Abstract
BackgroundIncreasing 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.MethodsData 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.ResultsOf 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.ConclusionsOur 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.
Highlights
Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported
A multivariate logistic regression model confirmed early neuraminidase inhibitor (NAI) use and that was the only predictor for the 60-day mortality in IPA patients (Table 5)
Our study has two important findings: 1) the prevalence of IPA in immunocompetent adult patients hospitalised with Influenza A-related pneumonia (FluA-p), was 3.0%. It was associated with increased mortality; 2) we identified age, leukocytes, lymphocytes and systemic corticosteroids use as risk factors for IPA diagnosis
Summary
Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Influenza is a respiratory infectious disease, caused by influenza viruses, and which can present seasonal epidemics and pandemics [1, 2]. Following infection by influenza viruses, patients can Nearly half of severe influenza patients present with pneumonia, which is mostly caused by influenza A [6]. Influenza pneumonia is often coinfected with other pathogens and this worsen the clinical symptoms and. Invasive pulmonary aspergillosis mostly and traditionally occurs in immunocompromised hosts, such as patients with hematopoietic stem cell transplantation, granulocyte deficiency and organ transplant recipients; but rarely in those with normal immune function [12, 13]. More cases of IPA have been reported in severe influenza patients and with increased mortality [14–16]. The most notable was that over 30% of these cases had no classic immunocompromised factors
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