Fungus (aspergillus) attacks patients with suppressed immune systems (3-12-96)

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Fungus attacks patients with suppressed immune systems

by Howington for Gannett News Service

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Shayne Quinkert's brain tumor had all but disappeared after six weeks of

radiation last fall, his mother says.

But Quinkert, of New Albany, Ind., died in November of another menace - a

fungus known as aspergillus that invaded his body and ate away his lung.

The fungus is found in soil, food mold, old buildings and elsewhere, and

poses no threat to most people. But to patients with suppressed immune

systems, including organ recipients and cancer patients, it can be deadly.

Transplant surgeons and administrators at Jewish Hospital in Louisville,

Ky., where Quinkert was treated, say deaths from aspergillus can occur at

all hospitals that do organ transplants. Airborne spores can enter from

outside the hospital though doorways or ventilation systems, or in plants or

food.

Quinkert's mother, Lin Quinkert, believes there is another source. She

recently sued Jewish Hospital, saying construction to replace the hospital's

brick exterior stirred up aspergillus spores from under old bricks.

Hospital construction projects can stir vast quantities of dirt into the air

and increase risk of aspergillus infection, said Dr. Rana Hajjeh of the

Centers for Disease Control and Prevention's division of bacterial and

mycotic diseases.

Not all patients infected with the fungus become ill. It can establish

harmless colonies in airways and is easily treated with antibiotics. Lin

Quinkert's suit accused the hospital, a leading regional organ transplant

center, of negligence by exposing Shayne to the fungus. Families of four

other Jewish Hospital patients - three of whom died - also have hired

lawyers.

The hospital administration says Shayne Quinkert contracted the infection

outside the hospital, and has an expert report saying there is no evidence

of more aspergillus cases than usual for a hospital of its sort.

But the cases spurred persistent rumors among hospital employees. Even some

seasoned nurses asked for special air filters at nursing stations " as if

this was the Ebola virus or bubonic plague, " said Dr. Frederick Bentley,

co-director of abdominal organ transplantation at Jewish Hospital.

Bentley said he was " very assured that the hospital has taken all of the

steps (needed to combat aspergillus infection). If I thought today that if

we did a transplant they were going to be at increased risk for an

aspergillus infection, I wouldn't do them. "

The hospital's consultant, Dr. Rhame of the University of Minnesota,

reviewed the records of 11 of 17 organ-transplant patients with evidence of

aspergillus since September 1994, and concluded only one patient acquired

his infection while in the hospital.

Most aspergillus cases " are acquired in the community, " Rhame wrote. He also

reviewed two neurosurgery cases, including Shayne Quinkert' s, and said both

were " clearly community-acquired. "

Rhame also wrote in his preliminary report - a final one is not yet

complete - that " Jewish Hospital is and has been acting aggressively to be

sure no such problem is or will be present. "

During its long renovation, Jewish Hospital moved immuno-suppressed patients

to wings far from the construction and placed special filters in some rooms.

Some were moved just 11 days after the death of Goodwin, 56, of

Winchester, Ky., a lung transplant recipient. His death certificate says he

died of an aspergillus infection that spread through his body. The hospital

says the patients were moved as a precaution. His widow has hired a lawyer.

Two other deaths have been linked to aspergillus. Bernard L. Wooley III, 43,

of Somerset, Ky., who received a liver in 1994, died last summer of

respiratory failure, but his death certificate lists aspergillosis as a

contributing cause.

And Freddie D. Bare, 42, of s Creek, Ky., died in November of " invasive

aspergillosis involving just about every organ of his body, " said Dr.

Nichols, a pathologist who performed Bare's autopsy at his family's

request and who also is Kentucky medical examiner.

Both Bare and Wooley were in and out of the hospital repeatedly after their

transplants, making it difficult to prove where they became infected.

Jewish Hospital administrators say Shayne Quinkert was infected elsewhere

because he was not diagnosed until more than seven weeks after leaving the

hospital. The incubation period averages about four weeks.

His mother does not believe the answer is so obvious.

Shayne had a shunt placed in his brain to relieve pressure from the tumor,

and stayed in the hospital for 10 days in August. He later began radiation

treatments and took steroids, which further weakened his immune system.

By mid-September, he developed flu-like symptoms that antibiotics did not

alleviate. On Oct. 11, his internist admitted him to Memorial Hospital

in Jeffersonville, Ind., where he was diagnosed with aspergillosis.

On Nov. 3, surgeons operated to repair internal bleeding, and found the

upper lobe of Shayne's left lung was full of dead tissue due to

aspergillosis, and removed it. Hours later, his mother said, he died.

The cause of death was aspergillus infection, coupled with bacterial

pneumonia and an infection of the central nervous system, according to

Indiana death records.

" None of this will bring Shayne back, " Quinkert said. " I don't want anyone

else to be put through what I've been through. "

PATRICK HOWINGTON, Fungus attacks patients with suppressed immune systems.,

Gannett News Service, 03-12-1996, pp arc.