Table II.
Results from nested-case control analyses examining underlying conditions associated with implantation mycoses, adjusting for age, sex, and US census region—United States, 2017 to 2021*
| Chromoblastomycosis and phaeohyphomycotic abscess (n = 609) | Sporotrichosis (n = 512) | Mucormycosis (n = 427) | Eumycetoma (n = 211) | |||||
|---|---|---|---|---|---|---|---|---|
| Underlying conditions | No. (%) | aOR, 95% CI | No. (%) | aOR, 95% CI | No. (%) | aOR, 95% CI | No. (%) | aOR, 95% CI |
| Diabetes mellitus | 99 (16.3) | 2.35 (1.82–3.03) | 52 (10.2) | 1.04 (0.76–1.43) | 123 (28.8) | 3.63 (2.81–4.68) | 33 (15.6) | 1.75 (1.15–2.66) |
| Dyslipidemia | 109 (17.9) | 1.03 (0.80–1.33) | 108 (21.1) | 1.56 (1.21–2.00) | 116 (27.2) | 1.14 (0.88–1.48) | 38 (18.0) | 0.84 (0.56–1.27) |
| Hypertension | 166 (27.3) | 2.37 (1.88–3.00) | 112 (21.9) | 1.12 (0.87–1.44) | 174 (40.7) | 2.78 (2.15–3.59) | 67 (31.8) | 2.38 (1.67–3.40) |
| Immunosuppressive conditions and medications | 92 (15.1) | 2.55 (2.03–3.21) | 90 (17.6) | 2.57 (2.04–3.23) | 203 (47.5) | 12.31 (10.06–15.08) | 56 (26.5) | 4.28 (3.12–5.86) |
| Cancer | 34 (5.6) | — | 19 (3.7) | — | 131 (30.7) | — | 15 (7.1) | — |
| IMID | 21 (3.4) | — | 25 (4.9) | — | 27 (6.3) | — | 7 (3.3) | — |
| HIV | 3 (0.5) | — | 1 (0.2) | — | 4 (0.9) | — | 0 (0.0) | — |
| SOT/SCT | 6 (1.0) | — | 2 (0.4) | — | 71 (16.6) | — | 7 (3.3) | — |
| Immunosuppressive medication receipt | 44 (7.2) | — | 59 (11.5) | — | 83 (19.4) | — | 40 (19.0) | — |
| Prednisone | 41 (6.7) | — | 51 (10.0) | — | 76 (17.8) | — | 36 (17.1) | — |
| Mycophenolate mofetil | 1 (0.2) | — | 1 (0.2) | — | 13 (3.0) | — | 3 (1.4) | — |
| TNF-α inhibitor† | 3 (0.5) | — | 8 (1.6) | — | 1 (0.2) | — | 2 (0.9) | — |
| Tacrolimus | 3 (0.5) | — | 1 (0.2) | — | 21 (4.9) | — | 3 (1.4) | — |
aOR, Adjusted odds ratio; IMID, immune-mediated inflammatory disease; SOT/SCT, solid organ transplant or stem cell transplant; TNF-α, Tumor necrosis factor-alpha.
This analysis includes patients who had continuous insurance enrollment during the 90 d before the initial mycosis diagnosis date. Underlying medical conditions were indicated on or within the 90 d preceding the mycosis diagnosis. Using a nested case-control study design, we performed a logistic regression to evaluate associations between underlying conditions and each mycosis, adjusting for age, sex, and region. The percentage of patients diagnosed in the inpatient setting was 5.4% for chromoblastomycosis, 4.7% for sporotrichosis, 41.0% for mucormycosis, and 3.8% for eumycetoma.
This category includes the 5 U.S. Food and Drug Administration-approved TNF-α inhibitors: infliximab, adalimumab, etanercept, golimumab, and certolizumab.