Severe ARDS in a critically ill influenza patient with invasive pulmonary aspergillosis

Pietsch, Urs; Müller-Höcker, Christina; Enzler-Tschudy, Annette; Filipovic, Miodrag

doi:10.1007/s00134-016-4379-3

Cited by 8 publications

(2 citation statements)

References 1 publication

(1 reference statement)

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“…Loss of ciliary function of the bronchial tree during acute IB infection may have predisposed the patient to the development of an invasive fungal infection. 1 , 34 A. fumigatus culture turned positive only after 5 days of intubation. Despite adequate treatment with voriconazole and association with caspofungin, our patient died.…”

Section: Discussionmentioning

confidence: 97%

Post-influenza aspergillosis, do not underestimate influenza B

Nulens¹,

Bourgeois

2017

IDR

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Our objective is to highlight and focus on post-influenza aspergillosis, triggered by influenza B virus. This relatively new clinical entity is often associated with a fulminant course of respiratory decline and high mortality. A 51-year immunocompetent woman, without any medical history or risk factors for developing a complicated influenza infection, was admitted to the intensive care unit. During admission, she presented with an afebrile flu-like syndrome, myocarditis, rhabdomyolysis, multiple organ failure, and evolved to severe respiratory distress. The broncho-alveolar lavage contained influenza B RNA, and the culture revealed Aspergillus fumigatus. Despite maximal organ support, immunoglobulin, antiviral and antifungal therapy, the patient died. This case demonstrates that influenza B virus may be life threatening even to immunocompetent adults and may trigger an invasive Aspergillus superinfection.

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Section: Discussionmentioning

confidence: 97%

Post-influenza aspergillosis, do not underestimate influenza B

Nulens¹,

Bourgeois

2017

IDR

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“…The main diagnostic clue for airway-invasive Aspergillus tracheobronchitis is epithelial plaques, pseudomembranes or ulcers that can be visualized via bronchoscopy, as radiological features may be subtle [31]. Worsening of radiographic pulmonary infiltrates in patients with influenza is often attributed to progression of ARDS or bacterial infection, leading to a change of antimicrobial therapy without performing diagnostic procedures [32]. Patients who survived IAPA received antifungal therapy much earlier than those who did not (2 days after diagnosis of influenza among survivors versus 9 days among non-survivors) [8], suggesting that early diagnosis and administration of antifungal therapy may be important.…”

Section: Clinical Presentation and Diagnosis Of Iapamentioning

confidence: 99%

Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion

et al. 2020

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Purpose: Invasive pulmonary aspergillosis is increasingly reported in patients with influenza admitted to the intensive care unit (ICU). Classification of patients with influenza-associated pulmonary aspergillosis (IAPA) using the current definitions for invasive fungal diseases has proven difficult, and our aim was to develop case definitions for IAPA that can facilitate clinical studies. Methods: A group of 29 international experts reviewed current insights into the epidemiology, diagnosis and management of IAPA and proposed a case definition of IAPA through a process of informal consensus. Results: Since IAPA may develop in a wide range of hosts, an entry criterion was proposed and not host factors. The entry criterion was defined as a patient requiring ICU admission for respiratory distress with a positive influenza test temporally related to ICU admission. In addition, proven IAPA required histological evidence of invasive septate hyphae and mycological evidence for Aspergillus. Probable IAPA required the detection of galactomannan or positive Aspergillus culture in bronchoalveolar lavage (BAL) or serum with pulmonary infiltrates or a positive culture in upper respiratory samples with bronchoscopic evidence for tracheobronchitis or cavitating pulmonary infiltrates of recent onset. The IAPA case definitions may be useful to classify patients with COVID-19-associated pulmonary aspergillosis (CAPA), while awaiting further studies that provide more insight into the interaction between Aspergillus and the SARS-CoV-2-infected lung.

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