Coinfection of mucormycosis and aspergillosis: case series

Authors: Swati Khullar, Mragnayani Pandey, Reshu Agarwal, Prashant Mani, Janya Sachdev, Gagandeep Singh, Immaculata Xess

Affiliation: Department of Microbiology, All India Institute of Medical Sciences, New Delhi

Objective: The study aimed to review epidemiology of coinfection, associated risk factors, treatment and outcome in suspected invasive fungal infection cases.
Method: A prospective study for the duration of one year (January- December 2017) was performed on suspected cases of invasive fungal infections.
Result: During the study period, direct microscopy showed the presence of both septate and aseptate hyphae in 18 samples (8 tissues, 6 respiratory and 4 nasal crust/ nasal scrapping) received from 12 cases. Culture showed either growth of aspergillus and/or mucorales in 83.3 % samples (15/18) and 17 isolates were obtained. Aspergillus flavus was the most common isolated spp (7/17) followed by Aspergillus niger and Lichtheimia corymbifera (4/17) each and one isolate each of Rhizopus microsporus and Aspergillus fumigatus. Diabetes mellitus was the most common underlying predisposing factor in 8 cases followed by one case each of chronic kidney disease and sarcoidosis. In two cases, underlying factor could not be ascertained. Surgical debridement along with liposomal amphotericin B was the mainstay of treatment in all cases. Favourable outcome was achieved in all except one who succumbed to death.
Conclusion: We emphasize need of a higher level of clinical suspicion of mixed fungal infections in immunocompromised individuals for early diagnosis and timely management.