Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 05505 Seoul, Republic of Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 05505 Seoul, Republic of Korea.
Med Mycol. 2024 Aug 2;62(8). doi: 10.1093/mmy/myae081.
Although research on aspergillosis and mucormycosis confection is important to optimize antifungal therapy, data on this issue is scarce. Thus, we systematically investigated aspergillosis coinfection in patients with proven mucormycosis. Medical records of adult patients with proven mucormycosis whose formalin-fixed paraffin-embedded (FFPE) tissue sections were available, in a tertiary hospital from August 2007 to July 2023 were retrospectively reviewed to assess coinfection with aspergillosis. We noted cultures of fungi from sterile and non-sterile sites and performed polymerase chain reaction (PCR) assays on FFPE tissues to detect Aspergillus- and Mucorales-specific DNA. Sixty-seven patients with proven mucormycosis, including 12 (18%) with a positive culture of the mucormycosis agent from sterile site cultures, were enrolled. Fungal cultures from sterile and non-sterile sites revealed Aspergillus spp. growth in nine (13%) of the 67 patients, including two sterile and seven non-sterile cultures. The fungal PCR analysis from the FFPE sections was positive for Aspergillus-specific PCR in five (7%) and positive for both Aspergillus- and Mucorales-specific PCR results in eight (12%). Overall, 21 (31%) of the 67 patients with proven mucormycosis had microbiologic and/or molecular evidence of aspergillosis coinfection. Positive blood or bronchoalveolar lavage fluid galactomannan results were more common in the coinfection group (67% [14/21]) than in the mucormycosis group (37% [17/46], P = .024). No significant difference in mortality between the two groups was observed. Approximately one-third of patients with proven mucormycosis exhibited molecular and/or microbiologic evidence of aspergillosis coinfection. Further research is needed to identify patients with aspergillosis and mucormycosis coinfections, for optimal antifungal therapy.
虽然曲霉病和毛霉病联合感染的研究对于优化抗真菌治疗很重要，但关于这个问题的数据却很少。因此，我们系统地调查了确诊毛霉病患者的曲霉病合并感染。回顾性分析了 2007 年 8 月至 2023 年 7 月在一家三级医院就诊的确诊毛霉病的成年患者的病历，这些患者的福尔马林固定石蜡包埋（FFPE）组织切片可用，以评估曲霉病合并感染。我们注意到无菌和非无菌部位的真菌培养物，并对 FFPE 组织进行聚合酶链反应（PCR）检测，以检测曲霉属和毛霉目特异性 DNA。共纳入 67 例确诊毛霉病患者，其中 12 例（18%）无菌部位培养出毛霉病病原体阳性。无菌和非无菌部位的真菌培养物显示，67 例患者中有 9 例（13%）生长有曲霉属，其中 2 例无菌培养阳性，7 例非无菌培养阳性。FFPE 切片的真菌 PCR 分析中，5 例（7%）为曲霉属特异性 PCR 阳性，8 例（12%）为曲霉属和毛霉目特异性 PCR 结果均阳性。总的来说，67 例确诊毛霉病患者中，有 21 例（31%）有曲霉病合并感染的微生物学和/或分子证据。合并感染组（67%[14/21]）血或支气管肺泡灌洗液半乳甘露聚糖检测阳性的患者比毛霉病组（37%[17/46]）更常见（P=0.024）。两组患者的死亡率无显著差异。约三分之一的确诊毛霉病患者有曲霉病合并感染的分子和/或微生物学证据。需要进一步研究以确定曲霉病和毛霉病合并感染的患者，从而优化抗真菌治疗。
