{Reference Type}: Journal Article
{Title}: 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).
{Author}: Muthu V;Agarwal R;Rudramurthy SM;Thangaraju D;Shevkani MR;Patel AK;Shastri PS;Tayade A;Bhandari S;Gella V;Savio J;Madan S;Hallur V;Maturu VN;Srinivasan A;Sethuraman N;Sibia RPS;Pujari S;Mehta R;Singhal T;Saxena P;Gupta V;Nagvekar V;Prayag P;Patel D;Xess I;Savaj P;Sehgal IS;Panda N;Rajagopal GD;Parwani RS;Patel K;Deshmukh A;Vyas A;Gandra RR;Sistla SK;Padaki PA;Ramar D;Panigrahi MK;Sarkar S;Rachagulla B;Vallandaramam P;Premachandran KP;Pawar S;Gugale P;Hosamani P;Dutt SN;Nair S;Kalpakkam H;Badhwar S;Kompella KK;Singla N;Navlakhe M;Prayag A;Singh G;Dhakecha P;Chakrabarti A;
{Journal}: Mycoses
{Volume}: 67
{Issue}: 5
{Year}: 2024 May
{Factor}: 4.931
{DOI}: 10.1111/myc.13745
{Abstract}: <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.