The same mould, a second clinic, and this time people really were infected

Purpureocillium lilacinum is an environmental mould that can cause a
range of human infections. **Infection in immunocompetent people is
uncommon**, though eye infections have been reported.

**Three patients developed P. lilacinum corneal infections after laser eye
surgery at a New York City ophthalmology clinic. One required a corneal
transplant.**

What was found

**The investigation identified infection prevention and control deficiencies
at the clinic that potentially resulted in mould exposure.**

**After infection prevention and control measures were implemented, no further
cases were identified.**

That last sentence is as close to proof as an outbreak investigation gets: the
problem was identified, the practices changed, and the cases stopped.

Why this one is different

The CDC reported another P. lilacinum cluster in the same period — 22
patients at a Washington dermatology clinic, where the mould was in reused
saline bottles and nobody was actually infected. A pseudo-outbreak.

This is the other kind. Three real infections, in eyes, one requiring a
transplant of the cornea.

Both came from the same environmental organism finding its way into a clinical
procedure through a lapse in technique. The difference in outcome is the
difference between contaminating a specimen and contaminating a patient.

The conclusion

**Adherence to published infection prevention and control guidance during
all procedures in ambulatory settings can reduce the risk for health
care–associated infections and related complications.**

Ambulatory settings is the operative phrase. Infection control is built and
audited around hospitals; a great deal of surgery now happens in clinics and
day units, and a laser eye procedure is surgery.

*Source: Chang ME, Mantell E, Greendyke WG, et al. Purpureocillium lilacinum
Keratitis Outbreak Associated with an Ophthalmology Clinic — New York City,

2024. MMWR, Centers for Disease Control and Prevention.*