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Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016–2019

Authors :
Chi-Jung Wu
Cong-Tat Cia
Hsuan-Chen Wang
Chang-Wen Chen
Wei-Chieh Lin
Jen-Chieh Lee
Po-Sheng Chen
Chih-Cheng Hsieh
Wei-Ting Li
Po-Lan Su
Xin-Min Liao
Ming-I Hsieh
Pui-Ching Choi
Wen-Chien Ko
Source :
Journal of Fungi, Vol 8, Iss 1, p 49 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

Details

Language :
English
ISSN :
2309608X
Volume :
8
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Fungi
Publication Type :
Academic Journal
Accession number :
edsdoj.7a0dd8e560094dcfb9c43201b0c1aa2a
Document Type :
article
Full Text :
https://doi.org/10.3390/jof8010049