UPMC is investigating whether the deaths of two heart transplant patients are linked to fungal infections they may have contracted in UPMC Presbyterian's cardiothoracic intensive care unit, hospital officials said Thursday. 
 
 Earlier this week, UPMC insisted that there was just one ICU patient who had contracted an infection from mold. That patient survived and is being treated. The ICU was closed Sept. 3, the day the case was confirmed, and its 18 patients were relocated. 
 
 But Thursday’s surprising disclosure, three days after word leaked out about the closure of the ICU, was not due to “not being transparent,” said Tami Minnier, UPMC’s chief quality control officer. “It was because of the clinical complexity” of their cases. 
 
 “We firmly believe we should have talked to the [two] families [of the deceased patients] first” before telling the public, which occurred later this week, she said. 
 
 The case is confounding, Ms. Minnier said, because not only does UPMC not yet know what role the infections may have played in the two patients’ deaths, it does not know the source of the mold and whether it came from the ICU. 
 
 Complicating the investigation is that preliminary testing shows that all three patients contracted a different, but related, fungal infection: rhizopus for the first patient, a heart transplant patient who died in October; rhizomucor in another heart transplant patient who died in June; and still another, lichtheimia, in the most recent patient, a lung transplant patient whose case was detected two weeks ago and who is still being treated. 
 
 All three molds are in the same fungi phylum, called zygomycetes, and they are related. 
 
 However, they are not the same as the mold that investigators found in the drywall in the ICU after the latest confirmed case on Sept. 3, though UPMC would not identify the mold found in the drywall. 
 
 “It’s very unusual to find those types of fungi there” in a hospital building, said Herb Laymen, owner of U.S. Micro-Solutions in Greensburg, an environmental laboratory that helps investigate fungi and other special pathogens in buildings, including hospitals. “You’ve got to have water someplace” for those molds to flourish. 
 
 Another common cause of mold outbreaks, he said, is construction, or deconstruction projects, both of which have occurred at UPMC Presbyterian in recent years, including the deconstruction of the old Children’s Hospital building, which adjoined Presbyterian. 
 
 “Any time you tear a building down, there are a lot of things that can come out of it,” Mr. Laymen said. 
 
 Andy Streifel, a health care environmentalist at the University of Minnesota and one of the world’s leading authorities on fungal outbreaks, said he was called in by UPMC after it did some of that deconstruction at UPMC Presbyterian. 
 
 “They were very proactive,” Mr. Streifel said of UPMC. “They did everything they could think of. We took all sorts of precautions [in response to the deconstruction.] I don’t think [UPMC] was negligent here.” 
 
 When he was told how UPMC closed down its ICU when it confirmed a fungal infection on Sept. 3, Mr. Streifel said: “Closing that ICU down is an extremely proactive approach. That’s extremely difficult for a hospital” to close an ICU. 
 
 But should UPMC have disclosed the first two cases when they occurred in October and June, particularly since the cardiothoracic ICU had never had a mold problem before? 
 
 Ms. Minnier said that “one infection usually doesn’t trigger us to go into this depth” and investigate the cause. 
 
 Even the second, June case would not necessarily have triggered a full-scale investigation, she said, because it and the first, October case “had a different bug.” 
 
 “And with the time in between — October to June — they weren’t close together. They have to be temporal; they have to be close,” she said. 
 
 It was only after a physician detected the most recent case — the fungal infection in a lung transplant patient — that the same physician saw a possible tie to the two earlier cases, she said. That triggered the full review of every patient’s case over the last year and closure of the 20-bed ICU. 
 
 The review found that there had been 56 patients in the ICU over the prior year, eight of them transplant patients. Three of those transplant patients had been infected and five had not. The other 48, non-transplant patients, were not infected. 
 
 As part of UPMC’s recent disclosure to patients and the public, it launched an online blog on which it says it will report new information about its investigation as it occurs. 
 
 You can see it here — http://​insideupmc.upmc.com/​upmc-presbyterian-closes-cardiothoracic-intensive-care-unit-investigates-mold/ 
 
 “We’ve never done it before. I’ve never done it before,” Ms. Minnier said. “I may regret it.” ||||| Records show that two heart transplant patients who had fungal infections and died over the past year stayed in the same room where mold was recently found in the UPMC Presbyterian cardiothoracic intensive care unit, according to a statement Thursday. 
 
 VIDEO: Watch Paul Van Osdol's report 
 
 One of the patients had lichtheimia and died in October 2014; the other had rhizomucor and died in June, said UPMC chief quality officer Tami Minnier. 
 
 "Although the role that the mold may have played in their deaths cannot be definitively determined, we have notified their families of the suspected link to the mold in our CTICU. Transparency with patients is one of our guiding principles, and we are very sorry for the loss of these loved ones," Minnier said in a written statement. 
 
 The discovery of mold in toilets and behind walls earlier this month prompted the hospital to shut down the cardiothoracic ICU for cleaning and analysis by UPMC infection prevention experts and an private remediation company. It's unclear when the unit may reopen. 
 
 Dr. Cyril Wecht, a former Allegheny County medical examiner, said mold is rarely fatal. 
 
 "It is not common to find molds in lungs, and therefore not common to find molds contributing to or causing death," he said. "I can't remember the last case I ever had in which a mold infection was the cause of death." 
 
 Just a rotten fruit or vegetable would have been enough to introduce mold into the ICU, Wecht said. 
 
 "As far as mold in a wall is concerned, that is a total mystery," he said. 
 
 The discovery of mold in the unit was made after a patient tested positive for mold in his lung tissue on Sept. 3, according to UPMC spokeswoman Wendy Zellner. It's unclear what prompted that patient to be tested. 
 
 The contaminated patient was moved out of the cardiothoracic unit right away as were a few other patients in the immediate vicinity of the mold, which was also discovered in some of the unit's walls. Fifteen patients remained in the ICU until they were removed last week upon the discovery of more mold in the 20-bed unit. 
 
 Zellner said the hospital has yet to determine what caused the mold contamination. 
 
 News of the mold outbreak and the two deaths came as a shock to the relatives of some patients Thursday. 
 
 "Very concerned right now. I did not know that," said Jessica Beckelheimer, whose fiance is in the hospital. "That's what he came in here for -- his lungs." 
 
 "It's a hospital, and you bring people here to get well, not to get sick and die," said Mary Dixon, the wife of another patient. 
 
 In her statement, Minnier said, "Some might ask why we did not find this problem sooner. Given the very complicated nature of these patients' illnesses and the sporadic and very limited scope of these infections, we marvel at the care and detective work that found this pattern at all. Of course, we wish that no patients had been harmed." 
 
 Wecht said he wants to know more. 
 
 "Were autopsies done on these two patients? I believe they should have been done," he said. "I believe if they had any suspicion these patients had acquired infections, those cases should have been reported to the medical examiner's office." 
 
 The mold cases under review at UPMC Presbyterian Hospital are under jurisdiction of Pennsylvania's health department. Allegheny County's health department declined comment on the case. It can speak, however, to the bigger picture concerning mold and public health. 
 
 
 
 "Mold is typically not a serious health risk," said David Namey, program chief of housing and community environment for the county health department. "The most common health risk for healthy people are those that have allergic reactions to mold. And that would be runny nose, watery eyes or nasal congestion, those types of things," he said. "People who are severely immuno-compromised could be at a higher risk," he said. 
 
 
 
 Namey said those with severely compromised immune systems should take precautions. 
 
 
 
 "They need to be careful. They need to be aware if there is mold in their surroundings and take action to remediate those situations," he said. "It's a rare circumstance when you see people who are infected with a mold infection or a fungal infection. And it's typically not going to be in one's home, especially if they're otherwise healthy individuals." 
 
 
 
 Transplant patients are on drugs that suppress their immune systems to prevent organ rejection.
– A Pittsburgh hospital says it is in the midst of "a very active investigation" after two patients died in its cardiothoracic intensive care unit, which was later found to contain mold. UPMC Presbyterian Hospital's quality control chief Tami Minnier says a fungal infection first appeared on the leg of a heart transplant patient last October. A second infection was found on the buttocks of another transplant patient this past June, reports the AP; both patients died, though doctors aren't sure whether the infections caused the deaths. Hospital officials didn't connect the two cases because they occurred so far apart and the molds in each case were different, but related. Only when a third type of fungal infection was discovered in a lung transplant patient two weeks ago did hospital workers connect the dots and the ICU was closed on Sept. 3, reports the Pittsburgh Post-Gazette. Though investigators found mold in toilets and behind the walls of the unit, per WTAE, experts aren't sure if it played a role in the deaths as it was a different type than those found in patients. "It's just heartbreaking," Minnier says. "I can't tell you how many hours we have already spent trying to understand it." Minnier says a total of 56 patients have stayed in the ICU over the past year. The three patients infected were among eight transplant patients. The unit's remaining 18 patients have been removed to another part of the hospital while a remediation company clears up the mold, per the Gazette. "It's a hospital, and you bring people here to get well, not to get sick and die," says the wife of a patient. A mold expert says it’s "very unusual" to see the types of fungi found in the patients in a hospital, but it's possible recent construction projects at UPMC caused an outbreak.