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Invasive mold infections in Thailand, Taiwan, India, China and Singapore

July 27 2017

Invasive mould infection (IMI) is a term for a large spectrum of emerging invasive diseases such as aspergillosis, zygomycosis, phaeohyphomycosis, or other mould infections. A recent study of the epidemiological and clinical characteristics of 155 IMI cases among Asian patients (Thailand, Taiwan, India, China and Singapore) has just been published by Dr Porpon Rotjanapan from Ramathibodi Hospital, Bangkok, Thailand and colleagues. In retrospective data from 2012 of 155 IMI cases found an incidence rate between 0.024 and 0.236 per 1,000 patient-days in hospital.

Proven IMI was described in a high proportion of the total cases (47.7%) based on medical, mycology and histopathology laboratory records. The rest of cases were categorised as probable IMI, and it is likely that many cases remain undiagnosed. Prolonged steroid use (39.4%) and recent neutropenia (38.7%) were the most common risk factors. The predominant clinical manifestations were fever (69%), cough (50.3%) and breathlessness (49.7%). Porpon et al also reported that diabetes mellitus (DM) is the first ranked underlying disease noted with rheumatologic diseases the second most common.  IMI clearly  affects a wide variety of patients.

The IMI included aspergillosis (72%), mucormycosis (10%), Fusariois (2.3%), and rare infections in the remainder. Aspergillus fumigatus (n=36) and Aspergillus flavus (n=29) were detected most often. However, different countries showed distinct patterns of the mould grown from culture due to geographical factors, the disease spectrum and the clinical management of the disease. The most common site of infection is the lung, with very variable CT findings, followed by sinus-related cases.

Empiric therapy with conventional amphotericin was the most common practice (31%), and voriconazole for targeted therapy (50%). A definitive surgical procedure was done in 31% of the cases. Despite the use of antifungal therapy the 90-day mortality rate is 32.9%. This rate is lower than the rate from specific groups of patients for example patient with organ transplants or disseminated diseases because the study included all patients with IMI, and excludes patients in whom the diagnosis was missed.