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Gold JAW, Adjei S, Gundlapalli AV, Huang YLA, Chiller T, Benedict K, Toda M. Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020-December 2021. Emerg Infect Dis 2023; 29:1433-1437. [PMID: 37347805 PMCID: PMC10310397 DOI: 10.3201/eid2907.221771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019-2021. During 2020-2021, patients hospitalized with COVID-19-associated fungal infections had higher (48.5%) in-hospital mortality rates than those with non-COVID-19-associated fungal infections (12.3%). Improved fungal disease surveillance is needed, particularly during respiratory virus pandemics.
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Benedict K, Jackson BR, Toda M. Diagnosis Codes for Mold Infections and Mold Exposure Before and After Hurricane Harvey Among a Commercially Insured Population-Houston, Texas, 2016-2018. Disaster Med Public Health Prep 2023; 17:e504. [PMID: 36927602 PMCID: PMC10640901 DOI: 10.1017/dmp.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Indoor mold after flooding poses health risks, including rare but serious invasive mold infections. The purpose of this study was to evaluate use of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for mold infection and mold exposure in Houston, Texas, during the year before and the year after Hurricane Harvey. METHODS This study used data from MarketScan, a large health insurance claims database. RESULTS The incidence of invasive mold infections remained unchanged in the year after Hurricane Harvey; however, the incidence of diagnosis codes for mold exposure nearly doubled compared with the year before the hurricane (6.3 vs 11.0 per 100 000 enrollees, rate ratio: 1.7, 95% confidence interval 1.0-3.1). CONCLUSIONS Diagnosis codes alone may not be sufficiently sensitive to detect changes in invasive mold infection rates within this population and time frame, demonstrating the need for more comprehensive studies.
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Affiliation(s)
| | | | - Mitsuru Toda
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Toda M, Williams S, Jackson BR, Wurster S, Serpa JA, Nigo M, Grimes CZ, Atmar RL, Chiller TM, Ostrosky-Zeichner L, Kontoyiannis DP. Invasive Mold Infections Following Hurricane Harvey-Houston, Texas. Open Forum Infect Dis 2023; 10:ofad093. [PMID: 36910694 PMCID: PMC10003735 DOI: 10.1093/ofid/ofad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background Characterizing invasive mold infection (IMI) epidemiology in the context of large flooding events is important for public health planning and clinical decision making. Methods We assessed IMI incidence (per 10 000 healthcare encounters) 1 year before and after Hurricane Harvey at 4 hospitals in Houston, Texas. Potential IMI cases were assigned as proven or probable cases using established definitions, and surveillance cases using a novel definition. We used rate ratios to describe IMI incidence and multivariable logistic regression to examine patient characteristics associated with IMI case status. Results IMI incidence was significantly higher posthurricane (3.69 cases) than prehurricane (2.50 cases) (rate ratio, 1.48 [95% confidence interval, 1.10-2.00]), largely driven by surveillance IMI cases. Aspergillus was the most common species cultured (33.5% prehurricane and 39.9% posthurricane). About one-quarter (25.8%) of IMI patients lacked classical IMI risk factors such as hematologic malignancy and transplantations. Overall, 45.1% of IMI patients received intensive care, and in-hospital all-cause mortality was 24.2%. Conclusions IMI incidence likely increased following Hurricane Harvey and outcomes for IMI patients were severe. Patient and clinician education on IMI prevention and identification is warranted, particularly as the frequency of extreme weather events increases due to climate change.
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Affiliation(s)
- Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samantha Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sebastian Wurster
- Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Jose A Serpa
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Masayuki Nigo
- Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Carolyn Z Grimes
- Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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He Q, Li M, Cao J, Zhang M, Feng C. Diagnosis values of Dectin-1 and IL-17 levels in plasma for invasive pulmonary aspergillosis in bronchiectasis. Front Cell Infect Microbiol 2022; 12:1018499. [PMID: 36304934 PMCID: PMC9592802 DOI: 10.3389/fcimb.2022.1018499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Among immunocompetent patients, patients with bronchiectasis are considered to be a high-risk group for invasive pulmonary aspergillosis (IPA). Early diagnosis and treatment can improve the prognosis of patients. Objectives We aimed to investigate the diagnostic value of Dectin-1 and IL-17 for diagnosing IPA with bronchiectasis. Methods We retrospectively collected data on patients with bronchiectasis who had been hospitalized in the Third Affiliated Hospital of Soochow University between September 2018 to December 2021. Dectin-1, IL-17 and GM were measured by enzyme-linked immunosorbent assays. Results A total of 129 patients were analyzed in the study, of whom 33 had proven or probable IPA with bronchiectasis. The remaining 96 patients served as controls. The plasma Dectin-1 and IL-17 levels in the IPA group were significantly higher than that in the control group (P=0.005; P<0.001). The plasma GM, BALF GM, plasma Dectin-1 and IL-17 assays had sensitivities of 39.4%, 62.5%, 69.7% and 78.8%, respectively, and specificities of 89.2%, 91.5%, 72.9% and 71.9%, respectively. The sensitivity of Dectin-1 and IL-17 in plasma was higher than that in plasma and BALF GM. while the specificity is lower than that of plasma and BALF GM. The diagnostic sensitivity and specificity of plasma GM combined with IL-17 for IPA in bronchiectasis were greater than 80%. The combination of plasma GM and IL-17 can improve the sensitivity of the GM test, but does not reduce the diagnostic specificity. The plasma Dectin-1 and IL-17 showed positive linear correlations with the bronchiectasis severity Index (BSI) score in linear regression. Conclusions Plasma Dectin-1 and IL-17 levels were significantly higher in bronchiectasis patients with IPA. The sensitivity of Dectin-1 and IL-17 was superior to that of GM for the diagnosis of IPA in patients with bronchiectasis. The combination of GM and IL-17 in plasma is helpful for the diagnosis of IPA in bronchiectasis patients who cannot tolerate invasive procedures.
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Langfeldt A, Gold JAW, Chiller T. Emerging Fungal Infections: from the Fields to the Clinic, Resistant Aspergillus fumigatus and Dermatophyte Species: a One Health Perspective on an Urgent Public Health Problem. CURRENT CLINICAL MICROBIOLOGY REPORTS 2022; 9:46-51. [PMID: 36188157 PMCID: PMC9512973 DOI: 10.1007/s40588-022-00181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review For this review, we use a One Health approach to examine two globally emerging public health threats related to antifungal drug resistance: triazole-resistant Aspergillus fumigatus infections, which can cause a life-threatening illness in immunocompromised hosts, and antifungal-resistant dermatophytosis, which is an aggressive skin infection caused by dermatophyte molds. We describe the state of current scientific knowledge and outline necessary public health actions to address each issue. Recent Findings Recent evidence has identified the agricultural use of triazole fungicides as an important driver of triazole-resistant A. fumigatus infections. Antifungal-resistant dermatophyte infections are likely driven by the inappropriate use of antifungal drugs and antibacterial and corticosteroid creams. Summary This review highlights the need for a One Health approach to address emerging antifungal resistant infections, emphasizing judicious antifungal use to preserve available treatments; strengthened laboratory capacity to identify antifungal resistance; and improved human, animal, and environmental surveillance to detect emerging resistance, monitor trends, and evaluate the effectiveness of efforts to decrease spread.
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Affiliation(s)
- Antonia Langfeldt
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
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Benedict K, Gold JAW, Jenkins EN, Roland J, Barter D, Czaja CA, Johnston H, Clogher P, Farley MM, Revis A, Harrison LH, Tourdot L, Davis SS, Phipps EC, Felsen CB, Tesini BL, Escutia G, Pierce R, Zhang A, Schaffner W, Lyman M. Low sensitivity of ICD-10 coding for culture-confirmed candidemia cases in an active surveillance system—United States, 2019–2020. Open Forum Infect Dis 2022; 9:ofac461. [DOI: 10.1093/ofid/ofac461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
We evaluated healthcare facility use of ICD-10 codes for culture-confirmed candidemia cases detected by active public health surveillance during 2019–2020. Most cases (56%) did not receive a candidiasis code, suggesting that studies relying on ICD-10 codes likely underestimate disease burden.
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Affiliation(s)
- Kaitlin Benedict
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeremy A W Gold
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Emily N Jenkins
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
- ASRT, Inc. , Atlanta, Georgia , USA
| | - Jeremy Roland
- California Emerging Infections Program , Oakland, California , USA
| | - Devra Barter
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Christopher A Czaja
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Helen Johnston
- Colorado Department of Public Health and Environment , Denver, Colorado , USA
| | - Paula Clogher
- Connecticut Emerging Infections Program, Yale School of Public Health , New Haven, Connecticut , USA
| | - Monica M Farley
- Emory University School of Medicine , Atlanta, Georgia , USA
- Atlanta VA Medical Center , Atlanta, Georgia , USA
| | - Andrew Revis
- Atlanta VA Medical Center , Atlanta, Georgia , USA
- Georgia Emerging Infections Program , Atlanta, Georgia , USA
- Foundation for Atlanta Veterans Education and Research , Atlanta, Georgia , USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA
| | - Laura Tourdot
- Minnesota Department of Health , Saint Paul, Minnesota , USA
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program , Albuquerque, New Mexico , USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program , Albuquerque, New Mexico , USA
- University of New Mexico , Albuquerque, New Mexico , USA
| | | | - Brenda L Tesini
- University of Rochester School of Medicine , Rochester, New York , USA
| | - Gabriela Escutia
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | - Alexia Zhang
- Public Health Division, Oregon Health Authority , Portland, Oregon USA
| | | | - Meghan Lyman
- Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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Gold JAW, Ahmad FB, Cisewski JA, Rossen LM, Montero AJ, Benedict K, Jackson BR, Toda M. Increased Deaths From Fungal Infections During the Coronavirus Disease 2019 Pandemic-National Vital Statistics System, United States, January 2020-December 2021. Clin Infect Dis 2022; 76:e255-e262. [PMID: 35717660 PMCID: PMC9214147 DOI: 10.1093/cid/ciac489] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying of fungal infections during the COVID-19 pandemic. METHODS Using NVSS's January 2018-December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100 000 population) of deaths due to fungal infection by fungal pathogen, COVID-19 association, demographic characteristics, and year. RESULTS Numbers and age-adjusted rates of deaths due to fungal infection increased from 2019 (n = 4833; rate, 1.2 [95% confidence interval, 1.2-1.3]) to 2021 (n = 7199; rate, 1.8 [1.8-1.8] per 100 000); of 13 121 such deaths during 2020-2021, 2868 (21.9%) were COVID-19 associated. Compared with non-COVID-19-associated deaths (n = 10 253), COVID-19-associated deaths more frequently involved Candida (n = 776 [27.1%] vs n = 2432 [23.7%], respectively) and Aspergillus (n = 668 [23.3%] vs n = 1486 [14.5%]) and less frequently involved other specific fungal pathogens. Rates of death due to fungal infection were generally highest in nonwhite and non-Asian populations. Death rates from Aspergillus infections were approximately 2 times higher in the Pacific US census division compared with most other divisions. CONCLUSIONS Deaths from fungal infection increased during 2020-2021 compared with previous years, primarily driven by COVID-19-associated deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in patients with COVID-19, especially in certain racial/ethnic groups and geographic areas.
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Affiliation(s)
- Jeremy A W Gold
- Corresponding author: Jeremy A. W. Gold, MD, MS, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop H24-10, Atlanta, GA 30329, USA,
| | - Farida B Ahmad
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Jodi A Cisewski
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Lauren M Rossen
- National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Alejandro J Montero
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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