Epidemiology and clinical characteristics of invasive mould infections: A multicenter, retrospective analysis in five Asian countries

Abstract

Formal, large-scale, multicenter studies of invasive mould infection (IMI) in Asia are rare. This 1-year, retrospective study was designed to assess the incidence and clinical determinants of IMI in centers in five countries (Thailand, Taiwan, Singapore, China, India). Patients treated in a single year (2012) were identified through discharge diagnoses, microbiology, and histopathology logs, and entered based on published definitions of IMI. A total of 155 cases were included (median age 54 years; 47.7% male). Of these, 47.7% had proven disease; the remainder had probable IMI. The most frequent host factors were prolonged steroid use (39.4%) and recent neutropenia (38.7%). Common underlying conditions included diabetes mellitus (DM; 30.9%), acute myeloid leukemia (19.4%), and rheumatologic conditions (11.6%). DM was more common in patients with no recent history of neutropenia or prolonged steroid use (P = .006). The lung was the most frequently involved site (78.7%), demonstrating a range of features on computed tomography (CT). Aspergillus was the most common mould cultured (71.6%), primarily A. fumigatus and A. flavus, although proportions varied in different centers. The most often used antifungal for empiric therapy was conventional amphotericin. Ninety-day mortality was 32.9%. This is the first multicenter Asian study of IMI not limited to specific patient groups or diagnostic methods. It suggests that DM and rheumatologic conditions be considered as risk factors for IMI and demonstrates that IMI should not be ruled out in patients whose chest features on CT do not fit the conventional criteria.

A 23 bp cyp51A Promoter Deletion Associated With Voriconazole Resistance in Clinical and Environmental Isolates of Neocosmospora keratoplastica

“…There is heightened concern about invasive mould infections (IMIs) as a consequence of the increasing number of immunocompromised patients (Lass-Flörl and Cuenca-Estrella, 2017;Rotjanapan et al, 2018). Fusaria are among the most frequent cause of IMIs after aspergilli (Nucci and Anaissie, 2007).…”

“…Most Fusarium species have low susceptibilities to the majority of azole antifungals (Tupaki-Sreepurna et al, 2017;Rotjanapan et al, 2018;Herkert et al, 2019) and patients with IFs have high mortality rates (Esnakula et al, 2013;Silva et al, 2013;Okada et al, 2018). Voriconazole (VRC) and amphotericin B (AMB) are the recommended treatment options for localised infections and IFs (Efeİris et al, 2016;Okada et al, 2018).…”

<p>Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes</p>

“…Clinical symptoms typically manifest as fever, cough, dyspnea, chest pain, and hemoptysis; 7,8 however, these characteristics only present in some patients. Radiologic examination of the lungs of these patients showed various presentations, only a few had typical features of fungal infection, such as denseness, cavitation, an air crescent sign (11%), or a halo sign (4.1%~7%); 8,9 some even showed negative results (15%). 10 The 1.3-ß-D-glucan (BG) test is used to detect the BG antigen, which is commonly resides on the fungal surface.…”

Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

“…A large-scale international multicenter study conducted by Tacoone et al investigated ICU patient with IA and found that older age, bone marrow transplant, higher sequential organ failure assessment (SOFA) score, mechanical ventilation use and requirement for renal replacement therapy were predictors of a poor outcome [ 1 ]. Another multicenter study by Porpon et al evaluated the epidemiology of invasive mold infection in five Asian countries and concluded that disseminated diseases, rheumatologic condition and higher GM levels were predictors of mortality [ 8 ]. Since there is no overall consensus, it is necessary to have more evidence regarding prognostic factors to identify patients with IPA who are at a higher risk of mortality.…”