More than one-third of invasive mold disease cases at four Atlanta hospitals occurred in patients without classic risk factors, according to a CDC surveillance report published July 30.
The finding suggests surveillance and clinician suspicion built only around the usual predisposing conditions could miss a substantial share of a rare but often fatal infection.
The CDC reviewed 968 patients with potential invasive mold disease identified across four Atlanta hospitals and their outpatient clinics from 2020 to 2024, classifying 449, or 46%, as having the infection.
Of those cases, 35% occurred in patients with none of the host factors — hematologic malignancy, prolonged neutropenia, transplant or immunosuppressive therapy — that typically raise clinical suspicion for IMD. About half, 53%, met at least one clinical or radiologic criterion supporting the diagnosis.
The infections were severe. Half of the 449 patients needed a ventilator, 43% were transferred into an ICU within two weeks of testing, and 45% died within 90 days.
Fifty-eight patients (13%) had a current or recent COVID-19 diagnosis, and they fared worse than those without: 66% were admitted to an ICU versus 39%, and 66% died within 90 days versus 41%.
Aspergillus species were the most common cause, accounting for 71% of cases, and pulmonary infections were the most frequent site at 68%.
IMD is not a nationally notifiable condition, and without a clear baseline, the CDC said hospitals struggle to distinguish sporadic cases from healthcare-associated outbreaks. Nationally, invasive mold diseases are associated with more than 15,000 hospitalizations and $1.3 billion in direct medical costs a year, with case-fatality rates that can approach 85%.
The CDC said clinicians should stay vigilant for IMD as a life-threatening complication in patients with immunocompromising conditions or critical illness, and that continued surveillance could speed recognition and help catch healthcare-associated outbreaks earlier.
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