Influenza virus infections in patients with malignancies –– characteristics and outcome of the season 2014/15. A survey conducted by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO)

Abstract

Influenza virus infections (IVI) may pose a vital threat to immunocompromised patients such as those suffering from malignancies, but specific data on epidemiology and outcome in these patients are scarce. In this study, we collected data on patients with active cancer or with a history of cancer, presenting with documented IVI in eight centres in Germany. Two hundred and three patients were identified, suffering from haematological malignancies or solid tumours; 109 (54 %) patients had active malignant disease. Influenza A was detected in 155 (77 %) and Influenza B in 46 (23 %) of patients (genera not determined in two patients). Clinical symptoms were consistent with upper respiratory tract infection in 55/203 (27 %), influenza-like illness in 82/203 (40 %), and pneumonia in 67/203 (33 %). Anti-viral treatment with oseltamivir was received by 116/195 (59 %). Superinfections occurred in 37/203 (18 %), and admission on an intensive care unit was required in 26/203 (13 %). Seventeen patients (9 %) died. Independent risk factors for death were delayed diagnosis of IVI and bacterial or fungal superinfection, but not underlying malignancy or ongoing immunosuppression. In conclusion, patients with IVI show high rates of pneumonia and mortality. Early and rapid diagnosis is essential. The high rate of pneumonia and superinfections should be taken into account when managing IVI in these patients.Beate Hermann, Nicola Lehners, Daniel Teschner and Marie von Lilienfeld-Toal contributed equally to this work.

Impact of patient characteristics and treatment procedures on hospitalization cost and length of stay in Japanese patients with influenza: A structural equation modelling approach

“…These patients are also at high risk of developing influenza‐related complications. A German study that included 203 patients who had influenza along with haematologic and solid tumours reported a high rate of pneumonia and bacterial or fungal superinfections . Influenza also appears to have a detrimental impact on the outcome of cancer treatment by delaying the initiation of anticancer therapy …”

Severe viral pneumonia in adults: what is important for the ICU physician?

“…If RSV or other respiratory viruses are confirmed, the decision to start antiviral treatment will depend on patient characteristic: presence of risk factors for a poor outcome, history of immunosuppression, and severity of respiratory failure [18,31]. It is important to underline that bacterial super-infection is a common complication of severe viral pneumonia; bacterial culture and empiric antibiotic treatment should be considered in case of clinical suspicion [32]. Indeed, it is estimated that during 2009 pandemic, bacterial superinfection complicated up to 25/50% of severe influenza A pneumonitis [33].…”

Frequently asked questions regarding SARS-CoV-2 in cancer patients—recommendations for clinicians caring for patients with malignant diseases

“…For diagnosis of LRTID in patients with CARV infection including SARS-CoV-2, CT scans should be used rather than chest Xray [29][30][31]. If LRTID is present, patients should undergo standard microbiological testing to test for bacterial or fungal superinfection since superinfection is the most dangerous complication in any CARV-infection [5].…”

“…Influenza and RSV can be treated with specific antivirals, which is essential for the care of infected cancer patients. Importantly, cancer patients with CARV-infections are prone to co-infections, and bacterial/ fungal superinfections are the primary cause of CARVassociated mortality in cancer patients [5].…”