Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study

Abstract

Background Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.Methods Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. Results Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio ( HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio ( OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis ( OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10×10 9 /L ( OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8×10 9 /L on admission ( OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use ( OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. Conclusions Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.

Serious fungal disease incidence and prevalence in Indonesia

“…Invasive aspergillosis (IA) was estimated in four groups, haematologic malignancy (13% of acute myeloid leukaemia patients), 17,18 and an equal number of cases in all other lymphomas, leukaemia and multiple myeloma patients, 19 in 4% of those who died of AIDS, 20 in 1%–4% of transplant recipients, in 2.6% of lung cancer patients 21 and in 1.3% of those admitted to hospital with COPD 22 . Mucormycosis was estimated using international rates 23 .…”

“…43 Our annual incidence estimate is 7,540 cases (Table 3). Most of the cryptococcal meningitis 11 Chen et al 2020 17 Lortholary et al, 2011 19 Antinori et al, 2009 Guinea, 2010 22 Herbrecht et al, 50 Kalista et al 2017 51 Rusli 2012 52 Mursinah et al 2016 53 Montravers et al, 2011 57 Hustrini et al 2019 58 Recurrent vulvovaginal candidiasis 6%-9% of women between 15 and 54 years of age, as per references International Foxman et al, 2013 30 Denning et al, 2018…”