Current Epidemiology and Infection Characteristics of Non-Aspergillus Mold Infections: A Multicenter Study in Australia and New Zealand

Chin Fen Neoh; Sharon C-A Chen; Arthur J Morris; Christopher H Heath; Shu Jin Tan; Rebekah Lane; Shio Yen Tio; Sze Yen Tay; Matthew B Roberts; Karina Kennedy; Sebastiaan J van Hal; Hugh C Murray; Robert Pickles; Natasha Marcella Vaselli; Abby Douglas; Karen Urbancic; Mahesh Menon; Adam Stewart; Julia C Howard; Caitlin Keighley; Spiros Miyakis; Rohan Beresford; Louise Cooley; Marjoree Sehu; Catriona L Halliday; Sarah Kidd; David C M Kong; Tim Spelman; Leon J Worth; Monica A Slavin; Australian and New Zealand Study Group for non-Aspergillus mold infections

doi:10.1093/cid/ciag029

Current Epidemiology and Infection Characteristics of Non-Aspergillus Mold Infections: A Multicenter Study in Australia and New Zealand

Clin Infect Dis. 2026 Jan 21:ciag029. doi: 10.1093/cid/ciag029. Online ahead of print.

Authors

Chin Fen Neoh^{1

2

3}, Sharon C-A Chen^{4

5}, Arthur J Morris^{6

7}, Christopher H Heath^{8

9

10}, Shu Jin Tan¹¹, Rebekah Lane⁷, Shio Yen Tio^{1

2

12}, Sze Yen Tay¹³, Matthew B Roberts¹⁴, Karina Kennedy¹⁵, Sebastiaan J van Hal^{5

16}, Hugh C Murray¹⁷, Robert Pickles^{18

19}, Natasha Marcella Vaselli²⁰, Abby Douglas^{1

2

3

21}, Karen Urbancic^{1

21}, Mahesh Menon²², Adam Stewart²³, Julia C Howard²⁴, Caitlin Keighley^{25

26

27}, Spiros Miyakis²⁶, Rohan Beresford²⁸, Louise Cooley²⁹, Marjoree Sehu³⁰, Catriona L Halliday⁴, Sarah Kidd^{31

32}, David C M Kong^{33

34}, Tim Spelman³⁵, Leon J Worth^{1

2

3}, Monica A Slavin^{1

2

3

12}; Australian and New Zealand Study Group for non-Aspergillus mold infections

Collaborators

Australian and New Zealand Study Group for non-Aspergillus mold infections:
Amy Crowe, Jane Davies, Michelle England, Dianne Gardam, Rupert Handy, May E Leitch, Catherine Marshall, Sarah Lynar, Owen Robinson, Philip Selby, Olivia Smibert, Peter Simos, Kar Yee Yong

Affiliations

¹ National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
² Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
³ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Clinical Mycology Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, New South Wales, Australia.
⁵ The University of Sydney Institute of Infectious Diseases, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁶ New Zealand Mycology Reference Laboratory, Auckland, New Zealand.
⁷ Te Toka Tumai, Auckland City Hospital, Auckland, New Zealand.
⁸ Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
⁹ Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹⁰ School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
¹¹ Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.
¹² Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹³ Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
¹⁴ Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹⁵ ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia.
¹⁶ Department of Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
¹⁷ Department of Infectious Diseases, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
¹⁸ Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia.
¹⁹ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
²⁰ Department of Infectious Diseases, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
²¹ Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
²² Department of Infectious Diseases, Wesley Hospital, Brisbane, Queensland, Australia.
²³ Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²⁴ Health New Zealand Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand.
²⁵ Southern.IML Pathology, a Sonic Healthcare practice, Coniston, New South Wales, Australia.
²⁶ Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia.
²⁷ Graduate school of medicine, University of Wollongong, Wollongong, New South Wales, Australia.
²⁸ Department of Infectious Diseases, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
²⁹ Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia.
³⁰ Department of Infectious Diseases, Peninsula Health, Melbourne, Victoria, Australia.
³¹ National Mycology Reference Centre, SA Pathology, Adelaide, Australia.
³² School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia.
³³ Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
³⁴ The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia.
³⁵ Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.

PMID: 41562321
DOI: 10.1093/cid/ciag029

Abstract

Background: Understanding the epidemiology of invasive non-Aspergillus mold infections is essential to inform effective therapy. Robust regional studies remain scarce. This study aimed to determine the epidemiology and infection characteristics of non-Aspergillus mold infections in Australasia.

Methods: A 21-center, retrospective study of proven/probable non-Aspergillus mold infections from 2016 to 2023 was conducted in Australia and New Zealand. Data collected included demographic, clinical, microbiological, treatment and outcome information until 180 days of follow-up.

Results: Of 421 cases, 346 (82.2%) were proven infections and 315 (74.8%) were localized. Lung (n=150/421, 35.6%) was the most common site of infection. Twenty cases (4.8%) were due to >1 non-Aspergillus mold pathogen, resulting in 443 isolates altogether. Dematiaceous molds, inclusive of Lomentospora prolificans (n=96, 21.7%), Scedosporium spp. (n=87, 19.6%) and other dematiaceous molds of various genera (n=48, 10.8%), were the most common (n=231, 52.1%), followed by Mucorales (n=141, 31.8%). Common underlying conditions were hematological malignancy (n=146/421, 34.7%) and diabetes mellitus (n=122/421, 29.0%) while 68 cases (16.2%) had no comorbidities. Lymphopenia was present in 46.6% (n=196/421). One-third (n=138/421, 32.8%) received antifungal prophylaxis 30 days before non-Aspergillus mold diagnosis and L. prolificans was the most common cause of breakthrough infections (p<0.001). All-cause 90-day mortality was 31.4% (n=132/421), with higher mortality observed in L. prolificans (n=51/89, 57.3%) and Mucorales (n=56/129, 43.4%) infections.

Conclusions: L. prolificans, Scedosporium spp. and Mucorales are the most frequent non-Aspergillus mold pathogens in Australasia, with other emerging species and mixed infections encountered. Mortality from L. prolificans and Mucorales infections remains high.

Keywords: epidemiology; non-Aspergillus mold; rare mold infections.

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