Invasive fungal infections associated with prior respiratory viral infections in immunocompromised hosts
Increased risk of invasive pulmonary aspergillosis after influenza infection has been reported; however data are limited.
To describe Invasive fungal infections (IFI) associated with preceding respiratory viral infection at a large referral center.
We reviewed all IFI cases among patients with positive influenza and/or RSV nasopharyngeal/lower respiratory tract PCR from October 2015 to December 2016. Cases of pulmonary IFI were classified as possible, probable, and definite based on EORTC-MSG definitions.
We identified 8 cases (4 influenza, 4 RSV); 3 with probable Aspergillosis, 1 possible Aspergillosis, 1 probable Histoplasmosis, 1 probable Mucormycosis, and 2 possible IFI (consistent clinical and imaging findings). Half of our patients were men with a mean age of 64 years (SD 8) and median Charlson Comorbidity Score of 3.5 (IQR 3-7). Most common risk factors were stem cell transplant (75%) and neutropenia (62.5%). Four patients were on antifungal prophylaxis at presentation. All patients received anti-viral therapy with oseltamivir/ribavirin and 50% received empiric antibiotics. Median duration from onset of viral infection to diagnosis of IFI was 8.5 days (IQR 2.5-14) and 75% were diagnosed during the same admission. All received antifungal therapy; 62.5% required ICU care, and 37.5% died during index hospitalization.
Our study supports earlier observations describing IFI following respiratory viral infection in immunocompromised hosts. Secondary IFI occurred in 1.4% of our cohort and most occurred during the index admission. IFI following viral illness is associated with high mortality and early detection and therapy may improve outcomes.
KeywordsPulmonary invasive fungal infection Fungal infection Influenza RSV Immunocompromised host
This work was supported, in part, by the National Center for Advancing Translational Sciences (NCATS) [UL1 TR000135]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Institutional review board approval was obtained prior to the study. The reviewer approved waiver of the requirement to obtain informed consent in accordance with 45 CFR 46.116. The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments.
- 7.Park DW, Yhi JY, Koo G, Jung SJ, Kwak HJ, Moon JY, et al. Fatal clinical course of probable invasive pulmonary aspergillosis with influenza B infection in an immunocompetent patient. Tuberc Respir Dis (Seoul). 2014;77:141–4. https://doi.org/10.4046/trd.2014.77.3.141.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Vehreschild JJ, Brockelmann PJ, Bangard C, Verheyen J, Vehreschild MJGT, Michels G, et al. Pandemic 2009 influenza A(H1N1) virus infection coinciding with invasive pulmonary aspergillosis in neutropenic patients. Epidemiol Infect. 2012;140:1848–52. https://doi.org/10.1017/S0950268811002603.CrossRefPubMedGoogle Scholar
- 10.De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the 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 (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21. https://doi.org/10.1086/588660.CrossRefPubMedPubMedCentralGoogle Scholar