Multiple diagnostic methods for mucormycosis: A retrospective case series

Wang, JiaXin; Wang, YaoMin; Han, Fei; Chen, Jianghua

doi:10.1002/jcla.24588

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Most of the current studies on the diagnosis of IFD by mNGS are clinical case reports (Chen et al, 2021;Wang et al, 2022;Cui et al, 2022;Hu et al, 2022). Several studies have focused on the diagnosis of pulmonary infections by mNGS, Peng et al reported on 60 patients with suspected pneumonia in severe immunodeficiency and analyzed the diagnostic efficacy of mNGS versus CMTs for pneumonia (Peng et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease

Wang

You²,

Fu³

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundMetagenomic next-generation sequencing (mNGS) is increasingly being used to detect pathogens directly from clinical specimens. However, the optimal application of mNGS and subsequent result interpretation can be challenging. In addition, studies reporting the use of mNGS for the diagnosis of invasive fungal infections (IFIs) are rare.ObjectiveWe critically evaluated the performance of mNGS in the diagnosis of pulmonary IFIs, by conducting a multicenter retrospective analysis. The methodological strengths of mNGS were recognized, and diagnostic cutoffs were determined.MethodsA total of 310 patients with suspected pulmonary IFIs were included in this study. Conventional microbiological tests (CMTs) and mNGS were performed in parallel on the same set of samples. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the logarithm of reads per kilobase per million mapped reads [lg(RPKM)], and read counts were used to predict true-positive pathogens.ResultThe majority of the selected patients (86.5%) were immunocompromised. Twenty species of fungi were detected by mNGS, which was more than was achieved with standard culture methods. Peripheral blood lymphocyte and monocyte counts, as well as serum albumin levels, were significantly negatively correlated with fungal infection. In contrast, C-reactive protein and procalcitonin levels showed a significant positive correlation with fungal infection. ROC curves showed that mNGS [and especially lg(RPKM)] was superior to CMTs in its diagnostic performance. The area under the ROC curve value obtained for lg(RPKM) in the bronchoalveolar lavage fluid of patients with suspected pulmonary IFIs, used to predict true-positive pathogens, was 0.967, and the cutoff value calculated from the Youden index was −5.44.ConclusionsIn this study, we have evaluated the performance of mNGS-specific indicators that can identify pathogens in patients with IFIs more accurately and rapidly than CMTs, which will have important clinical implications.

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Section: Discussionmentioning

confidence: 99%

“…Most of the current studies on the diagnosis of IFD by mNGS are clinical case reports ( Chen et al., 2021 ; Wang et al., 2022 ; Cui et al., 2022 ; Hu et al., 2022 ). Several studies have focused on the diagnosis of pulmonary infections by mNGS, Peng et al.…”

Section: Discussionmentioning

confidence: 99%

Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease

Wang

You²,

Fu³

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Despite improvement in early recognition of the disease, diagnosis remains challenging, which results in delayed appropriate treatment and poor outcomes [55]. Considerable progress has been made in the development of various PCR diagnostics in MCR.…”

Section: Microbiological Diagnosis Of Mucormycosismentioning

confidence: 99%

“…Metagenomic next-generation sequencing was the main method used to diagnose MCR (67%) or colonization (22%) with Lichtheimia in a series of patients with underlying hematological malignancy, solid organ transplant, pulmonary disease, or trauma [61 ▪ ]. In another series, samples from patients with pulmonary MCR were analyzed by using metagenomic next-generation sequencing and culture; in one patient with disseminated infection only metagenomic next-generation sequencing confirmed the diagnosis [55]. Zhang and colleagues described two patients with hematologic malignancies treated with chemotherapy and targeted therapy whose courses were complicated one by nasal MCR caused by Lichtheimia ramosa and the other by cutaneous infection with Mucor irregularis [62].…”

Section: Microbiological Diagnosis Of Mucormycosismentioning

confidence: 99%

Mucormycosis: update on clinical presentation, diagnosis, and treatment

Dailey Garnes,

Kontoyiannis

2023

Current Opinion in Infectious Diseases

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Purpose of review Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. Recent findings The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. Summary Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.

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Multiple diagnostic methods for mucormycosis: A retrospective case series

Wang

Han

et al. 2022

Clinical Laboratory Analysis

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Background Mucormycosis is a rare invasive fungal disease with high mortality. Early diagnosis and targeted drugs are crucial to improving clinical outcomes. Methods We searched the electronic hospital database of the First Affiliated Hospital of Zhejiang University School of Medicine for adult patients with mucormycosis between 2000 and 2021. Demographic, clinical, treatment, and outcome data were collected and compared with the data in the relevant literature. Results Eleven cases of mucormycosis—four of multisite infection, one of skin infection, five of lung infection, and one of gastrointestinal infection—were found and analyzed. The patients were diagnosed mainly based on pathological and histological findings, and three patients had metagenomic next‐generation sequencing findings. Delayed diagnosis (i.e., diagnosis >7 days after patient admission or >30 days after onset of symptoms) results in poor prognosis compared with early diagnosis. Conclusions Improving awareness and shortening diagnosis time may improve the prognosis of mucormycosis. If mucormycosis is suspected, appropriate samples should be collected as soon as possible and submitted for biopsy, culture, or mNGS to confirm the diagnosis.

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Multiple diagnostic methods for mucormycosis: A retrospective case series

Cited by 3 publications

References 27 publications

Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease

Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease

Mucormycosis: update on clinical presentation, diagnosis, and treatment

Multiple diagnostic methods for mucormycosis: A retrospective case series

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