AUTHOR=Zhan Yangqing , Lu Chun , Li Shaoqiang , Zhao Jin , Li Zhengtu , Gu Yingying , Ye Feng 

TITLE=Successful Management of Mixed Mycosis in HIV-Negative Patients With Different Immune Status: A Case Series Report

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.851891

DOI=10.3389/fcimb.2022.851891

ISSN=2235-2988

ABSTRACT=<sec><title>Objective</title><p>The limited information available on mixed mycosis involving the lungs makes the understanding of mixed fungal diseases insufficient and affects prognosis. Our study aims to improve understanding by exploring experience in the successful management of mixed fungal infections.</p></sec><sec><title>Methods</title><p>Patients who had two types of mycosis involving the lung at the same disease course were retrospectively enrolled.</p></sec><sec><title>Results</title><p>Between September 2011 and December 2019, 17 patients with proven mixed mycosis were enrolled. Four patients were immunocompromised, with one case each of lung transplantation, corticosteroid treatment, STAT3 hyper-IgE syndrome, and anti-IFN-γ autoantibody-associated immunodeficiency syndrome. Among 13 patients who were not immunocompromised, 9 had type 2 diabetes mellitus. Eight cases were coinfection with <italic>Mucor</italic> and <italic>Aspergillus</italic>, 4 cases were <italic>Cryptococcus</italic> and <italic>Aspergillus</italic>, 2 cases were <italic>Talaromyces marneffei</italic> and <italic>Cryptococcus</italic>, 2 cases were <italic>Talaromyces marneffei</italic> and <italic>Aspergillus</italic>, and 1 case was <italic>Candida</italic> and <italic>Aspergillus</italic>. Seven patients were diagnosed with mixed pulmonary mycosis at almost the same time. Among the remaining 10 patients, the initial treatment was ineffective in four cases, and six patients showed a partial response to the initial antifungal treatment, but the original fungal lesions became re-enlarged. Three patients were admitted to the intensive care unit during hospitalization, and one patient died. Another <italic>Mucor</italic> coinfection patient died due to treatment refusal.</p></sec><sec><title>Conclusion</title><p>Mixed mycosis involving the lungs is not uncommon in patients without apparent immune deficiency diseases. During the management of mycosis, we recommend keeping mixed mycosis in mind for patients with a poor response to initial antifungal treatment, even in immunocompetent populations, and identifying the cause of illness through a rigorous procedure.</p></sec>