Invasive Pulmonary Aspergillosis after Influenza A Infection in an Immunocompetent Patient

Abstract

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Invasive pulmonary aspergillosis in patients with influenza infection: A retrospective study and review of the literature

“…Despite there being no significant differences in mortality between the two groups, the lengths of ICU [25 (13-39) vs 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), P = 0.005] and total hospital stays [28 (14-58) vs 18 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), P = 0.002] was higher in the IPA group than in the control group (Table 2).…”

“…In addition to our current cases, we searched the English language published literature using PubMed/Medline with the search terms 'influenza' and 'aspergillus' or 'aspergillosis' from January 2009 to March 2018. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17][18]…”

“…The systemic steroid application was commonly regarded as the risk factor for influenza and IPA confections in studies before. 8 In this way, the 'Steroids after ICU admission' was identified as primary factor for power analysis. The power was 0.77, which might verify the sample size was adequate to identify risk factors.…”

Invasive fungal infection by Aspergillus flavus in immunocompetent hosts: A case series and literature review

“…fumigatusVoriconazoleRecovery Ratermann KL et al [20]51FemaleNear Drowning experienceLungA. fumigatusAmphotericin B and VoriconazoleDemise Subramanian S et al [21]40MaleNoneOrbit, brain and pterygopalatine fossaNot specifiedAmphotericin and SurgeryNo Follow up Kwon OK et al [22]60MaleInfluenza A, HTNLungNot specifiedVoriconazoleRecovery Bajaj N et al [7]22MaleNoneHeartA. fumigatusVoriconazoleRecovery Mohammed AP et al [1]33FemaleNoneLungsA.…”

Aspergillosis related to severe influenza: A worldwide phenomenon?

“…[2][3][4][5] More recently, IPA could develop concurrently with severe influenza in otherwise immunocompetent individuals unrelated to the use of corticosteroids. 6,7 However, three current studies with large cohorts were not mentioned by Huang et al 1 Two recent studies from the Netherlands and Belgium confirmed that patients with severe influenza are at risk to develop influenza-associated aspergillosis (IAA). 8,9 Both studies reported that IAA was diagnosed in 16% (23/144) and 19% (83/432) of influenza cases, with mortality rates of 61% (14/23) and 45% (37/83).…”