Severe Influenza With Invasive Pulmonary Aspergillosis in Immunocompetent Hosts: A Retrospective Cohort Study.

Yishan Duan,Binmiao Liang,Yusha Chen,Xuemei Ou,Xinyan Ou

doi:10.3389/fmed.2020.602732

Abstract

Background: Influenza was an independent risk factor for invasive pulmonary aspergillosis (IPA). In light of increasing incidence and mortality of influenza associated aspergillosis, our study summarized risk factors, clinical characteristics, and prognostic factors of developing aspergillosis in immunocompetent hosts with influenza to further screen high-risk population and improve outcome.Methods: We reviewed the patient characteristics, laboratory examinations, radiological imaging, and microbiology data of 72 influenza patients with IPA and 84 influenza patients without IPA admitted to West China Hospital.Result: Our study shown that aspergillosis co-infection increased overall mortality of severe influenza from 22.6 to 52.8%, along with higher white blood count (WBC) (10.9 ± 5.0 vs. 8.4 ± 3.3, P = 0.016), Neutrophiles (9.5 ± 5.0 vs. 7.0 ± 3.8, P = 0.023), procalcitonin (PCT) (8.6 ± 15.9 vs. 1.2 ± 2.1, P = 0.009), and a lower CD4+ T cell count (189.2 ± 135.3 vs. 367.1 ± 280.0, P = 0.022) in death group. No impact of age, gender, underlying diseases, immunosuppressive agents and steroids use, CD4+ T cell count on incidence of influenza associated aspergillosis was observed. But influenza associated aspergillosis cases mostly accompanied with more H1N1 subtype (91.7 vs. 79.8%, P = 0.037) and higher level of C-reactive protein (CRP) (117.6 ± 88.1 vs. 78.5 ± 75.2, P = 0.017) and interleukin 6 (IL-6) (133.5 ± 149.2 vs. 69.9 ± 100.0, P = 0.021) than those without aspergillosis.Conclusion: Aspergillosis co-infection in severe influenza patients can lead to a significant increased mortality, which was associated with severe respiratory failure due to mixed infection and immunosuppression. Pulmonary excessive inflammatory response was related with IPA co-infection.

Highlights

Increasing aspergillosis co-infection have been reported as a common complication of severe influenza and became an important cause of increased mortality among severe influenza patients in recent years [1,2,3,4,5,6,7]
From December 2018 to March 2019, 156 patients were diagnosed with severe influenza infection in West China Hospital of Sichuan University, of which 72 patients matched our invasive pulmonary aspergillosis (IPA) definition
Fever was the main symptom of severe influenza, but no difference was observed in patients with and without aspergillosis in term of fever (63.1 vs. 73.6%, P = 0.161)

Summary

Introduction

Increasing aspergillosis co-infection have been reported as a common complication of severe influenza and became an important cause of increased mortality among severe influenza patients in recent years [1,2,3,4,5,6,7]. A sharp increase in reported cases occurred after the 2009 H1N1 influenza pandemic and 128 influenza associated aspergillosis cases have been published up to June 2018 in literature review of cases and case series [6], and the incidence rate of invasive pulmonary aspergillosis (IPA) reached up to 19% in the setting of severe influenza [3]. Significant increased aspergillosis co-infection in the setting of severe influenza suggested that severe influenza was probably one of host factors. Influenza was an independent risk factor for invasive pulmonary aspergillosis (IPA). In light of increasing incidence and mortality of influenza associated aspergillosis, our study summarized risk factors, clinical characteristics, and prognostic factors of developing aspergillosis in immunocompetent hosts with influenza to further screen high-risk population and improve outcome

Methods

Results

Discussion

Conclusion