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Clinical Characteristics, Health Care Utilization, and Outcomes Among Patients in a Pilot Surveillance System for
Jeremy A W Gold1, Andrew Revis2, Stepy Thomas2
1Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Background:
Invasive mold diseases (IMDs) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.
Methods:
During 2017-2019, the Emerging Infections Program conducted active IMD surveillance at 3 Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician's diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG vs non-MSG IMD cases.
Results:
Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66 [63.5%]), mucormycosis (n = 8 [7.7%]), and fusariosis (n = 4 [3.8%]); the most frequently affected body sites were pulmonary (n = 66 [63.5%]), otorhinolaryngologic (n = 17 [16.3%]), and cutaneous/deep tissue (n = 9 [8.7%]). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.
Conclusions:
IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude over one-half of clinically significant IMD cases.
Insights
Invasive mold diseases (IMDs) are severe, but surveillance is lacking. A pilot system found high mortality and diverse presentations, suggesting current criteria may miss many cases.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health Surveillance
Background:
- Invasive mold diseases (IMDs) are a significant cause of severe illness.
- There is a lack of comprehensive public health data on IMDs.
- This study describes a pilot laboratory-based surveillance system for IMDs.
Purpose of the Study:
- To describe data from a pilot invasive mold disease surveillance system.
- To characterize patient features and compare outcomes between different case classifications.
- To evaluate the utility of existing surveillance criteria.
Main Methods:
- Active surveillance was conducted at 3 Atlanta-area hospitals from 2017-2019.
- Potential IMD cases were identified through histopathology, culture, and Aspergillus galactomannan testing.
- Cases were classified using European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria or by clinician diagnosis.
Main Results:
- Of 304 potential IMD patients, 104 met a case definition (41 MSG, 63 non-MSG).
- Invasive aspergillosis was the most common IMD (63.5%), followed by mucormycosis (7.7%) and fusariosis (3.8%).
- Pulmonary (63.5%) and otorhinolaryngologic (16.3%) sites were most frequently affected; 32.7% 90-day mortality was observed.
Conclusions:
- IMD patients exhibit high mortality and varied clinical presentations.
- Robust IMD surveillance is crucial for tracking emerging trends.
- Strict adherence to MSG criteria may exclude over half of clinically significant IMD cases, highlighting the need for broader case definitions.
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