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. 2021 Mar 19;7(3):227.
doi: 10.3390/jof7030227.

Epidemiological Correlation of Pulmonary Aspergillus Infections with Ambient Pollutions and Influenza A (H1N1) in Southern Taiwan

Jien-Wei Liu  1   2 , Yee-Huang Ku  3 , Chien-Ming Chao  3 , Hsuan-Fu Ou  4 , Chung-Han Ho  5   6 , Khee-Siang Chan  7 , Wen-Liang Yu  7   8
Affiliations

Epidemiological Correlation of Pulmonary Aspergillus Infections with Ambient Pollutions and Influenza A (H1N1) in Southern Taiwan

Jien-Wei Liu et al. J Fungi (Basel). .

Abstract

An increase in fungal spores in ambient air is reported during a spike in particulate matter (PM2.5 and PM10) aerosols generated during dust or smog events. However, little is known about the impact of ambient bioaerosols on fungal infections in humans. To identify the correlation between the incidence of pulmonary aspergillosis and PM-associated bioaerosols (PM2.5 and PM10), we retrospectively analyzed data between 2015 and 2018 (first stage) and prospectively analyzed data in 2019 (second stage). Patient data were collected from patients in three medical institutions in Tainan, a city with a population of 1.88 million, located in southern Taiwan. PM data were obtained from the Taiwan Air Quality Monitoring Network. Overall, 544 non-repeated aspergillosis patients (first stage, n = 340; second stage, n = 204) were identified and enrolled for analysis. The trend of aspergillosis significantly increased from 2015 to 2019. Influenza A (H1N1) and ambient PMs (PM2.5 and PM10) levels had significant effects on aspergillosis from 2015 to 2018. However, ambient PMs and influenza A (H1N1) in Tainan were correlated with the occurrence of aspergillosis in 2018 and 2019, respectively. Overall (2015-2019), aspergillosis was significantly correlated with influenza (p = 0.002), influenza A (H1N1) (p < 0.001), and PM2.5 (p = 0.040) in Tainan City. Using a stepwise regression model, influenza A (H1N1) (p < 0.0001) and Tainan PM10 (p = 0.016) could significantly predict the occurrence of aspergillosis in Tainan. PM-related bioaerosols and influenza A (H1N1) contribute to the incidence of pulmonary aspergillosis.

Keywords: PM10; PM2.5; aspergillosis; fungus; influenza A (H1N1); pollution.

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Conflict of interest statement

All authors have no potential conflicts.

Figures

Figure 1
Figure 1
Invasive pulmonary aspergillosis (IPA)cases per month in 2019 are significantly higher than those in 2015–2018 and the trends of IPA cases show a significant increase from 2018 to 2019 (slope, 0.500, p = 0.005) and 2015 to 2019 (slope, 0.185; p < 0.00001).
Figure 2
Figure 2
A map of Tainan City with the closest reporting station to each hospital: Xinying station closest to Chi Mei Medical Center, Liouying (H1); Annan station closest to Chi Mei Medical Center, Chali (H2); and West-Central station closest to Chi Mei Medical Center, Tainan (H3), showing no significant difference of PM2.5 among the three zones in Tainan.
Figure 3
Figure 3
From 2015 to 2019, Tainan IPA monthly cases (blue curve) are positively correlated with local PM2.5 (μg/m3) in Tainan (red curve) and influenza A (H1N1), but have no statistically significant correlation with influenza A (H3N2) and influenza B. A surge in IPA commonly occurs in the influenza epidemic during the peak period of PM2.5 in spring seasons (January-March), except an autumn flu (July-September) during a low PM2.5 period and an unusual influenza A (H1N1) epidemic in 2019. The vertical axis represents the monthly case number for each variable of IPA, Influenza A (H1N1), influenza A (H3N2), and influenza B, as well as the monthly average concentration of Tainan PM2.5 (µg/m3). The p values refer to Spearman’s correlation between IPA and each variable. Tainan PM2.5 represents data from West-Central station.
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