{
  "abstract": "Objectives\n\nTo develop consensus-based, pragmatic recommendations for the diagnosis and management of fungal pneumonia in non-neutropenic critically ill adults in India and Asia, where the dual burden of mucormycosis and resource-limited healthcare settings creates distinct challenges.Methods\n\nUsing a modified Delphi process, 20 multidisciplinary experts participated in the first round, and 19 completed the second and third rounds of anonymous voting on risk factors, diagnostic strategies, and management of invasive pulmonary aspergillosis (IPA), pulmonary mucormycosis (PM), and Pneumocystis jirovecii pneumonia (PCP). Consensus was defined as ≥ 70% agreement or disagreement; statements with 60-69% agreement were categorized as \"suggest,\" while the remaining were classified as \"no consensus.\"Results\n\nKey risk factors included severe chronic obstructive pulmonary disease, influenza, COVID-19, diabetes mellitus, and chronic liver or kidney disease. A multimodal diagnostic strategy combining contrast-enhanced computed tomography (CT), early bronchoalveolar lavage (BAL), microscopy, culture, and galactomannan (BAL threshold ≥ 1.0) was recommended, with molecular methods used where available. Liposomal amphotericin B was the preferred empiric agent in regions with high mucormycosis prevalence; voriconazole, posaconazole, or isavuconazole are first-line for proven IPA. Therapeutic drug monitoring is essential for azole antifungals, with a minimum treatment duration of 6-12 weeks. For PCP, empiric trimethoprim-sulfamethoxazole is recommended in immunosuppressed patients with diffuse ground-glass opacities on CT after exclusion of competing diagnoses. Adjunctive corticosteroids are recommended for PCP with severe hypoxemia (PaO₂ <70 mmHg) despite limited evidence in non-HIV patients.Conclusion\n\nWe provide practical, resource-adapted guidance for managing fungal pneumonia in non-neutropenic ICU patients, while highlighting research priorities. The proposed diagnostic criteria for IPA and PM are provisional consensus-based frameworks intended to support clinical decision-making and require prospective multicentre validation.Clinical trial number\n\nNot applicable.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.",
    "Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India. agarwal.ritesh@live.com.",
    "Department of Medical Microbiology, PGIMER, Chandigarh, India.",
    "Department of Infectious Diseases, Sterling Hospital, Ahmedabad, Gujarat, India.",
    "Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India.",
    "Department of Internal Medicine, Christian Medical College (CMC), Vellore, Tamil Nadu, India.",
    "Institute of Internal Medicine, Respiratory and Sleep Medicine, Director of Medanta Medical School, Gurugram, Haryana, India.",
    "Critical Care Unit, Apollo Specialty Hospitals, Chennai, India.",
    "Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.",
    "Institute of Internal Medicine, Respiratory and Sleep Medicine and Director of Medanta Medical School, Gurugram, Haryana, India.",
    "Fortis Memorial Research Institute, Gurugram, Haryana, India.",
    "Department of Pulmonary Medicine, Apollo Hospitals, Bengaluru, Karnataka, India.",
    "Department of Internal Medicine, Military Hospital, Suratgarh, Rajasthan, India.",
    "Sir Gangaram Hospital, New Delhi, India.",
    "Department of Infectious Diseases, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.",
    "Department of Infectious Diseases, Jupiter Hospital, Pune, Maharashtra, India.",
    "Metro Respiratory Centre, Metro Hospitals, Noida, India.",
    "Critical Care and Emergency Medicine, AMRI Hospital, Dhakuria, India.",
    "Doodhadhari Burfani Hospital Haridwar, Uttarakhand, India. arunaloke@hotmail.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Valliappan Muthu"
    },
    {
      "affs": [
        1
      ],
      "name": "Ritesh Agarwal",
      "orcid": "0000-0003-2547-7668"
    },
    {
      "affs": [
        0
      ],
      "name": "Inderpaul Singh Sehgal"
    },
    {
      "affs": [
        2
      ],
      "name": "Shivaprakash Mandya Rudramurthy"
    },
    {
      "affs": [
        3
      ],
      "name": "Atul Patel"
    },
    {
      "affs": [
        4
      ],
      "name": "Soundappan Kathirvel"
    },
    {
      "affs": [
        5
      ],
      "name": "Ooriapadickal Cherian Abraham"
    },
    {
      "affs": [
        6
      ],
      "name": "Pradip Kumar Bhattacharya"
    },
    {
      "affs": [
        7
      ],
      "name": "Dedeepiya Devaprasad"
    },
    {
      "affs": [
        8
      ],
      "name": "Mandeep Garg"
    },
    {
      "affs": [
        9
      ],
      "name": "Randeep Guleria"
    },
    {
      "affs": [
        10
      ],
      "name": "Neha Gupta"
    },
    {
      "affs": [
        11
      ],
      "name": "Ravindra Mehta"
    },
    {
      "affs": [
        12
      ],
      "name": "Puneet Saxena"
    },
    {
      "affs": [
        13
      ],
      "name": "Prakash Shastri"
    },
    {
      "affs": [
        14
      ],
      "name": "Tanu Singhal"
    },
    {
      "affs": [
        15
      ],
      "name": "Rajeev Soman"
    },
    {
      "affs": [
        16
      ],
      "name": "Deepak Talwar"
    },
    {
      "affs": [
        17
      ],
      "name": "Subhash Todi"
    },
    {
      "affs": [
        5
      ],
      "name": "George Varghese"
    },
    {
      "affs": [
        18
      ],
      "name": "Arunaloke Chakrabarti"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a4cny2e1n5cft.bib",
  "cited_by": 0,
  "doi": "10.1186/s12879-026-14157-x",
  "fulltext_url": "https://europepmc.org/articles/PMC13726158",
  "id": "a4cny2e1n5cft",
  "issns": [
    "1471-2334"
  ],
  "landing_url": "https://europepmc.org/article/MED/42972511",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2725|Antifungal resistance and susceptibility"
    ]
  ],
  "openalex": "W7172412869",
  "pdf_url": "https://europepmc.org/articles/PMC13726158?pdf=render",
  "pmcid": "PMC13726158",
  "pmid": "42972511",
  "published": "2026-08-04",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/a4cny2e1n5cft.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:45Z",
      "native_id": "MED:42972511",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42972511"
    },
    {
      "first_seen": "2026-11-05T12:22:33Z",
      "native_id": "PMC13726158",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12879-026-14157-x"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|Antifungal resistance and susceptibility",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Fungal pneumonia in non-neutropenic critically ill patients: a Delphi consensus from the Fungal Infection Study Forum, India, with implications for resource-limited settings.",
  "title_text": "Fungal pneumonia in non-neutropenic critically ill patients: a Delphi consensus from the Fungal Infection Study Forum, India, with implications for resource-limited settings.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:22:33Z",
  "url": "https://research.draconitic.com/paper/a4cny2e1n5cft",
  "venue": "BMC infectious diseases",
  "versions": []
}