Influenza an Independent Risk Factor for Invasive Pulmonary Aspergillosis

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Individuals who had invasive pulmonary aspergillosis had a higher 90-day mortality rate compared with individuals without invasive pulmonary aspergillosis.
Individuals who had invasive pulmonary aspergillosis had a higher 90-day mortality rate compared with individuals without invasive pulmonary aspergillosis.

Influenza is an independent risk factor in the development of invasive pulmonary aspergillosis, according to a study published in The Lancet Respiratory Medicine. Influenza also increases the rate of mortality in individuals with invasive pulmonary aspergillosis.

This retrospective, multicenter cohort study included 432 patients admitted to the intensive care unit with influenza, as well as 315 controls with community-acquired pneumonia. Of the influenza group, 19% (n=83) were diagnosed with invasive pulmonary aspergillosis within a median of 3 days post-admission. Similar incidences were seen for both influenza A and B. The rate of invasive pulmonary aspergillosis was 32% in those with influenza who were also immunocompromised (38 of 117). However, patients with influenza who were not immunocompromised (45 of 315) had a lower incidence of invasive pulmonary aspergillosis (14%). The control group experienced a 5% (n=16) incidence of invasive pulmonary aspergillosis.

Individuals  in the influenza cohort who had invasive pulmonary aspergillosis experienced a 90-day mortality rate of 51%, but this rate was 28% in patients with  patients without invasive pulmonary aspergillosis (P =.0001). Influenza proved to be an independent risk factor for invasive pulmonary aspergillosis (adjusted odds ratio 5.19; 95% CI, 2.63-10.26; P <.0001). It was also associated with higher APACHE II scores, being male, and using corticosteroids.

Adults with acute influenza were recruited for this study and had been admitted to 7 intensive care units throughout Belgium and The Netherlands. These individuals were ≥18 years old, had been admitted for ≥1 day with severe respiratory failure, revealed pulmonary infiltrates through imaging, and were diagnosed with influenza through a positive airway PCR test within the influenza cohort. Independent associations between influenza and invasive pulmonary aspergillosis in nonimmunocompromised individuals with influenza were investigated using logistic regression analysis and were compared with those with pneumonia.

The study researchers concluded, “Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.”

Reference

Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al; on behalf of the Dutch-Belgian Mycosis study group. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study [published online July 31, 2018]. Lancet Respir Med. doi:10.1016/S2213-2600(18)30274-1

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