Reducing Risk for Opportunistic Fungal Infection in the Immunocompromised:
A Guide to Cleaning and Management of the Home Environment
Speaker: Eugene C. Cole, DrPH
Department of Health Science
Level of Knowledge: Multi-Level
Life-threatening infections from common indoor environmental molds such as Aspergillus, Fusarium, Alternaria, Paecilomyces and Rhizopus, have continued to increase in those immunocompromised due to HIV/AIDS, neoplasms, cancer chemotherapy, transplantation, and underlying lung disease. Children with neutropenia or prolonged corticosteroid therapy are especially susceptible to infection. Species of Aspergillus in particular, are recognized as significant emerging pathogens in persons with AIDS. It is thus critical that the home environment be properly cleaned and environmentally managed to reduce fungal reservoirs at least one week prior to the arrival of the susceptible patient. Guidance for this risk reduction has been developed and includes: 1) controlling moisture in the air and on surfaces and materials; 2) cleaning reservoirs, by removing soil, dusts, and other potential growth substrates, 3) preventing amplification of residual fungi remaining after cleaning through disinfection, 4) restricting pollutant build-up and entry from outside the home, and 5) using efficient air-cleaning devices. Understanding and adherence to these recommendations for both resident occupants and experienced cleaning professionals is essential for achieving a meaningful risk reduction.