H. A. de Valk, A. Chakrabarti, J. Meis, and C. H. W. Klaassen, PLoS One 6:e16086, 2011,\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1371\/journal.pone.0016086\" xlink:type=\"simple\">https:\/\/doi.org\/10.1371\/journal.pone.0016086<\/jats:ext-link>\n              ). Minimum spanning tree (MST) and discriminant analysis of principal components (DAPC) were used for cluster analysis. DAPC analysis placed all 153 isolates in five clusters. Microsatellite marker pattern was clearly distinct for one cluster compared to the others. The same cluster was observed in an MST. This cluster included all outbreak isolates, air-sample isolates, and additional patient isolates from the outbreak hospital, previously undisclosed as outbreak related. The highest air prevalence of\n              <jats:italic>A. flavus<\/jats:italic>\n              was found in two technical risers of the outbreak ward, which were then sealed. Follow-up air samples were negative for\n              <jats:italic>A. flavus<\/jats:italic>\n              . Microsatellite typing defined the outbreak as nosocomial and facilitated the identification of an in-hospital source. Six months of follow-up air sampling was without\n              <jats:italic>A. flavus<\/jats:italic>\n              . Outbreak-related\/non-related isolates were easily distinguished with DAPC and MST, as the outbreak clone\u2019s distinct marker pattern was delineated in both statistical analyses. Thus, it could be a variant of\n              <jats:italic>A. flavus<\/jats:italic>\n              , with a niche ability to thrive in the outbreak-hospital environment.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              <jats:italic>Aspergillus flavus<\/jats:italic>\n              can cause severe infections and hospital outbreaks in immunocompromised individuals. Although lack of isogeneity does not preclude an outbreak, our study underlines the value of microsatellite genotyping in the setting of potential\n              <jats:italic>A. flavus<\/jats:italic>\n              outbreaks. Microsatellite genotyping documented an isogenic hospital outbreak with an internal source. This provided the \u201csmoking gun\u201d that prompted the rapid allocation of resources for thorough environmental sampling, the results of which guided immediate and relevant cleaning and source control measures. Consequently, we advise that vulnerable patients should be protected from exposure and that genotyping be included early in potential\n              <jats:italic>A. flavus<\/jats:italic>\n              outbreak investigations. Inspection and sampling are recommended at any site where airborne spores might disperse from. This includes rarely accessed areas where air communication to the hospital ward cannot be disregarded.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.00273-24","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T13:04:42Z","timestamp":1718715882000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["A single-source nosocomial outbreak of\n            <i>Aspergillus flavus<\/i>\n            uncovered by genotyping"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6557-5354","authenticated-orcid":false,"given":"A.","family":"Gewecke","sequence":"first","affiliation":[{"name":"Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9796-023X","authenticated-orcid":true,"given":"R. Kr\u00f8ger","family":"Hare","sequence":"additional","affiliation":[{"name":"Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Salg\u00e5rd","sequence":"additional","affiliation":[{"name":"Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Kyndi","sequence":"additional","affiliation":[{"name":"Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"H\u00f8g","sequence":"additional","affiliation":[{"name":"Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Nahimana","sequence":"additional","affiliation":[{"name":"Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Abou-Chakra","sequence":"additional","affiliation":[{"name":"Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. D.","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rosendahl","sequence":"additional","affiliation":[{"name":"Section for Ecology and Evolution, Department for Biology, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. H.","family":"Vissing","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4747-0144","authenticated-orcid":false,"given":"M. C.","family":"Arendrup","sequence":"additional","affiliation":[{"name":"Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark"},{"name":"Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark"},{"name":"Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0507.2008.01642.x"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/13693786.2010.505206"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.10476"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jof5030055"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12418"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ297"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2006.02.014"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/13693780802709073"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/164.5.998"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003189"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70017-8"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drup.2014.01.001"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00158"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01159-11"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.34.2.345-351.1996"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2004.02.007"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12451"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01269-09"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.38.10.3612-3618.2000"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0016086"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03477.x"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myz004"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00263-17"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.3114\/sim.2007.59.05"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1128\/genomeA.00168-15"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2156-11-94"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-015-9962-6"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1086\/342699"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2014.02.008"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00273-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00273-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T13:11:48Z","timestamp":1722949908000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.00273-24"}},"subtitle":[],"editor":[{"given":"Paschalis","family":"Vergidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,6]]}},"alternative-id":["10.1128\/spectrum.00273-24"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.00273-24","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,6]]},"assertion":[{"value":"2024-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00273-24"}}