Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre retrospective study from India

Clinical Microbiology and Infection, Год журнала: 2023, Номер 30(3), С. 368 - 374

Опубликована: Дек. 9, 2023

Язык: Английский

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Iron Levels in Bronchoalveolar Lavage Fluid of Hematological Patients with Suspected Invasive Pulmonary Aspergillosis and their Association with 12-week Mortality: A Retrospective Cohort Study

Mycopathologia, Год журнала: 2025, Номер 190(1)

Опубликована: Фев. 1, 2025

Accuracy of diagnostic tests for invasive pulmonary aspergillosis (IPA) using bronchoalveolar lavage fluid (BALF) remains suboptimal. Elevated tissue iron in lung transplant and murine models is linked to Aspergillus growth. This study examines the correlation between BALF levels, IPA, 12-week mortality. We conducted a retrospective cohort at tertiary care center, including 100 samples from patients with hematological malignancies suspected IPA 2014 2019. Data regarding concentrations, mycological tests, mortality were analyzed. Higher levels correlated greater likelihood based on EORTC/MSGERC 2020 definitions (p = 0.038). The ROC area was 0.648 (95% CI 0.531-0.764), an optimal cut-off 0.75 µmol/L distinguish cases (27 probable 0 proven IPA) controls (56 possible 17 no IPA), sensitivity 76.9% specificity 47.3%. Iron positively higher fungal loads (galactomannan: Spearman's ρ 0.323, p 0.001; PCR Ct-values: - 0.602, 0.002). A trend toward observed concentrations ≥ 0.90 compared lower 0.086). highest those followed by lowest without also correlating potentially However, given various potential confounding factors, further prospective studies are essential establish causality. These findings warrant additional investigation into as marker survival, but validation necessary before considering it supplementary current classification or IPA.

Язык: Английский

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Sensitivity and Specificity of Plasma and Bronchoalveolar Lavage Fluid PCR for Diagnosing Pulmonary Mucormycosis in Subjects With Diabetes Mellitus

Mycoses, Год журнала: 2025, Номер 68(4)

Опубликована: Апрель 1, 2025

ABSTRACT Background Mucorales polymerase chain reaction (PCR) is used to diagnose pulmonary mucormycosis (PM) among neutropenic individuals. However, data on the utility of PCR in patients with diabetes mellitus, another major risk factor for PM, are limited. Objective The primary objective was assess diagnostic performance a commercial real‐time assay (MucorGenius) plasma and bronchoalveolar lavage fluid (BALF) diagnosing PM (proven probable cases only) suspected invasive mould disease (IMD). For secondary objective, we evaluated MucorGenius all (proven, probable, possible) cases. Methods We prospectively enrolled IMD assessed (index test) BALF samples. A multidisciplinary team assigned final diagnosis (reference standard) based microscopy, histopathology, cytology, culture. report sensitivity, specificity, positive predictive value (PPV), negative (NPV) 95% confidence intervals (CI). Results 103 patients, whom 43 (41.7%) were confirmed have PM. Plasma showed sensitivity 18.6% (95% CI: 8.4–33.4), specificity 90.7% CI:77.9–97.4), PPV 66.7%, NPV 52.7%. Including possible PM/IMD improved 30.0% 18.9–43.2) retained at 90.7%. had better (47.4%) but poorer (69.6%), 56.3% 61.5%. Conclusion poor individuals mellitus. Further multicenter studies needed validate these findings.

Язык: Английский

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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)

Mycoses, Год журнала: 2024, Номер 67(5)

Опубликована: Май 1, 2024

Abstract Background Data on mixed mould infection with COVID‐19‐associated pulmonary aspergillosis (CAPA) and mucormycosis (CAPM) are sparse. Objectives To ascertain the prevalence of co‐existent CAPA in CAPM (mixed infection) whether is associated early mortality (≤7 days diagnosis). Methods We retrospectively analysed data collected from 25 centres across India mucormycosis. included only excluded subjects disseminated or rhino‐orbital defined if a respiratory specimen showed septate hyphae smear, histopathology culture grew Aspergillus spp. also compare demography, predisposing factors, severity COVID‐19, management patients without CAPA. Using case–control design, we assess (primary exposure) were CAPM. Results 105 The was 20% (21/105). Patients experienced (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) poorer survival at 6 weeks (7/21 [33.3] 46/77 [59.7%]; 0.03) than alone. On imaging, consolidation more commonly encountered infections Co‐existent (odds ratio [95% confidence interval], 19.1 [2.62–139.1]) independently after adjusting for hypoxemia during COVID‐19 other factors. Conclusion Coinfection not uncommon our portends worse prognosis. Prospective studies different countries required to know impact infection.

Язык: Английский

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COVID-19, mucormycosis, and the cow: Damned lies!

Indian Journal of Medical Microbiology, Год журнала: 2023, Номер 44, С. 100382 - 100382

Опубликована: Май 24, 2023

Язык: Английский

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Computed tomography findings of COVID-19-associated pulmonary mucormycosis: Data from a multicenter retrospective study (Mucovi2), India

Lung India, Год журнала: 2024, Номер 41(3), С. 221 - 224

Опубликована: Апрель 30, 2024

Dear Editor, A large number of mucormycosis cases were reported in India following the second wave COVID-19.[1] However, data on imaging appearance COVID-19-associated pulmonary (CAPM) are limited.[2] few published case reports CAPM and a systematic literature review suggested cavity consolidation as most common finding.[3-6] The primary objective current study was to describe computed tomography (CT) thorax findings at diagnosis. secondary objectives compare CT (1) patients with diabetes mellitus (DM) those no known traditional risk factors, (2) survivors non-survivors CAPM. MuCovi-2 multicentre retrospective conducted across 25 centres between 1 January 2021 30 June 2021. Data (microbiologically or pathologically confirmed) age-matched controls collected original study.[7] COVID-19 diagnosed by detecting SARS-CoV2 infection nasopharyngeal throat swabs rapid antigen testing reverse transcriptase polymerase chain reaction. Only subjects proven probable included present study, defined previously.[2] diagnosis management per prevalent guidelines.[2,8] clinical presentation, outcome entire cohort have been recently.[9] For we excluded inadequate data. We noted (as yes/no) radiological (cavity, consolidation, reversed halo sign (RHS), bird's nest sign, pneumothorax, mycotic aneurysm, pleural effusion, nodules, others) presented numbers (percentage) mean standard deviation (SD). used Mann–Whitney U Fisher's exact (or Chi-square) tests analyse difference continuous categorical variables. assumed statistical significance P value <0.05. 84 [Table 1]. participants' (SD) age 53.8 (12.5) years. DM predisposing factor 58/84 (69%) subjects. Glucocorticoid treatment for prescribed 82.3% (65/79) subjects, nearly 20% these received inappropriate glucocorticoid therapy (i.e., absence COVID-19-related hypoxemia). Cavity finding (56/84; 77.8%). RHS observed 14/84 (16.7%) Pleural effusion >10 lung nodules 19/84 (22.6%) 2/84 (2.4%) respectively. Tracheobronchial four one whom had an isolated tracheal lesion other parenchymal abnormality. Of 43 (51.2%) 41 (48.8%) CAPM, Bilateral disease significantly more (20/41 [48.8%] versus 9/43 [20.9%] among cases), frequent (15/43 [34.9%] 4/41 [9.8%] CAPM). None different similar only DM, except which less 2]. Survival 6 weeks 12 43/79 (54.4%) 37/73 (50.7%). found significant differences 6-weeks 3].Table 1: Baseline characteristics (n=84) diagnosisTable 2: Comparison without mellitusTable 3: CAPMTimely improves survival (PM), serious illness high mortality.[10,11] scan provides earliest clues diagnosing PM [Figure 1].[12] from factors such haematological malignancies organ transplant recipients.[13,14] Imaging appearances poorly studied. (66.7%) like DM.[15,16] frequently our (13%) than previous studies (48%).[17] Interestingly, infrequent (12%), even diabetic lesser frequency predominance cavities could be related duration before scan.[15] include masses; cavitation occurs later when lesions undergo central necrosis.[18] Neutropenic evaluated early chest thus manifest masses. Contrarily, presents common. participants (CAPM DM) possibly late during due severe COVID-19. Also, attributed hospital-acquired pneumonia. Although insensitive, notable may suggest (including uncontrolled DM).Figure Representative images showing typical signs mucormycosis: (a) right upper lobe along diffuse ground glass opacities (GGOs; related) pneumomediastinum, (b) side patchy bilateral lungs GGOs, (c) air-fluid level lower GGOs (d) artery aneurysm lobe; pneumothorax is also sideOur has limitations. retrospectively retrieved patients' records, not centrally reviewed. Despite relatively small. Further, protocol, use contrast, reporting influenced results. vary depending PM, do this information. comparator group (e.g., invasive aspergillosis); therefore, specificity unknown. individuals confirmed might missed where microbiological pathological confirmation unavailable. Isolated tracheobronchial (also COVID-19) any abnormalities series.[19] In summary, previously complicating DM. India. Prospective studies, including serial performed larger varying required. Financial support sponsorship Nil. Conflicts interest There conflicts interest.

Язык: Английский

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Immune and metabolic perturbations in COVID‐19‐associated pulmonary mucormycosis: A transcriptome analysis of innate immune cells

Mycoses, Год журнала: 2023, Номер 67(1)

Опубликована: Дек. 8, 2023

Abstract Background and Objectives The mechanisms underlying COVID‐19‐associated pulmonary mucormycosis (CAPM) remain unclear. We use a transcriptomic analysis of the innate immune cells to investigate host metabolic response pathways in patients with CAPM. Patients Methods enrolled subjects CAPM ( n = 5), (PM) without COVID‐19 (without mucormycosis, healthy controls 5) comorbid illness negative for SARS‐CoV‐2. Peripheral blood samples from cases were collected before initiating antifungal therapy, neutrophils monocytes isolated. RNA sequencing was performed using Illumina HiSeqX neutrophils. Raw reads aligned HISAT‐2 pipeline DESeq2 used differential gene expression. Gene ontology (GO) pathway Shiny GO application R packages (ggplot2, Pathview). Results derangement core responses noted. Pattern recognition receptors, dectin‐2, MCL, FcRγ receptors CLEC‐2, upregulated, but signalling such as JAK–STAT, IL‐17 CARD‐9 downregulated; mTOR MAP‐kinase elevated patients. complement NETosis, pro‐inflammatory responses, S100A8/A9, lipocalin MMP9, elevated. major glucose metabolism—glycolysis/gluconeogenesis, pentose phosphate pathway, HIF iron metabolism‐ferroptosis also upregulated Conclusions identified significant alterations possibly leading cellular overload hyperglycaemic state. Immune revealed altered recognition, signalling, effector functions state

Язык: Английский

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Non-Aspergillus Pulmonary Mold Infections

Опубликована: Янв. 1, 2024

Язык: Английский

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Cow dung, COVID-19, and mucormycosis … more damned lies

Indian Journal of Medical Microbiology, Год журнала: 2023, Номер 46, С. 100464 - 100464

Опубликована: Сен. 8, 2023

Язык: Английский

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