Invasive Pulmonary Aspergillosis in Influenza and RSV: A Retrospective Cohort Study

Abstract

Background: Recent studies in Europe and Asia have reported high incidences of invasive pulmonary aspergillosis (IPA) in patients with severe viral respiratory infections, even among immunocompetent individuals. Few large-scale studies have been done in the United States to understand the incidence of IPA in this population. Methods: Data was collected retrospectively on all patients with influenza or RSV infection admitted to the intensive care unit (ICU) at a single academic center in Chicago, IL between May 2008 and May 2018. IPA cases were defined using AspICU criteria. Baseline characteristics, demographics, disease severity, and outcomes were compared by Fisher exact and Mann-Whitney U tests for categorical and continuous variables. Findings: A total of 224 ICU patients with influenza and 153 with RSV met inclusion criteria over nine years. Among those, 7 (3·1%) patients with severe influenza and 8 (5·2%) with severe RSV were diagnosed with IPA based on the modified AspICU criteria. Among patients with severe influenza, history of hematopoietic stem cell transplantation was significantly associated with IPA, while history of hematopoietic stem cell transplantation, hematologic malignancy, and neutropenia were significantly associated with IPA in patients with severe RSV infection. Interpretation: The incidence of IPA complicating severe viral respiratory infection was significantly lower in our study compared to some European and Asian studies. Additionally, the majority of patients in our study had significant immunocompromising risk factors. Funding: This work was supported by the National Institutes of Health T32 Training grant [5T32AI095207] and data collection was supported by NCATS grant (UL1TR001422). Declaration of Interest: HHN and CV have no potential conflicts of interest to declare. MGI received research support, paid to Northwestern University, from AiCuris, Astellas, GlaxoSmithKline, Janssen and Shire; he is a paid consultant for Adagio, AlloVir, Celltrion, Cidara, Genentech, Roche, Janssen, Shionogi, Viracor Eurofins; he is also a paid member of DSMBs from CSL Behring, Janssen, Merck, SAB Biotherapeutics, Sequiris and Takeda; he receives royalty from UpToDate. Ethical Approval: This study was approved by the Northwestern Memorial Hospital Institutional Review Board office.