Fatal Mucormycosis and Aspergillosis in an Atypical Host: What Do We Know about Mixed Invasive Mold Infections?

Tsikala‐Vafea, Maria; Cao, Weibiao; Olszewski, Adam J.; Donahue, John E.; Farmakiotis, Dimitrios

doi:10.1155/2020/8812528

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…An important observation was that almost half of all patients with CAPA had corticosteroid exposure (Table 1). Steroids are increasingly recognized as an important risk factor for invasive mold infections [11,12,51,52], and more specifically mixed invasive mold infections [51,52], even in patients with no other risk factors [11,52]. Bartoletti et al, also pointed out that the high incidence of CAPA in their cohort could be associated with high utilization of corticosteroids and tocilizumab for COVID-19.…”

Section: Discussionmentioning

confidence: 98%

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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In this systematic review, we investigate the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of COVID-19-associated pulmonary aspergillosis (CAPA). We identified 85 cases from 22 studies. The frequency of CAPA is currently unknown but ranges between <5% to >30% in different case series; the possibility of colonization rather than invasive disease is the most important confounder. The vast majority of patients with CAPA did not have any of the classic host risk factors, such as immunosuppression from organ transplant or neutropenia, although a significant proportion (46%) had received corticosteroids. Age, pulmonary comorbidities and male sex were associated with higher mortality. Patients treated with voriconazole had numerically lower case-fatality rate. Clinical vigilance for CAPA is advisable in critically ill patients with COVID-19 who are not improving, even those who do not meet classic host criteria for invasive mycoses, especially if they are receiving corticosteroids. A thorough, multi-faceted diagnostic work-up and early initiation of a mold-active triazole may be lifesaving. Further research studies using standardized, uniform definitions of invasive disease and colonization are urgently needed.

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Section: Discussionmentioning

confidence: 98%

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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“…Another target could be Pentraxin 3 (PTX3), which has been shown to be a promising marker for aspergillosis ( Cunha et al, 2014 ). Mucormycosis frequently co-occurs with aspergillosis ( Alfano et al, 2006 ; Tsikala-Vafea et al, 2020 ; Johnson et al, 2021 ; Zayet et al, 2021 ). SNPs in PRRs like Toll-like receptors (TLRs) have already been associated with increased susceptibility to fungal infections ( Bergantim et al, 2013 ; Wang et al, 2013 ; Fischer et al, 2016 ; Zhang et al, 2019 ; Aqsa et al, 2020 ).…”

Section: Current Aspects In Diagnosis and Prediction Of Other Fungal ...mentioning

confidence: 99%

Mini Review: Risk Assessment, Clinical Manifestation, Prediction, and Prognosis of Mucormycosis: Implications for Pathogen- and Human-Derived Biomarkers

Acosta-España

Voigt

2022

Front. Microbiol.

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Mucormycosis is a fungal disease caused by members of the fungal order Mucorales, which are abundantly found in terrestrial environments. The fungi propagate clonally via mitospores, which are transmitted to humans through the air and cause superficial or invasive infections. The disease has emerged in recent years and coincides generally with immunosuppression on the patient side. Mucormycosis is still rarely recognized in the clinical because of its unspecific symptoms which often triggers misdiagnosis with bacterial or viral infections leading to prolonged therapeutic cycles and loss of valuable time to manage mucormycosis properly. Infected patients develop various clinical forms, most notably ranging from rhinocerebral via pulmonary to gastrointestinal forms. Traditional diagnosis is based on culture and histopathologic examinations of the affected tissue. But, the achievement of a precise result is time-consuming, labor-intensive, requires mycological expertise and the finding appears often too late. A rapid and precise diagnosis is mandatory because symptoms are non-specific and the disease is rapidly progressing with often fatal outcome. Mucormycosis was increasingly associated with other infections and underlying conditions and risk factors causing comorbidities, which are difficult to successfully manage. This mini-review summarizes the current knowledge on the epidemiology and causative agents of mucormycosis, transmission, risk factors, clinical presentation, diagnosis, and highlights the lack of appropriate biomarkers on the pathogen and the host sides for rapid pathogen and host susceptibility detection, respectively. Fungal antigens and single nucleotide polymorphisms (SNPs) in human host genes are useful for the assessment of susceptibility. This mini-review addresses possibilities for early prediction of susceptibility to mucormycosis based on forecasting of the risk of infection with fungal pathogens other than Mucorales. The topic of early prediction and diagnosis of mucormycosis represents a current research gap and highlights the importance of potential future developments in the area of risk assessment, susceptibility prognosis in conjunction with early diagnosis to reduce mortality in patients suffering from mucormycosis.

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“…Over 70 reported cases of Aspergillus and Mucorales coinfection were identified in this manner. However, only six cases demonstrated autopsy-proven aspergillosis and mucormycosis coinfection [ 4 , 5 , 6 , 7 , 8 , 9 ]. We summarized the reviewed cases where an autopsy was performed and which provided histologic evidence of disseminated dual fungal infection, as well as the cases we present, in Table 1 below.…”

Section: Introductionmentioning

confidence: 99%

Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature

Murray

Miller

et al. 2023

JoF

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Coinfection with invasive aspergillosis and mucormycosis in immunocompromised patients has been reported but is rarely confirmed by tissue histology or autopsy. Serum fungal biomarkers and culture are the primary diagnostic tools but are suboptimal for detecting fungal coinfection. Here, we present the cases of two patients who were immunocompromised due to hematologic malignancy where disseminated aspergillosis and mucormycosis coinfection was only diagnosed upon autopsy despite extensive fungal diagnostic workup, and also review recent literature of such instances of coinfection.

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Fatal Mucormycosis and Aspergillosis in an Atypical Host: What Do We Know about Mixed Invasive Mold Infections?

Cited by 5 publications

References 16 publications

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Mini Review: Risk Assessment, Clinical Manifestation, Prediction, and Prognosis of Mucormycosis: Implications for Pathogen- and Human-Derived Biomarkers

Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature

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