Repeated Aspergillusisolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?

Background: Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation), treatment (administration or not of antifungals) and prognosis (mortality) in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples. Methods: Records of adult patients (29 Spanish hospitals) presenting ≥2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation) or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging) or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates). Logistic regression models (step-wise) were performed using Aspergillosis (probable + proven), antifungal treatment and mortality as dependent variables. Significant (p < 0.001) models showing the highest R2 were considered. Results: A total of 245 patients were identified, 139 (56.7%) with Aspergillosis. Aspergillosis was associated (R2 = 0.291) with ICU admission (OR = 2.82), congestive heart failure (OR = 2.39) and steroids pre-admission (OR = 2.19) as well as with cavitations in X-ray/CT scan (OR = 10.68), radiological worsening (OR = 5.22) and COPD exacerbations/need for O2 interaction (OR = 3.52). Antifungals were administered to 79.1% patients with Aspergillosis (100% proven, 76.8% probable) and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation (OR = 12.38). In Aspergillosis patients its administration was positively associated (R2 = 0.312) with bronchospasm (OR = 9.21) and days in ICU (OR = 1.82) and negatively with Gold III + IV (OR = 0.26), stroke (OR = 0.024) and quinolone treatment (OR = 0.29). Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients (R2 = 0.290) with radiological worsening (OR = 3.04), APACHE-II (OR = 1.09) and number of antibiotics for treatment (OR = 1.51) and negatively with species other than A. fumigatus (OR = 0.14) and aspergillar tracheobronchitis (OR = 0.27). Conclusions: Administration of antifungals was not always closely linked to the diagnostic categorisation (colonisation vs. Aspergillosis), being negatively associated with severe COPD (GOLD III + IV) and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs/symptoms between this entity and pulmonary bacterial infections

Seaweed invasion! Temporal changes in beach conditions lead to increasing cenote usage and contamination in the Riviera Maya

Since 2011, tourism to Mexico\u27s Yucatan Peninsula has been heavily impacted by large masses of sargassum seaweed washing up on the beaches, with the largest seaweed event occurring in 2019. Seaweed deters beach tourism, potentially shifting tourism inland towards other activities such as swimming in cenotes (sinkholes). Our mixed methods study combined data from surveys of visitors to the region, interviews with tourists and tour operators, thematic analysis of newspaper articles, laws and policies and analysis of water samples from a cenote to understand the environmental impact on cenotes of this shifting tourism industry. We identified intentional efforts by the tourism industry to encourage cenote tourism in response to the seaweed problem, and our survey and interview data confirmed that tourists are choosing to visit cenotes in lieu of beaches. Water samples from one tourist cenote in 2019 indicated increased pollution relative to previous years. Current regulations and management of tourist cenotes are weak, creating the potential for significant long term harm to the environment and to the water sovereignty of surrounding communities. Regulation of cenotes should be strengthened to protect these fragile karst ecosystems and to give local and indigenous residents a formal voice in the management process

Impact of Tourist Behavior on the Discharge of Sunscreen Contamination in Aquatic Parks, Sinkholes, and Beaches of the Mexican Caribbean

The Mexican Caribbean is part of the Mesoamerican Barrier Reef System, considered the second largest reef system globally. This system, as well as inland aquatic ecosystems, are at risk of contamination due to the intensive use of sunscreen by the tourists who visit the Riviera Maya each year. At present, the regulation and management of sunscreens are inconsistent, with most policies and legislation focused on the protected marine areas with little current focus on inland aquatic ecosystems. An estimated 229.76 tons of sunscreen are used annually, with residues putting the health of the marine and freshwater aquatic ecosystems and residents at risk. Groundwater is used recreationally (e.g., tourists swimming in sinkholes or cenotes) and as household drinking water. To understand the environmental impacts of sunscreen use and the management implications, a mixed-methods study was carried out, combining survey and interview data on how tourists use sunscreen and their perceptions of discharge of sunscreens into the water, with analysis of regional, national and international policies and legislation. Our findings of touristic behaviors, gaps in current legislation, and the pollution implications of different sunscreen types provide useful information for future decision-making and the creation of stronger environmental regulations

Seaweed invasion! Temporal changes in beach conditions lead to increasing cenote usage and contamination in the Riviera Maya

Since 2011, tourism to Mexico\u27s Yucatan Peninsula has been heavily impacted by large masses of sargassum seaweed washing up on the beaches, with the largest seaweed event occurring in 2019. Seaweed deters beach tourism, potentially shifting tourism inland towards other activities such as swimming in cenotes (sinkholes). Our mixed methods study combined data from surveys of visitors to the region, interviews with tourists and tour operators, thematic analysis of newspaper articles, laws and policies and analysis of water samples from a cenote to understand the environmental impact on cenotes of this shifting tourism industry. We identified intentional efforts by the tourism industry to encourage cenote tourism in response to the seaweed problem, and our survey and interview data confirmed that tourists are choosing to visit cenotes in lieu of beaches. Water samples from one tourist cenote in 2019 indicated increased pollution relative to previous years. Current regulations and management of tourist cenotes are weak, creating the potential for significant long term harm to the environment and to the water sovereignty of surrounding communities. Regulation of cenotes should be strengthened to protect these fragile karst ecosystems and to give local and indigenous residents a formal voice in the management process

Seaweed Invasion! Temporal Changes in Beach Conditions Lead to Increasing Cenote Usage and Contamination in the Riviera Maya

Since 2011, tourism to Mexico&rsquo;s Yucat&aacute;n Peninsula has been heavily impacted by large masses of sargassum seaweed washing up on the beaches, with the largest seaweed event occurring in 2019. Seaweed deters beach tourism, potentially shifting tourism inland towards other activities such as swimming in cenotes (sinkholes). Our mixed methods study combined data from surveys of visitors to the region, interviews with tourists and tour operators, thematic analysis of newspaper articles, laws and policies and analysis of water samples from a cenote to understand the environmental impact on cenotes of this shifting tourism industry. We identified intentional efforts by the tourism industry to encourage cenote tourism in response to the seaweed problem, and our survey and interview data confirmed that tourists are choosing to visit cenotes in lieu of beaches. Water samples from one tourist cenote in 2019 indicated increased pollution relative to previous years. Current regulations and management of tourist cenotes are weak, creating the potential for significant long term harm to the environment and to the water sovereignty of surrounding communities. Regulation of cenotes should be strengthened to protect these fragile karst ecosystems and to give local and indigenous residents a formal voice in the management process

Repeated Aspergillusisolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?

Background: Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation), treatment (administration or not of antifungals) and prognosis (mortality) in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples. Methods: Records of adult patients (29 Spanish hospitals) presenting ≥2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation) or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging) or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates). Logistic regression models (step-wise) were performed using Aspergillosis (probable + proven), antifungal treatment and mortality as dependent variables. Significant (p < 0.001) models showing the highest R2 were considered. Results: A total of 245 patients were identified, 139 (56.7%) with Aspergillosis. Aspergillosis was associated (R2 = 0.291) with ICU admission (OR = 2.82), congestive heart failure (OR = 2.39) and steroids pre-admission (OR = 2.19) as well as with cavitations in X-ray/CT scan (OR = 10.68), radiological worsening (OR = 5.22) and COPD exacerbations/need for O2 interaction (OR = 3.52). Antifungals were administered to 79.1% patients with Aspergillosis (100% proven, 76.8% probable) and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation (OR = 12.38). In Aspergillosis patients its administration was positively associated (R2 = 0.312) with bronchospasm (OR = 9.21) and days in ICU (OR = 1.82) and negatively with Gold III + IV (OR = 0.26), stroke (OR = 0.024) and quinolone treatment (OR = 0.29). Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients (R2 = 0.290) with radiological worsening (OR = 3.04), APACHE-II (OR = 1.09) and number of antibiotics for treatment (OR = 1.51) and negatively with species other than A. fumigatus (OR = 0.14) and aspergillar tracheobronchitis (OR = 0.27). Conclusions: Administration of antifungals was not always closely linked to the diagnostic categorisation (colonisation vs. Aspergillosis), being negatively associated with severe COPD (GOLD III + IV) and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs/symptoms between this entity and pulmonary bacterial infections