Abstract
BackgroundSevere pneumonia caused by influenza virus infection can be secondary to invasive pulmonary fungal (IPF) infection.ObjectivesThis study aimed to summarize the incidence of IPF infection secondary to influenza virus infection and further explore its etiologic mechanism and high-risk factors.MethodsAll adult patients with confirmed influenza A (H1N1) virus infection admitted to the intensive care units (ICUs) of Nanjing Drum Hospital from November 2017 to March 2018 were retrospectively selected. The differences in baseline factors, risk factors, immune function and outcome parameters were studied between patients with and without IPF.ResultsOf the 19 critically ill patients with H1N1 infection, 11 (57.9%) developed IPF infection after 7 days of ICU admission. Two patients had proven and nine probable IPF infection. A difference in human leukocyte antigen–DR isotype (△HLA-DR; day 7–day 1) was found between the two groups. △HLA-DR (day 7–day 1) was higher in patients with no IPF infection than in those with IPF infection [(14.52 ± 14.21)% vs ( − 11.74 ± 20.22)%, P = 0.019]. The decline in HLA-DR indicated impaired immune function secondary to fungal infection in patients with H1N1 infection.ConclusionsIPF infection was diagnosed in 57.9% of critically ill patients with H1N1 virus infection after a median of 7 days following ICU admission. A continuous decline in immune function could lead to the development of IPF infections. Dynamic monitoring of immune function may help in the early detection of IPF infection.
Highlights
Since the first case of influenza A (H1N1) virus infection found in Mexico in 2009, the virus has spread worldwide and resulted in pandemics [1]
A total of 19 adult critically ill patients with confirmed H1N1 infection were included in the study between November 2017 and March 2018
No difference was observed in the onset to visiting time, aggravation time or intensive care units (ICUs) time (Table 3)
Summary
Since the first case of influenza A (H1N1) virus infection found in Mexico in 2009, the virus has spread worldwide and resulted in pandemics [1]. 60.8 million were infected with H1N1from April 2009 to April 2010; of these, 274,304 were hospitalized and 12,469 died in the USA [2, 3]. The H1N1 infection was usually complicated by several diseases including acute respiratory distress syndrome, cardiac disorders, bacterial pneumonia and others. Pneumonia was one of the most common complications. Influenza and pneumonia mortality accounted for 2.2% and 2.0%, becoming the eighth and ninth causes of death in 2009 and 2010 in the USA, respectively [4, 5]. Recent studies revealed that 18–61% of hospitalized patients with H1N1 infection had pneumonia characteristics, demanding more attention to influenzainduced pneumonia [6,7,8]. Severe pneumonia caused by influenza virus infection can be secondary to invasive pulmonary fungal (IPF) infection
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