Invasive Pulmonary Aspergillosis Complicating Noninfluenza Respiratory Viral Infections in Solid Organ Transplant Recipients

Abstract

Background: Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a complication of severe influenza and coronavirus disease 2019. The extent to which other respiratory viral infections (RVIs) predispose to IPA is unclear.

Methods: We performed a retrospective review of IPA occurring within 90 days of respiratory syncytial virus (RSV), parainfluenza, or adenovirus infections (noninfluenza respiratory viral infections [NI-RVIs]) in patients who underwent solid organ transplant between 1/15/2011 and 12/19/2017.

Results: At a median post-transplant follow-up of 43.4 months, 221 of 2986 patients (7.4%) developed 255 RSV, parainfluenza, or adenovirus infections. IPA complicating these NI-RVIs was exclusively observed in lung and small bowel transplant recipients, in whom incidence was 5% and 33%, respectively. Cumulative prednisone doses >140mg within 7 days and pneumonia at the time of NI-RVI were independent risk factors for IPA (odds ratio [OR], 22.6; 95% CI, 4.5-112; and OR, 7.2; 95% CI, 1.6-31.7; respectively). Mortality at 180 days following NI-RVI was 27% and 7% among patients with and without IPA, respectively (P = .04).

Conclusions: In conclusion, IPA can complicate RSV, parainfluenza, and adenovirus infection in lung and small bowel transplant recipients. Future research is needed on the epidemiology of IPA complicating various RVIs. In the interim, physicians should be aware of this complication.

Keywords: adenovirus; invasive pulmonary aspergillosis; parainfluenza; respiratory syncytial virus; solid organ transplantation.

Figure 1.

Time to noninfluenza respiratory virus infection, stratified by type of solid organ transplant. Abbreviations: MV, multi-visceral organ transplant; NI-RVI, noninfluenza respiratory virus infection.

Figure 2.

Mortality of patients with noninfluenza respiratory virus infection, stratified by presence or absence of invasive pulmonary aspergillosis. Abbreviations: IPA, invasive pulmonary aspergillosis; NI-RVI, noninfluenza respiratory virus infection.