Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016-2019.

Chi-Jung Wu,Wen-Chien Ko,Hsuan-Chen Wang,Pui-Ching Choi,Xin-Min Liao,Chang-Wen Chen,Cong-Tat Cia,Po-Sheng Chen,Jen-Chieh Lee,Wei-Ting Li,Chih-Cheng Hsieh,Po-Lan Su,Ming-I Hsieh,Wei-Chieh Lin

doi:10.3390/jof8010049

Abstract

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

Highlights

Introduction distributed under the terms andWhile being sporadically reported decades ago, influenza-associated pulmonary aspergillosis (IAPA) has been recognized as one of the major complications following influenza to date [1]
Influenza virus infection was impressed based on a positive result of the reverse transcriptase polymerase chain reaction (RT-PCR) test according to the World Health
Sixteen (66.7%) of 24 cases of IAPA had more than one respiratory sample with Aspergillus growth, and a total of 52 Aspergillus isolates were recovered from patients

Summary

Introduction

While being sporadically reported decades ago, influenza-associated pulmonary aspergillosis (IAPA) has been recognized as one of the major complications following influenza to date [1]. It was reported in 16–23% of patients with severe influenza in Belgium, the Netherlands, and Taiwan [1,2,3,4]. Host factors for invasive pulmonary aspergillosis (IPA) defined by the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG), and 25–30% were previously healthy [1,2]. Based on the AspICU algorithm, which was proposed for diagnosing IPA in critically ill patients without EORTC/MSG host factors, the classification of putative IPA requires a positive culture for Aspergillus in bronchoalveolar lavage fluid (BALF) without simultaneous bacterial growth, and patients suspected to have IPA but with bacterial co-isolation or not receiving bronchoscopic studies would remain unclassified [6]

Objectives

Methods

Results

Discussion

Conclusion