Epidemiology and Clinical Features of Invasive Fungal Infection in a US Health Care Network

Webb, Brandon; Ferraro, Jeffrey P.; Rea, Susan; Kaufusi, Stephanie; Goodman, Bruce; Spalding, James

doi:10.1093/ofid/ofy187

Cited by 127 publications

(113 citation statements)

References 22 publications

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“…A survey of the Intermountain Healthcare system, a large U.S. network of hospitals and clinics, from 2006 to 2015 identified 3,374 IFIs in 3,154 subjects. 56 Mucorales were implicated in 1.1% of these IFIs (mean incidence 0.3 cases/100,000 per year). Underlying diseases included DM (36.1%), HemeM (19.4%), HSCT (11.1%), and immunosuppressive therapy (61.1%).…”

Section: Pathogenesismentioning

confidence: 99%

“…Underlying diseases included DM (36.1%), HemeM (19.4%), HSCT (11.1%), and immunosuppressive therapy (61.1%). 56 Another study of > 560 hospitals covering 104 million patients in the United States from January 2005 to June 2014 identified 555 mucormycosis-related hospitalizations among > 47 million inpatient encounters (prevalence of 0.12 per 10,000 discharges). 57 The most common underlying conditions were DM (52%) and HemeM (40%).…”

Section: Pathogenesismentioning

confidence: 99%

“…100 In fact, DM is the proximate cause of mucormycosis in 27 to 52% of cases. 56,57,59 Diabetics with ketoacidosis are prone to develop the rhinocerebral form of mucormycosis. 15 The most common initial site of involvement is the sinuses, but spread to the orbit, bone, and brain may occur.…”

Section: Poorly Controlled Diabetes Mellitusmentioning

confidence: 99%

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Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

151

108

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

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Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

151

108

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“…26,27 Despite large and effective use of prophylaxis in acute myeloblastic leukemia (AML) patients and in allogeneic hematopoietic stem cell (alloHSCT) recipients, the overall incidence of IA continues to increase over time. [28][29][30] This increase can be explained by improved diagnosis, broader use of old and new immunosuppressive agents, and increase in organ transplantations. 29,31 ►Fig.…”

Section: Epidemiologymentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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“…1 The incidence of fungal infection has shown an upward trend. [2][3][4][5] Although significant improvements have been made in disease management and treatment of fungal infections, the mortality rate has only increased. 6 Early diagnosis of invasive fungal infection (IFI) is a difficult in routine clinical practice but key for the initiation of targeted therapies.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang¹,

Zhu²

2020

IDR

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Background: The diagnosis and treatment of invasive fungal infection (IFI) are still challenging due to its complexity and non-specificity. This study was aimed to investigate the clinical features, diagnosis process, and outcomes of patients with emerging IFIs. Methods: A retrospective review of emerging IFIs in adult patients at a university hospital in China was conducted; diagnoses were based on the criteria of EORTC/MSG 2008. Results: 145 IFI patients (pulmonary, intestinal and urinary) were enrolled in this study, including 80 proven (55.2%), 59 probable (40.7%), or 6 possible IFIs (4.1%). Among the 126 pulmonary IFIs, the positivity rate for sputum microscopy, sputum culture, and 1.3-ß-D-glucan (BG) test was 54.0%, 44.4%, and 37.3%, respectively. Among the 19 intestinal and urinary IFIs, routine examination of stool or urine and their culture were the main methods of detection. Positive results of 75 detected fungal strains from the samples showed that 30 cases were complicated with one or more bacterial infections. The average length of hospital stay of IFI patients was 14.0 (10.0, 20.0) days. The time from admission to antifungal therapy initiation (P<0.001), liver cirrhosis (P<0.001), hematological tumor (P<0.001), coinfection (P=0.019) and immune diseases (P=0.025) were independent predictors of prolonged hospitalization. Conclusion: Delayed time was the primary predictor of prolonged hospitalization. This prediction is suggested to improve IFI diagnostic and therapeutic process of IFI to promote prognosis.

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Epidemiology and Clinical Features of Invasive Fungal Infection in a US Health Care Network

Cited by 127 publications

References 22 publications

Mucormycosis

Mucormycosis

Invasive Pulmonary Aspergillosis

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

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