{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:52:37Z","timestamp":1776682357775,"version":"3.51.2"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Objects: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited. Methods: We conducted a retrospective, multicenter, observational study, with proven and probable IPA and PM patients from January 2004 to December 2017. Demographics, clinical manifestations, image reports, histopathological findings, and outcomes were analyzed. Results: A total of 46 IPA (33 proven and 13 probable) and 19 PM (18 proven and one probable) cases were analyzed. The majority of tissues (81% in IPA and 61% in PM) were obtained using bronchoscopy. Prior influenza infection was a predisposing factor for IPA, and abscess formation in CT scan was associated with PM (p = 0.0491, p = 0.0454, respectively). The positive culture rate for PM was lower than that for IPA (37% vs. 67%, p = 0.0294). The galactomannan (GM) level from serum and bronchoalveolar lavage (BAL) fluid was significantly higher in IPA than in PM (3.3 \u00b1 0.5 vs. 0.8 \u00b1 0.6, p = 0.0361; 4.0 \u00b1 0.6 vs. 0.59 \u00b1 0.1, p = 0.0473, respectively). The overall mortality rate was 65%, which was similar among IPA and PM groups. Systemic steroid exposure and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were independently correlated to mortality in IPA (p = 0.027, p = 0.026, respectively). However, there was no predictor for mortality found in PM patients. Conclusions: Influenza infection, abscess formation in CT scan, and GM level may help physicians to differentiate IPA and PM. Bronchoscopy-guided biopsy and lavage specimen provide timely and definite diagnosis. The prognosis of IPA is associated with systemic steroid exposure and higher APACHE II scores on admission.<\/jats:p>","DOI":"10.3390\/microorganisms7110531","type":"journal-article","created":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T02:48:31Z","timestamp":1573094911000},"page":"531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis"],"prefix":"10.3390","volume":"7","author":[{"given":"Chun-Yu","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care, Saint Paul\u2019s Hospital, 330 Taoyuan, Taiwan"},{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I-Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Mackay Memorial Hospital, 10491 Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Che-Chia","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Chiayi, 613 Chiayi, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Chun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Chiayi, 613 Chiayi, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8593-8492","authenticated-orcid":false,"given":"Wei-Lun","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Fu Jen Catholic University, 242 New Taipei City, Taiwan"},{"name":"Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, 243 New Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-6244","authenticated-orcid":false,"given":"Ko-Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung-Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Saint Paul\u2019s Hospital, 330 Taoyuan, Taiwan"},{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsuan-Ling","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8777-1638","authenticated-orcid":false,"given":"Kuo-Chin","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Chi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Dimopoulos","sequence":"additional","affiliation":[{"name":"Department of Critical Care, ATTIKON University Hospital, University of Athens, Medical School, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1164\/rccm.2008-740ST","article-title":"An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients","volume":"183","author":"Limper","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1378\/chest.14-0917","article-title":"Diagnosis and treatment of pulmonary aspergillosis syndromes","volume":"146","author":"Patterson","year":"2014","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"i39","DOI":"10.1093\/jac\/dkx032","article-title":"Invasive mould infections in the ICU setting: Complexities and solutions","volume":"72","author":"Bassetti","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13613-016-0230-9","article-title":"Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: Underlying conditions, diagnosis, and outcomes","volume":"7","author":"Lin","year":"2017","journal-title":"Ann. Intensive Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1007\/s00134-012-2673-2","article-title":"Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: A retrospective study","volume":"38","author":"Wauters","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1164\/rccm.201111-1978OC","article-title":"A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients","volume":"186","author":"Blot","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/tid.12060","article-title":"Epidemiology, outcomes, and mortality predictors of invasive mold infections among transplant recipients: A 10-year, single-center experience","volume":"15","author":"Neofytos","year":"2013","journal-title":"Transpl. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/cid\/cir122","article-title":"The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts","volume":"52","author":"Georgiadou","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1440-1843.2012.02283.x","article-title":"Invasive pulmonary aspergillosis in non-neutropenic patients with and without underlying disease: A single-centre retrospective analysis of 52 subjects","volume":"18","author":"Dai","year":"2013","journal-title":"Respirology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1086\/430710","article-title":"Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer","volume":"41","author":"Chamilos","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"684 e11","DOI":"10.1016\/j.cmi.2015.03.019","article-title":"Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis","volume":"21","author":"Jung","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/myc.12960","article-title":"Defining breakthrough invasive fungal infection-Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology","volume":"62","author":"Cornely","year":"2019","journal-title":"Mycoses"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/myc.12222","article-title":"Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies","volume":"57","author":"Abidi","year":"2014","journal-title":"Mycoses"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1086\/591969","article-title":"Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: Biological risk factors for infection according to time after transplantation","volume":"47","author":"Upton","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1086\/597615","article-title":"Increased virulence of Zygomycetes organisms following exposure to voriconazole: A study involving fly and murine models of zygomycosis","volume":"199","author":"Lamaris","year":"2009","journal-title":"J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1007\/s00330-017-5007-5","article-title":"Pulmonary mucormycosis: Serial morphologic changes on computed tomography correlate with clinical and pathologic findings","volume":"28","author":"Nam","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1183\/09031936.00062206","article-title":"Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease","volume":"30","author":"Bulpa","year":"2007","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s15010-017-0991-6","article-title":"Pulmonary mucormycosis: Clinical features and outcomes","volume":"45","author":"Lin","year":"2017","journal-title":"Infection"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1164\/rccm.200704-606OC","article-title":"Galactomannan in bronchoalveolar lavage fluid: A tool for diagnosing aspergillosis in intensive care unit patients","volume":"177","author":"Meersseman","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1186\/s13054-014-0458-4","article-title":"How to manage aspergillosis in non-neutropenic intensive care unit patients","volume":"18","author":"Bassetti","year":"2014","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1469-0691.2008.02122.x","article-title":"Correlation between galactomannan antigen levels in serum and neutrophil counts in haematological patients with invasive aspergillosis","volume":"15","author":"Cordonnier","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"611","DOI":"10.3109\/13693786.2012.669502","article-title":"Risk factors for mortality in patients with mucormycosis","volume":"50","author":"Spellberg","year":"2012","journal-title":"Med Mycol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Garcia-Vidal, C., Peghin, M., Cervera, C., Gudiol, C., Ruiz-Camps, I., Moreno, A., Royo-Cebrecos, C., Rosell\u00f3, E., de la Bellacasa, J.P., and Ayats, J. (2015). Causes of death in a contemporary cohort of patients with invasive aspergillosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0120370"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1086\/592255","article-title":"Factors associated with overall and attributable mortality in invasive aspergillosis","volume":"47","author":"Nivoix","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13054-014-0722-7","article-title":"Epidemiology of invasive aspergillosis in critically ill patients: Clinical presentation, underlying conditions, and outcomes","volume":"19","author":"Taccone","year":"2015","journal-title":"Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1086\/588660","article-title":"Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group","volume":"46","author":"Walsh","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1136\/thx.50.7.812","article-title":"Commentary: Unusual manifestations of aspergillosis","volume":"50","author":"Denning","year":"1995","journal-title":"Thorax"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/7\/11\/531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:32:05Z","timestamp":1760189525000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/7\/11\/531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,5]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["microorganisms7110531"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms7110531","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.2.13573\/v1","asserted-by":"object"}]},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,5]]}}}