tetano
Editor, Senior Moderator
Mycoses
. 2024 May;67(5):e13745.
doi: 10.1111/myc.13745. Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM)
Valliappan Muthu[SUP] 1 [/SUP], Ritesh Agarwal[SUP] 1 [/SUP], Shivaprakash Mandya Rudramurthy[SUP] 1 [/SUP], Deepak Thangaraju[SUP] 2 [/SUP], Manoj Radhakishan Shevkani[SUP] 3 [/SUP], Atul K Patel[SUP] 4 [/SUP], Prakash Srinivas Shastri[SUP] 5 [/SUP], Ashwini Tayade[SUP] 6 [/SUP], Sudhir Bhandari[SUP] 7 [/SUP], Vishwanath Gella[SUP] 8 [/SUP], Jayanthi Savio[SUP] 9 [/SUP], Surabhi Madan[SUP] 10 [/SUP], Vinaykumar Hallur[SUP] 11 [/SUP], Venkata Nagarjuna Maturu[SUP] 12 [/SUP], Arjun Srinivasan[SUP] 13 [/SUP], Nandini Sethuraman[SUP] 14 [/SUP], Raminder Pal Singh Sibia[SUP] 15 [/SUP], Sanjay Pujari[SUP] 16 [/SUP], Ravindra Mehta[SUP] 17 [/SUP], Tanu Singhal[SUP] 18 [/SUP], Puneet Saxena[SUP] 19 [/SUP], Varsha Gupta[SUP] 20 [/SUP], Vasant Nagvekar[SUP] 21 [/SUP], Parikshit Prayag[SUP] 22 [/SUP], Dharmesh Patel[SUP] 23 [/SUP], Immaculata Xess[SUP] 24 [/SUP], Pratik Savaj[SUP] 25 [/SUP], Inderpaul Singh Sehgal[SUP] 1 [/SUP], Naresh Panda[SUP] 1 [/SUP], Gayathri Devi Rajagopal[SUP] 2 [/SUP], Riya Sandeep Parwani[SUP] 3 [/SUP], Kamlesh Patel[SUP] 4 [/SUP], Anuradha Deshmukh[SUP] 6 [/SUP], Aruna Vyas[SUP] 7 [/SUP], Raghava Rao Gandra[SUP] 8 [/SUP], Srinivas Kishore Sistla[SUP] 8 [/SUP], Priyadarshini A Padaki[SUP] 9 [/SUP], Dharshni Ramar[SUP] 10 [/SUP], Manoj Kumar Panigrahi[SUP] 11 [/SUP], Saurav Sarkar[SUP] 11 [/SUP], Bharani Rachagulla[SUP] 12 [/SUP], Pattabhiraman Vallandaramam[SUP] 13 [/SUP], Krishna Prabha Premachandran[SUP] 14 [/SUP], Sunil Pawar[SUP] 15 [/SUP], Piyush Gugale[SUP] 16 [/SUP], Pradeep Hosamani[SUP] 17 [/SUP], Sunil Narayan Dutt[SUP] 17 [/SUP], Satish Nair[SUP] 17 [/SUP], Hariprasad Kalpakkam[SUP] 17 [/SUP], Sanjiv Badhwar[SUP] 18 [/SUP], Kiran Kumar Kompella[SUP] 19 [/SUP], Nidhi Singla[SUP] 20 [/SUP], Milind Navlakhe[SUP] 21 [/SUP], Amrita Prayag[SUP] 22 [/SUP], Gagandeep Singh[SUP] 24 [/SUP], Poorvesh Dhakecha[SUP] 25 [/SUP], Arunaloke Chakrabarti[SUP] 1 [/SUP]
Affiliations
Background: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse.
Objectives: To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis).
Methods: We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM.
Results: We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors.
Conclusion: Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.
Keywords: Rhizopus; aspergillus; corona virus; mixed mould infections; moulds; zygomycosis.
. 2024 May;67(5):e13745.
doi: 10.1111/myc.13745. Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM)
Valliappan Muthu[SUP] 1 [/SUP], Ritesh Agarwal[SUP] 1 [/SUP], Shivaprakash Mandya Rudramurthy[SUP] 1 [/SUP], Deepak Thangaraju[SUP] 2 [/SUP], Manoj Radhakishan Shevkani[SUP] 3 [/SUP], Atul K Patel[SUP] 4 [/SUP], Prakash Srinivas Shastri[SUP] 5 [/SUP], Ashwini Tayade[SUP] 6 [/SUP], Sudhir Bhandari[SUP] 7 [/SUP], Vishwanath Gella[SUP] 8 [/SUP], Jayanthi Savio[SUP] 9 [/SUP], Surabhi Madan[SUP] 10 [/SUP], Vinaykumar Hallur[SUP] 11 [/SUP], Venkata Nagarjuna Maturu[SUP] 12 [/SUP], Arjun Srinivasan[SUP] 13 [/SUP], Nandini Sethuraman[SUP] 14 [/SUP], Raminder Pal Singh Sibia[SUP] 15 [/SUP], Sanjay Pujari[SUP] 16 [/SUP], Ravindra Mehta[SUP] 17 [/SUP], Tanu Singhal[SUP] 18 [/SUP], Puneet Saxena[SUP] 19 [/SUP], Varsha Gupta[SUP] 20 [/SUP], Vasant Nagvekar[SUP] 21 [/SUP], Parikshit Prayag[SUP] 22 [/SUP], Dharmesh Patel[SUP] 23 [/SUP], Immaculata Xess[SUP] 24 [/SUP], Pratik Savaj[SUP] 25 [/SUP], Inderpaul Singh Sehgal[SUP] 1 [/SUP], Naresh Panda[SUP] 1 [/SUP], Gayathri Devi Rajagopal[SUP] 2 [/SUP], Riya Sandeep Parwani[SUP] 3 [/SUP], Kamlesh Patel[SUP] 4 [/SUP], Anuradha Deshmukh[SUP] 6 [/SUP], Aruna Vyas[SUP] 7 [/SUP], Raghava Rao Gandra[SUP] 8 [/SUP], Srinivas Kishore Sistla[SUP] 8 [/SUP], Priyadarshini A Padaki[SUP] 9 [/SUP], Dharshni Ramar[SUP] 10 [/SUP], Manoj Kumar Panigrahi[SUP] 11 [/SUP], Saurav Sarkar[SUP] 11 [/SUP], Bharani Rachagulla[SUP] 12 [/SUP], Pattabhiraman Vallandaramam[SUP] 13 [/SUP], Krishna Prabha Premachandran[SUP] 14 [/SUP], Sunil Pawar[SUP] 15 [/SUP], Piyush Gugale[SUP] 16 [/SUP], Pradeep Hosamani[SUP] 17 [/SUP], Sunil Narayan Dutt[SUP] 17 [/SUP], Satish Nair[SUP] 17 [/SUP], Hariprasad Kalpakkam[SUP] 17 [/SUP], Sanjiv Badhwar[SUP] 18 [/SUP], Kiran Kumar Kompella[SUP] 19 [/SUP], Nidhi Singla[SUP] 20 [/SUP], Milind Navlakhe[SUP] 21 [/SUP], Amrita Prayag[SUP] 22 [/SUP], Gagandeep Singh[SUP] 24 [/SUP], Poorvesh Dhakecha[SUP] 25 [/SUP], Arunaloke Chakrabarti[SUP] 1 [/SUP]
Affiliations
- PMID: 38767273
- DOI: 10.1111/myc.13745
Background: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse.
Objectives: To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis).
Methods: We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM.
Results: We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors.
Conclusion: Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.
Keywords: Rhizopus; aspergillus; corona virus; mixed mould infections; moulds; zygomycosis.