Invasive Pulmonary Aspergillosis in Patients with Influenza Infection: A Retrospective Study and Review of the Literature

There has been a rapid increase in the number of influenza and invasive pulmonary aspergillosis (IPA) co-infection.

To explore the risk factors and predictors of a poor prognosis in influenza and IPA co-infection.

We included patients with confirmed influenza during the 2017 to 2018 influenza season and cases of influenza and IPA co-infection in the literature.

A total of 64 patients with influenza infection were admitted to ICU. Of these patients, 18 were co-infected with IPA. Others were assigned to the control group (n=46). A total of 45 patients from the literature were added to the IPA group (n=63). A multivariate logistic regression suggested that influenza patients who were given steroids after ICU admission, who had a WBC of more than 10*10^9/L on ICU admission, and whose CT findings manifested as multiple nodules and cavities might have a higher risk of developing IPA. Compared to survivors, non-survivors had higher SOFA scores (16±4 points vs. 8±4 points, P<0.001), lower CD4 + T cell counts on ICU admission [315 (83-466) cells/μl vs. 152 (50-220) cells/μl, P=0.031] and more requirement ECMO support [13 (50%) vs. 7 (18.9%), P=0.015].

Influenza patients who are given steroids after ICU admission, who have WBCs of greater than 10*10^9/L on ICU admission, and whose CT imaging shows multiple nodules and cavities might have a high risk of IPA. Higher SOFA scores, CD4 + T cell counts lower than 200 cells/μl on ICU admission and more ECMO requirement might be predictors of a poor prognosis.

https://www.ncbi.nlm.nih.gov/pubmed/30661296