Severe Bacterial Superinfection Based on Influenza A (H1N1) Pneumonia in a Heart-Lung Transplant Recipient

Yıldırım, Yasemin; Pecha, Simon; Sill, B.; Deuse, T.; Reichenspurner, H.

doi:10.1055/s-0032-1331895

Thorac cardiovasc Surg

2013

DOI: 10.1055/s-0032-1331895

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Severe Bacterial Superinfection Based on Influenza A (H1N1) Pneumonia in a Heart-Lung Transplant Recipient

Yasemin Yıldırım¹,

Simon Pecha²,

B. Sill³

et al.

Abstract: A 47-year-old heart-lung transplant recipient presented to our outpatient transplant clinic with respiratory infection. Her nose and throat swabs for influenza A (H1N1) infection were negative. Broncheoalveolar lavage showed a positive result for H1N1 infection. Antiviral therapy was initiated. Because of superinfection with Pseudomonas aeruginosa and Aspergillus terreus, her clinical condition worsened. The clinical condition of the patient improved with antibiotic and antifungal treatment. Negative nose and … Show more

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Invasive Aspergillosis Associated With Severe Influenza Infections

Crum-Cianflone

2016

Open Forum Infectious Diseases

106

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Background. Invasive aspergillosis may occur in the setting of severe influenza infections due to viral-induced respiratory epithelium disruption and impaired immune effects, but data are limited.Methods. A retrospective study was conducted among severe influenza cases requiring medical intensive care unit (ICU) admission at an academic center during the 2015–2016 season. Data collected included respiratory cultures, medical conditions and immunosuppressants, laboratory and radiographic data, and outcomes. A systematic literature review of published cases in the English language of aspergillosis complicating influenza was conducted.Results. Six (75%) of 8 ICU influenza cases had Aspergillus isolated; 5 were classified as invasive disease. No ICU patient testing negative for influenza infection developed aspergillosis during the study period. Among cases with invasive aspergillosis, influenza infection was type A (H1N1) (n = 2) and influenza B (n = 3). Published and current cases yielded n = 57 (European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria: 37% proven, 25% probable, and 39% possible cases). An increasing number of cases were reported since 2010. Sixty-five percent of cases lacked classic underlying conditions at admission for aspergillosis, 86% had lymphopenia, and 46% died.Conclusions. Aspergillosis may occur in the setting of severe influenza infections even among immunocompetent hosts. Risks may include influenza A (H1N1) or B infections and viral-induced lymphopenia, although further studies are needed. Prompt diagnosis and antifungal therapy are recommended given high mortality rates.

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Invasive Aspergillosis Associated With Severe Influenza Infections

Crum-Cianflone

2016

Open Forum Infectious Diseases

106

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Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment

Vanderbeke

Spriet

Breynaert

et al. 2018

Current Opinion in Infectious Diseases

136

102

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Bacterial superinfection of critically ill influenza patients is well-known, but in recent years, more and more reports describe invasive aspergillosis as a frequent complication as well. This review summarizes the available literature on the association of invasive pulmonary aspergillosis (IPA) with severe influenza (influenza-associated aspergillosis, IAA), including epidemiology, diagnostic approaches and treatment options. Recent findings Though IPA typically develops in immunodeficient patients, non-classically immunocompromised patients such as critically ill influenza patients are at high-risk for IPA as well. The morbidity and mortality of IPA in these patients is high and in the majority of them, the onset occurs early after intensive care unit admission. Currently, standard of care (SOC) consists of close follow-up of these critically ill influenza patients with high diagnostic awareness for IPA. As soon as there is clinical, mycological or radiological suspicion for IAA, antifungal azole-based therapy (e.g. voriconazole) is initiated, in combination with therapeutic drug monitoring (TDM). Antifungal treatment regimens should reflect local epidemiology of azole-resistant Aspergillus species and should be adjusted to clinical evolution. TDM is necessary as azoles like voriconazole are characterized by nonlinear pharmacokinetics, especially in critically ill patients.

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Invasive pulmonary aspergillosis in patients with influenza infection: report of two cases and systematic review of the literature

Alshabani

Haq

Miyakawa

et al. 2014

Expert Review of Respiratory Medicine

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Superinfection or coinfections are major causes of morbidity and mortality in patients with influenza. There are limited data on invasive pulmonary aspergillosis (IPA) in this setting. We conducted a systematic review of the literature for patients with IPA following influenza infection. A total of 68 patients (two reported from our institution and 66 identified by literature review) were analyzed. The majority of patients had underlying comorbid illnesses. Overall, the mortality rate in this cohort was 47%. On multivariate analysis, H1N1 infection was associated with better outcome (odds ratio [OR]: 0.19; 95% CI: 0.05-0.67; p = 0.010), whereas corticosteroid therapy during hospitalization was associated with worse outcome (OR: 13.5; 95% CI: 3.65-49.67; p < 0.0001). In conclusion, IPA is an emerging serious infection in patients with influenza. A high index of suspicion is necessary for the timely identification and treatment of these patients.

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Severe Bacterial Superinfection Based on Influenza A (H1N1) Pneumonia in a Heart-Lung Transplant Recipient

Cited by 4 publications

References 4 publications

Invasive Aspergillosis Associated With Severe Influenza Infections

Invasive Aspergillosis Associated With Severe Influenza Infections

Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment

Invasive pulmonary aspergillosis in patients with influenza infection: report of two cases and systematic review of the literature

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