Active Surveillance for Invasive Mold Disease - Four Hospitals, Atlanta, Georgia, 2020-2024

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Public Health Surveillance

Background:

• Invasive mold diseases (IMDs) are rare but life-threatening infections affecting immunocompromised individuals.
• Common causative agents include Aspergillus spp., Mucorales, Fusarium spp., and Scedosporium spp.
• IMDs can manifest in various body sites, including lungs, sinuses, and the central nervous system.

Purpose of the Study:

• To describe the epidemiology and characteristics of IMDs in Atlanta, Georgia, from 2020-2024.
• To establish baseline data for future IMD surveillance and outbreak detection.
• To highlight the need for broader diagnostic considerations beyond classic risk factors.

Main Methods:

• Active, laboratory-based surveillance was conducted at four Atlanta hospitals.
• Potential IMD cases were identified via positive mold cultures or Aspergillus galactomannan tests.
• Cases were classified using established National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria.

Main Results:

• 449 IMD cases were identified, with Aspergillus spp. being the most common pathogen (71%).
• Pulmonary infections were most frequent (68%), followed by cutaneous (11%) and sinus/nasal (10%).
• The 90-day all-cause mortality rate was 45%, significantly higher in patients with recent COVID-19 (66%).

Conclusions:

• IMDs are associated with high ICU admission and mortality rates, especially in patients with recent COVID-19.
• A substantial proportion of IMD cases occurred in patients lacking traditional host risk factors.
• Vigilance for IMDs is crucial, and surveillance should broaden to include patients without classic risk factors.