Table 1.
A literature review was performed by searching PubMed for combinations of Aspergillus/aspergillosis, Mucor/Mucorales/mucormycosis, and mixed mycosis, mixed mycotic infection, coinfection or dual infection to identify relevant papers in English. Cases referenced in the papers initially retrieved were also collected. Over 70 reported cases of Aspergillus and Mucorales coinfection were identified in this manner. Cases were excluded from the table based on (1) if the patient survived, (2) if an autopsy was not performed after patient passed, (3) if infection was of the superficial skin or due to trauma, and (4) if the paper did not provide images of the fungal histology. Patient 1 and 2 are the cases described in our paper. Fungal cultures were taken at time of autopsy unless otherwise stated. Fungal culture and biomarker timing are when the specimens were obtained, not when the results were available to clinicians. ND = not done, GM = galactomannan, BDG = beta-D-glucan, BAL = bronchoalveolar lavage, CSF = cerebrospinal fluid, AmB = amphotericin B, L-AmB = liposomal amphotericin B.
| Patient | Age | Gender | Underlying Condition | Immunosuppressive Treatment | Antifungal Treatment | Autopsy Evidence of Dual Invasive Fungal Infections | Fungal Identification (Genus/Species) | Fungal Biomarkers | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Aspergillosis | Mucormycosis | By Tissue Culture | By DNA Sequencing on FFPE Block | GM | BDG | ||||||
| 1 | 41 | F | B-ALL, sirolimus related pericardial effusion | chemotherapy, radiation, and steroids | none | lungs | lungs, brain, stomach, small bowel, large bowel, kidney, bladder, uterus, pancreas | ND | A. fumigatus (Lung), C. bertholleitiae (lung, brain, small bowel, pancreas, stomach) | neg (8 d prior to death); 1.47 (serum; 1 d prior to death) | neg (<31 pg/mL, 8 d prior to death); 148 pg/mL (1 d prior to death) |
| 2 | 63 | F | AML, small bowel obstruction | clinical trial of FLT3 inhibitor | none | lungs | lungs, small bowel, liver, spleen | ND | A. fumigatus (lung), M. indicus (small bowel) | ND | ND |
| 3 | 79 | M4 | CLL | chlorambucil and obinutuzumab; corticosteroids | none | lungs | heart, lymph node, thyroid, kidney, brain | A. fumigatus (lungs) from autopsy tissue | L. corymbifera (heart) | neg (~8 weeks prior to death), >9.3 immediately prior to death | neg (~8 weeks prior to death), neg (immediately prior to death) |
| 4 | 19 | M5 | ALL | presumed chemotherapy for ALL | oral AmB | lung, brain | lung, liver, spleen | A. fumigatus (lung, brain), Rhizopus spp. (lung, liver, spleen) from autopsy tissue | ND | ND | ND |
| 5 | 55 | F6 | dermatomyositis | prednisone | voriconazole, L-AmB | brain | brain | ND | ND | pos (blood, 11-months before death), pos (BAL, 10-month before death), pos (CSF, 5 month before death) | ND |
| 6 | 52 | M7 | heart transplant | transplant immunosuppression | none | lung | lung | A. fumigatus (lung biopsy 60 d post-transplant); A. fumigatus and Mucor spp. (15 w post-transplant) | ND | 3.3 (60 days post-transplant) | ND |
| 7 | 70’s | F8 | p-ANCA vasculitis | steroids and azathioprine | fluconazole, micafungin, L-AmB | lungs | lungs, heart | ND | ND | ND | pos (7 days prior to death) |
| 8 | 61 | M9 | hematologic malignancy | prednisolone | unknown | lung | lung | ND | ND | ND | ND |