The Changing Epidemiology of Invasive Aspergillosis in the Non-Traditional Host: Risk Factors and Outcomes

Vázquez, José Antonio; Tovar-Torres, Maria; Hingwe, Ameet; Cheema, Faiqa; Welch, Verna L; Ford, Kimbal D.

doi:10.15761/pccm.1000114

Cited by 16 publications

(13 citation statements)

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“…In our mixed cohort of patients, invasive aspergillosis (IA) (40.7%, 103/253) emerged as the most common IFI, followed by mucormycosis (24.5%, 62/253). This is in accordance with studies conducted in the hematological patient population [34,35] and in contrast with reports of invasive candidiasis being the most common IFI [13,36]. Traditional underlying conditions noted in this study were dominated by prolonged exposure to corticosteroids (24.5%), diabetes mellitus (23.7%), and hematological malignancies (19.8%).…”

Section: Discussionsupporting

confidence: 91%

Epidemiology and Antifungal Susceptibility Patterns of Invasive Fungal Infections (IFIs) in India: A Prospective Observational Study

Dabas

Xess

Pandey

et al. 2021

JoF

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The epidemiology of invasive fungal infections (IFI) is ever evolving. The aim of the present study was to analyze the clinical, microbiological, susceptibility, and outcome data of IFI in Indian patients to identify determinants of infection and 30-day mortality. Proven and probable/putative IFI (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group and AspICU criteria) from April 2017 to December 2018 were evaluated in a prospective observational study. All recruited patients were antifungal naïve (n = 3300). There were 253 episodes of IFI (7.6%) with 134 (52.9%) proven and 119 (47%) probable/putative infections. There were four major clusters of infection: invasive candidiasis (IC) (n = 53, 20.9%), cryptococcosis (n = 34, 13.4%), invasive aspergillosis (IA) (n = 103, 40.7%), and mucormycosis (n = 62, 24.5%). The significant risk factors were high particulate efficiency air (HEPA) room admission, ICU admission, prolonged exposure to corticosteroids, diabetes mellitus, chronic liver disease (CLD), acquired immunodeficiency syndrome (AIDS), coronary arterial disease (CAD), trauma, and multiorgan involvement (p < 0.5; odds ratio: >1). The all-cause 30-day mortality was 43.4% (n = 110). It varied by fungal group: 52.8% (28/53) in IC, 58.8% (20/34) in cryptococcosis, 39.8% (41/103) in IA, and 33.9% (21/62) in mucormycosis. HEPA room, ICU admission for IC; HEPA rooms, diabetes mellitus for cryptococcosis; hematological malignancies, chronic kidney disease (CKD), sepsis, galactomannan antigen index value ≥1 for IA and nodules; and ground glass opacities on radiology for mucormycosis were significant predictors of death (odds ratio >1). High minimum inhibitory concentration (MIC) values for azoles were observed in C. albicans, C. parapsilosis, C. glabrata, A. fumigatus, A. flavus, R. arrhizus, R. microsporus, and M. circinelloides. For echinocandin, high MIC values were seen in C. tropicalis, C. guillermondii, C. glabrata, and A. fumigatus. This study highlights the shift in epidemiology and also raises concern of high MICs to azoles among our isolates. It warrants regular surveillance, which can provide the local clinically correlated microbiological data to clinicians and which might aid in guiding patient treatment.

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Section: Discussionsupporting

confidence: 91%

Epidemiology and Antifungal Susceptibility Patterns of Invasive Fungal Infections (IFIs) in India: A Prospective Observational Study

Dabas

Xess

Pandey

et al. 2021

JoF

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“…The mortality rates associated with invasive aspergillosis range from 30 to 95% based on the patient population and underlying medical conditions [6]. However, the global burden of invasive aspergillosis is most likely underestimated due to reasons such as lack of surveil-lance measures and standardization, as well as the low sensitivity of current diagnostic assays [7,8].…”

Section: Introductionmentioning

confidence: 99%

Genetic Analyses of Amphotericin B Susceptibility in Aspergillus fumigatus

Fan¹,

Korfanty²,

Xu³

2021

JoF

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Aspergillus fumigatus is a ubiquitous saprophytic mold that can cause a range of clinical syndromes, from allergic reactions to invasive infections. Amphotericin B (AMB) is a polyene antifungal drug that has been used to treat a broad range of systemic mycoses since 1958, including as a primary treatment option against invasive aspergillosis in regions with high rates (≥10%) of environmental triazole resistance. However, cases of AMB-resistant A. fumigatus strains have been increasingly documented over the years, and high resistance rates were recently reported in Brazil and Canada. The objective of this study is to identify candidate mutations associated with AMB susceptibility using a genome-wide association analysis of natural strains, and to further investigate a subset of the mutations in their putative associations with differences in AMB minimum inhibitory concentration (MIC) and in growths at different AMB concentrations through the analysis of progeny from a laboratory genetic cross. Together, our results identified a total of 34 candidate single-nucleotide polymorphisms (SNPs) associated with AMB MIC differences—comprising 18 intergenic variants, 14 missense variants, one synonymous variant, and one non-coding transcript variant. Importantly, progeny from the genetic cross allowed us to identify putative SNP–SNP interactions impacting progeny growth at different AMB concentrations.

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“…Invasive aspergillosis (infections caused by Aspergillus) also occurs in immunocompromised patients, but cases have also been reported in immunocompetent patients in the intensive care unit (ICU) or following surgery. [20][21][22][23][24] One study reported that ∼10% of invasive aspergillosis cases occurred in postsurgical patients. 25…”

Section: Overview Of Mold and Imismentioning

confidence: 99%

Patient notification about suspected hospital-associated outbreaks of invasive mold infections: Considerations for public health and hospital personnel

Gandhi

Benedict

Toda

et al. 2021

Infect. Control Hosp. Epidemiol.

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A common type of fungal disease investigation involves hospital-associated clusters of invasive mold infections (IMIs), which typically occur among immunocompromised patients. Responding to IMI clusters can be challenging for public health and hospital personnel for several reasons such as difficulty of confirming the existence of an outbreak, difficulty of determining source. Although many resources exist to guide patient notification about healthcare incidents (eg, bloodborne exposures, disease outbreaks), IMI clusters involve special considerations related to the complex diseases, uncertain exposures, and differential benefits and risks of notification. Early, nuanced communication about hospital-associated IMI clusters is almost always the best course of action to help reduce risks to patients’ health and foster trust between patients and hospitals.

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The Changing Epidemiology of Invasive Aspergillosis in the Non-Traditional Host: Risk Factors and Outcomes

Cited by 16 publications

References 0 publications

Epidemiology and Antifungal Susceptibility Patterns of Invasive Fungal Infections (IFIs) in India: A Prospective Observational Study

Epidemiology and Antifungal Susceptibility Patterns of Invasive Fungal Infections (IFIs) in India: A Prospective Observational Study

Genetic Analyses of Amphotericin B Susceptibility in Aspergillus fumigatus

Patient notification about suspected hospital-associated outbreaks of invasive mold infections: Considerations for public health and hospital personnel

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