Abstract：
BACKGROUND: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：与COVID-19相关的肺曲霉病（CAPA）和COVID-19相关的肺毛霉菌病（CAPM）混合霉菌感染的数据很少。
目的：确定CAPM（混合霉菌感染）中共存CAPA的患病率，以及混合霉菌感染是否与早期死亡率（诊断≤7天）相关。
方法：我们回顾性分析了从印度25个中心收集的关于COVID-19相关毛霉菌病的数据。我们仅包括CAPM，并排除了播散性或犀牛眶毛霉菌病的受试者。如果呼吸道标本在涂片上显示有纵隔菌丝，我们定义了共存的CAPA，组织病理学或培养生长的曲霉属。我们还比较了人口统计，诱发因素,COVID-19的严重程度，以及有和没有CAPA的CAPM患者的管理。使用病例控制设计，我们评估了混合霉菌感染(主要暴露)是否与CAPM早期死亡率相关.
结果：我们纳入了105例CAPM患者。混合霉菌感染的患病率为20％（21/105）。混合霉菌感染患者早期死亡（9/21[42.9%]vs.15/84[17.9%]；p=0.02）和6周生存率较差（7/21[33.3]vs.46/77[59.7%]；p=0.03)比单独的CAPM。在成像方面，与CAPM相比，混合霉菌感染更常见于合并。共存CAPA(赔率比[95%置信区间]，19.1[2.62-139.1]）在校正COVID-19期间的低氧血症和其他因素后，与CAPM的早期死亡率独立相关。
结论：CAPA和CAPM的共感染在我们的CAPM患者中并不少见，预示着预后较差。需要进行来自不同国家的前瞻性研究，以了解混合霉菌感染的影响。
目的：确定CAPM（混合霉菌感染）中共存CAPA的患病率，以及混合霉菌感染是否与早期死亡率（诊断≤7天）相关。
方法：我们回顾性分析了从印度25个中心收集的关于COVID-19相关毛霉菌病的数据。我们仅包括CAPM，并排除了播散性或犀牛眶毛霉菌病的受试者。如果呼吸道标本在涂片上显示有纵隔菌丝，我们定义了共存的CAPA，组织病理学或培养生长的曲霉属。我们还比较了人口统计，诱发因素,COVID-19的严重程度，以及有和没有CAPA的CAPM患者的管理。使用病例控制设计，我们评估了混合霉菌感染(主要暴露)是否与CAPM早期死亡率相关.
结果：我们纳入了105例CAPM患者。混合霉菌感染的患病率为20％（21/105）。混合霉菌感染患者早期死亡（9/21[42.9%]vs.15/84[17.9%]；p=0.02）和6周生存率较差（7/21[33.3]vs.46/77[59.7%]；p=0.03)比单独的CAPM。在成像方面，与CAPM相比，混合霉菌感染更常见于合并。共存CAPA(赔率比[95%置信区间]，19.1[2.62-139.1]）在校正COVID-19期间的低氧血症和其他因素后，与CAPM的早期死亡率独立相关。
结论：CAPA和CAPM的共感染在我们的CAPM患者中并不少见，预示着预后较差。需要进行来自不同国家的前瞻性研究，以了解混合霉菌感染的影响。
