%0 Journal Article
%T 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).
%A Muthu V
%A Agarwal R
%A Rudramurthy SM
%A Thangaraju D
%A Shevkani MR
%A Patel AK
%A Shastri PS
%A Tayade A
%A Bhandari S
%A Gella V
%A Savio J
%A Madan S
%A Hallur V
%A Maturu VN
%A Srinivasan A
%A Sethuraman N
%A Sibia RPS
%A Pujari S
%A Mehta R
%A Singhal T
%A Saxena P
%A Gupta V
%A Nagvekar V
%A Prayag P
%A Patel D
%A Xess I
%A Savaj P
%A Sehgal IS
%A Panda N
%A Rajagopal GD
%A Parwani RS
%A Patel K
%A Deshmukh A
%A Vyas A
%A Gandra RR
%A Sistla SK
%A Padaki PA
%A Ramar D
%A Panigrahi MK
%A Sarkar S
%A Rachagulla B
%A Vallandaramam P
%A Premachandran KP
%A Pawar S
%A Gugale P
%A Hosamani P
%A Dutt SN
%A Nair S
%A Kalpakkam H
%A Badhwar S
%A Kompella KK
%A Singla N
%A Navlakhe M
%A Prayag A
%A Singh G
%A Dhakecha P
%A Chakrabarti A
%J Mycoses
%V 67
%N 5
%D 2024 May
%M 38767273
%F 4.931
%R 10.1111/myc.13745
%X <B>BACKGROUND: </B>Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse.<BR><B>OBJECTIVE: </B>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).<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.