A patient on chemotherapy develops fever and respiratory symptoms; sputum culture yields Aspergillus fumigatus. What initial step should begin an outbreak investigation?

• A. Identify areas of construction or renovation near the patient's location
• B. Review air handling systems in the hospital
• C. Postpone investigation until more cases
• D. Notify occupational health authorities

Answer: (A)

The key idea is that Aspergillus outbreaks in hospitals are often tied to environmental sources, especially construction or renovation that disturbs dust and releases spores. When a patient on chemotherapy develops symptoms and a culture grows Aspergillus fumigatus, the first step is to check for nearby construction or renovation activities around the patient’s location. This quickly helps explain how a large number of spores could reach a vulnerable patient and points to immediate containment actions, such as dust control, barriers, and possibly relocating the patient or enhancing filtration. Once this potential source is identified, investigators can proceed to assess ventilation and air-handling systems and consider environmental sampling as needed. Delaying the inquiry until more cases appear isn’t helpful, and while notifying occupational health is important, it isn’t the first step in identifying the environmental source of exposure.