Concurrent pulmonary Aspergillus and non-Aspergillus mold infections in allogeneic hematopoetic cell transplant...

Area of Science:

• Mycology
• Hematology
• Infectious Diseases

Background:

• Patients with hematologic malignancies and hematopoietic cell transplantation (HCT) recipients are highly susceptible to invasive mold infections (IMIs).
• Risk factors and clinical presentations for Aspergillus spp. and non-Aspergillus spp. IMIs often overlap, complicating diagnosis.
• Early and accurate diagnosis is crucial for effective treatment of IMIs in immunocompromised populations.

Observation:

• Three cases of HCT recipients with probable co-infections involving both Aspergillus spp. and non-Aspergillus spp. invasive pulmonary molds are presented.
• In two cases, antifungal treatment was escalated to voriconazole, but non-Aspergillus molds were only diagnosed post-mortem.
• These observations underscore the diagnostic challenges in identifying concurrent fungal pathogens in this vulnerable patient group.

Findings:

• Co-infection with Aspergillus spp. and non-Aspergillus spp. can occur in HCT recipients.
• Delayed diagnosis of non-Aspergillus molds, even after initiating broad-spectrum antifungals like voriconazole, can happen.
• Clinical presentation alone may not differentiate between Aspergillus and non-Aspergillus IMIs, especially in co-infections.

Implications:

• There is a critical need for enhanced and rapid diagnostic tools for fungal infections in immunocompromised patients.
• Clinicians must maintain a high index of suspicion for concurrent Aspergillus and non-Aspergillus IMIs.
• Improved diagnostic strategies are essential to guide appropriate antifungal therapy and improve outcomes for HCT recipients at risk for IMIs.