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)

• Published in: Mycoses Vol. 67; no. 5; pp. e13745 - n/a
• Main Authors: Muthu, Valliappan, Agarwal, Ritesh, Rudramurthy, Shivaprakash Mandya, Thangaraju, Deepak, Shevkani, Manoj Radhakishan, Patel, Atul K., Shastri, Prakash Srinivas, Tayade, Ashwini, Bhandari, Sudhir, Gella, Vishwanath, Savio, Jayanthi, Madan, Surabhi, Hallur, Vinaykumar, Maturu, Venkata Nagarjuna, Srinivasan, Arjun, Sethuraman, Nandini, Sibia, Raminder Pal Singh, Pujari, Sanjay, Mehta, Ravindra, Singhal, Tanu, Saxena, Puneet, Gupta, Varsha, Nagvekar, Vasant, Prayag, Parikshit, Patel, Dharmesh, Xess, Immaculata, Savaj, Pratik, Sehgal, Inderpaul Singh, Panda, Naresh, Rajagopal, Gayathri Devi, Parwani, Riya Sandeep, Patel, Kamlesh, Deshmukh, Anuradha, Vyas, Aruna, Gandra, Raghava Rao, Sistla, Srinivas Kishore, Padaki, Priyadarshini A., Ramar, Dharshni, Panigrahi, Manoj Kumar, Sarkar, Saurav, Rachagulla, Bharani, Vallandaramam, Pattabhiraman, Premachandran, Krishna Prabha, Pawar, Sunil, Gugale, Piyush, Hosamani, Pradeep, Dutt, Sunil Narayan, Nair, Satish, Kalpakkam, Hariprasad, Badhwar, Sanjiv, Kompella, Kiran Kumar, Singla, Nidhi, Navlakhe, Milind, Prayag, Amrita, Singh, Gagandeep, Dhakecha, Poorvesh, Chakrabarti, Arunaloke
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01.05.2024
• Subjects: Adult; Aged; Aspergillosis; aspergillus; Case-Control Studies; Coinfection - epidemiology; Coinfection - microbiology; Coinfection - mortality; corona virus; COVID-19; COVID-19 - complications; COVID-19 - mortality; Demography; Female; Humans; Hyphae; Hypoxemia; India - epidemiology; Infections; Lung Diseases, Fungal - complications; Lung Diseases, Fungal - epidemiology; Lung Diseases, Fungal - mortality; Male; Medical prognosis; Middle Aged; mixed mould infections; Mold; Mortality; moulds; Mucormycosis; Mucormycosis - complications; Mucormycosis - epidemiology; Mucormycosis - mortality; Prevalence; Pulmonary Aspergillosis - complications; Pulmonary Aspergillosis - epidemiology; Pulmonary Aspergillosis - mortality; Retrospective Studies; Rhizopus; SARS-CoV-2; zygomycosis; India; zygomycosis; aspergillus; moulds; mixed mould infections; Rhizopus; corona virus
• ISSN: 0933-7407; 1439-0507; 1439-0507
• 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.