Fungal pneumonia in non-neutropenic critically ill patients: a Delphi consensus from the Fungal Infection Study Forum, India, with implications for resource-limited settings.

@article{muthu2026fungal,
  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.}},
  author = {Valliappan Muthu and Ritesh Agarwal and Inderpaul Singh Sehgal and Shivaprakash Mandya Rudramurthy and Atul Patel and Soundappan Kathirvel and Ooriapadickal Cherian Abraham and Pradip Kumar Bhattacharya and Dedeepiya Devaprasad and Mandeep Garg and Randeep Guleria and Neha Gupta and Ravindra Mehta and Puneet Saxena and Prakash Shastri and Tanu Singhal and Rajeev Soman and Deepak Talwar and Subhash Todi and George Varghese and Arunaloke Chakrabarti},
  journal = {BMC infectious diseases},
  year = {2026},
  month = aug,
  doi = {10.1186/s12879-026-14157-x},
  url = {https://europepmc.org/article/MED/42972511},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Fungal pneumonia in non-neutropenic critically ill patients: a Delphi consensus from the Fungal Infection Study Forum, India, with implications for resource-limited settings.
AU  - Valliappan Muthu
AU  - Ritesh Agarwal
AU  - Inderpaul Singh Sehgal
AU  - Shivaprakash Mandya Rudramurthy
AU  - Atul Patel
AU  - Soundappan Kathirvel
AU  - Ooriapadickal Cherian Abraham
AU  - Pradip Kumar Bhattacharya
AU  - Dedeepiya Devaprasad
AU  - Mandeep Garg
AU  - Randeep Guleria
AU  - Neha Gupta
AU  - Ravindra Mehta
AU  - Puneet Saxena
AU  - Prakash Shastri
AU  - Tanu Singhal
AU  - Rajeev Soman
AU  - Deepak Talwar
AU  - Subhash Todi
AU  - George Varghese
AU  - Arunaloke Chakrabarti
PY  - 2026
DA  - 2026/08/04
JO  - BMC infectious diseases
DO  - 10.1186/s12879-026-14157-x
UR  - https://europepmc.org/article/MED/42972511
AB  - Objectives  To 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  Using 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  Key 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  We 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  Not applicable.
SN  - 1471-2334
ER  -