Invasive pulmonary aspergillosisas a complication  of severe influenza (case report)

During last years the frequency of invasive pulmonary aspergillosis (IPA) in immunocompetent patients has increased. Clinical case report of successful treatment invasive aspergillosis with influenza A(H1N1) presented in the article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.

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Invasive pulmonale Aspergillose

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0817-7432 ◽

2019 ◽

Vol 144 (17) ◽

pp. 1218-1222

Author(s):

Hanna Matthews ◽

Holger Rohde ◽

Dominic Wichmann ◽

Stefan Kluge

Keyword(s):

Influenza Infection ◽

Invasive Pulmonary Aspergillosis ◽

Organ Transplant ◽

Severe Neutropenia ◽

Solid Organ ◽

First Line ◽

Pulmonary Aspergillosis ◽

Hematopoietic Stem ◽

Severe Influenza ◽

Life Threatening

AbstractInvasive pulmonary aspergillosis is a life-threatening disease occurring in patients with severe immunosuppression. It is classically associated with severe neutropenia following hematopoietic stem cell transplantation, but other risk factors include COPD, corticosteroid therapy, solid organ transplant, liver failure and preceding severe influenza infection. Due to the high mortality of the disease, rapid diagnosis and treatment are crucial. Diagnosis is based on CT scan and bronchoscopy including microscopy, culture and galactomannan detection in BAL. Histopathology remains the gold standard diagnosis but is not feasible in many cases. First line treatment is voriconazole, new recommendations also support the triazole isavuconazole.

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Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01257-w ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Liang Chen ◽

Xiudi Han ◽

Yanli Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Risk Factors ◽

Influenza A ◽

Invasive Pulmonary Aspergillosis ◽

Neuraminidase Inhibitor ◽

Teaching Hospitals ◽

Multivariate Logistic Regression Model ◽

Pulmonary Aspergillosis ◽

Hospitalised Patients ◽

Increased Risk ◽

Immunocompetent Patients

Abstract Background Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. Methods Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. Results Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191–15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048–1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681–76.764, p < 0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028–6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676–73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002–0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. Conclusions Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.

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Failure of extracorporeal membrane oxygenation to rescue acute respiratory distress syndrome caused by dual infection of influenza A (H1N1) and invasive pulmonary aspergillosis

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2017.01.010 ◽

2017 ◽

Vol 116 (7) ◽

pp. 563-564 ◽

Cited By ~ 4

Author(s):

Po-An Su ◽

Wen-Liang Yu

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Influenza A ◽

Distress Syndrome ◽

Invasive Pulmonary Aspergillosis ◽

Dual Infection ◽

Pulmonary Aspergillosis ◽

Influenza A H1n1

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Fulminant invasive pulmonary aspergillosis in immunocompetent patients—a two-case report

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2003.00792.x ◽

2003 ◽

Vol 9 (12) ◽

pp. 1224-1227 ◽

Cited By ~ 26

Author(s):

M. Cornet ◽

H. Mallat ◽

D. Somme ◽

E. Guérot ◽

G. Kac ◽

...

Keyword(s):

Case Report ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Immunocompetent Patients

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Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study

10.21203/rs.3.rs-20930/v1 ◽

2020 ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Risk Factors ◽

Influenza A ◽

Invasive Pulmonary Aspergillosis ◽

Neuraminidase Inhibitor ◽

Teaching Hospitals ◽

Multivariate Logistic Regression Model ◽

Pulmonary Aspergillosis ◽

Hospitalised Patients ◽

Increased Risk ◽

Immunocompetent Patients

Abstract Background Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.Methods Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. Results Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio ( HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio ( OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis ( OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10×10 9 /L ( OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8×10 9 /L on admission ( OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use ( OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. Conclusions Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.

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A strategy based on galactomannan antigen detection and PCR for invasive pulmonary aspergillosis following influenza A (H1N1) pneumonia

Journal of Infection ◽

10.1016/j.jinf.2012.07.007 ◽

2012 ◽

Vol 65 (5) ◽

pp. 470-473 ◽

Cited By ~ 10

Author(s):

Christophe Guervilly ◽

Antoine Roch ◽

Stéphane Ranque ◽

Jean-Marie Forel ◽

Sami Hraiech ◽

...

Keyword(s):

Influenza A ◽

Invasive Pulmonary Aspergillosis ◽

Antigen Detection ◽

Pulmonary Aspergillosis ◽

Influenza A H1n1 ◽

Galactomannan Antigen ◽

H1n1 Pneumonia

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Pandemic 2009 influenza A(H1N1) virus infection coinciding with invasive pulmonary aspergillosis in neutropenic patients

Epidemiology and Infection ◽

10.1017/s0950268811002603 ◽

2011 ◽

Vol 140 (10) ◽

pp. 1848-1852 ◽

Cited By ~ 17

Author(s):

J. J. VEHRESCHILD ◽

P. J. BRÖCKELMANN ◽

C. BANGARD ◽

J. VERHEYEN ◽

M. J. G. T. VEHRESCHILD ◽

...

Keyword(s):

Influenza A ◽

Influenza Pandemic ◽

Invasive Pulmonary Aspergillosis ◽

Remission Induction ◽

Pulmonary Aspergillosis ◽

Influenza A H1n1 ◽

Neutropenic Patients ◽

Matched Data ◽

The Impact ◽

H1n1 Virus Infection

SUMMARYIn patients receiving anti-neoplastic chemotherapy, the impact of influenza on the incidence of invasive pulmonary aspergillosis (IPA) remains unknown. We matched data of the Cologne Cohort of Neutropenic Patients (CoCoNut) with records from the Institute for Virology and compared the findings to historical data. During the pandemic, we diagnosed influenza A(H1N1) in five patients with malignancies and febrile neutropenia refractory to antibiotic therapy. Probable IPA was diagnosed in three of these patients on the grounds of typical computed tomography morphology and microbiological results. Three of five patients receiving remission-induction chemotherapy for acute myeloid leukaemia developed aspergillosis although receiving posaconazole prophylaxis. In the 3 years before the influenza pandemic, only 2/77 patients of this group developed infection. Infection with influenza A(H1N1) may increase the risk for invasive aspergillosis in neutropenic patients. Pulmonary aspergillosis is an important additional differential diagnosis in neutropenic influenza patients with pneumonia.

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Invasive Pulmonary Aspergillosis in Adults With Avian Influenza A (H7N9) Pneumonia in China: A Retrospective Study

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz682 ◽

2020 ◽

Vol 221 (Supplement_2) ◽

pp. S193-S197 ◽

Cited By ~ 4

Author(s):

Pengfei Zou ◽

Chen Wang ◽

Shufa Zheng ◽

Feifei Guo ◽

Li Yang ◽

...

Keyword(s):

Avian Influenza ◽

Influenza A ◽

Invasive Pulmonary Aspergillosis ◽

Antibiotic Use ◽

Study Data ◽

Pulmonary Aspergillosis ◽

Multicenter Cohort Study ◽

Severe Influenza ◽

H7n9 Infection ◽

Hospital Stays

Abstract Cases of severe influenza with Aspergillus infection are commonly reported in patients with severe influenza. However, the epidemiology, risk factors, and outcomes of invasive pulmonary aspergillosis (IPA) in patients with avian influenza A (H7N9) infection remain unclear. We performed a retrospective multicenter cohort study. Data were collected from patients with avian influenza A (H7N9) infection admitted to 17 hospitals across China from February 2013 through February 2018. We found that IPA was diagnosed in 18 (5.4%) of 335 patients; 61.1% of patients with IPA (11 of 18) were identified before or within 2 days after an H7N9 virus–negative result. The median hospital stays in patients with or without IPA were 23.5 and 18 days, respectively (P < .01), and the median intensive care unit stays, respectively, were 22 and 12 days (P < .01). Smoking in the past year and antibiotic use for >7 days before admission were independently associated with IPA (adjusted odds ratio [95% confidence interval], 6.2 [1.7–26] for smoking and 4.89 [1.0–89] for antibiotic use). These findings provided important insights into the epidemiology and outcomes of IPA in patients with H7N9 infection in China.

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Fatal pandemic influenza A/H1N1 infection complicated by probable invasive pulmonary aspergillosis

Mycoses ◽

10.1111/j.1439-0507.2011.02051.x ◽

2011 ◽

pp. no-no ◽

Cited By ~ 1

Author(s):

Sung-Han Kim ◽

Mi-Na Kim ◽

Sang-Oh Lee ◽

Sang-Ho Choi ◽

Yang Soo Kim ◽

...

Keyword(s):

Pandemic Influenza ◽

Influenza A ◽

Invasive Pulmonary Aspergillosis ◽

H1n1 Infection ◽

Pulmonary Aspergillosis ◽

Influenza A H1n1

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Invasive Aspergillosis Associated With Severe Influenza Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw171 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 56

Author(s):

Nancy F. Crum-Cianflone

Keyword(s):

Invasive Aspergillosis ◽

Influenza A ◽

English Language ◽

Fungal Infections ◽

Influenza Infection ◽

Invasive Disease ◽

Influenza B ◽

European Organization ◽

Severe Influenza ◽

Influenza A H1n1

Abstract Background. Invasive aspergillosis may occur in the setting of severe influenza infections due to viral-induced respiratory epithelium disruption and impaired immune effects, but data are limited. Methods. A retrospective study was conducted among severe influenza cases requiring medical intensive care unit (ICU) admission at an academic center during the 2015–2016 season. Data collected included respiratory cultures, medical conditions and immunosuppressants, laboratory and radiographic data, and outcomes. A systematic literature review of published cases in the English language of aspergillosis complicating influenza was conducted. Results. Six (75%) of 8 ICU influenza cases had Aspergillus isolated; 5 were classified as invasive disease. No ICU patient testing negative for influenza infection developed aspergillosis during the study period. Among cases with invasive aspergillosis, influenza infection was type A (H1N1) (n = 2) and influenza B (n = 3). Published and current cases yielded n = 57 (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 criteria: 37% proven, 25% probable, and 39% possible cases). An increasing number of cases were reported since 2010. Sixty-five percent of cases lacked classic underlying conditions at admission for aspergillosis, 86% had lymphopenia, and 46% died. Conclusions. Aspergillosis may occur in the setting of severe influenza infections even among immunocompetent hosts. Risks may include influenza A (H1N1) or B infections and viral-induced lymphopenia, although further studies are needed. Prompt diagnosis and antifungal therapy are recommended given high mortality rates.

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