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. 2022 Jan 4;8(1):49.
doi: 10.3390/jof8010049.

Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016-2019

Chi-Jung Wu  1   2 , Cong-Tat Cia  3 , Hsuan-Chen Wang  1 , Chang-Wen Chen  3   4 , Wei-Chieh Lin  3 , Jen-Chieh Lee  3 , Po-Sheng Chen  3 , Chih-Cheng Hsieh  3 , Wei-Ting Li  3 , Po-Lan Su  5 , Xin-Min Liao  5 , Ming-I Hsieh  1 , Pui-Ching Choi  1 , Wen-Chien Ko  2   4
Affiliations

Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016-2019

Chi-Jung Wu et al. J Fungi (Basel). .

Abstract

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016-2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

Keywords: Aspergillus flavus; Aspergillus fumigatus; Aspergillus terreus; Taiwan; aspergillosis; azole resistance; bronchoscopy; galactomannan; influenza; radiology; tracheobronchitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bronchoscopic examination in case 17 with influenza-associated pulmonary aspergillosis (IAPA) due to A. fumigatus, which demonstrated vesicles and whitish patches over bilateral bronchial tress (a), and in case 23 with IAPA due to A. flavus, which demonstrated an area of whitish plague over left secondary carina that was difficult to remove (b), but resolved under voriconazole in a follow-up bronchoscopic examination eight days later.
Figure 2
Figure 2
Initial (left) and follow-up (right) radiological images of six patients with influenza-associated aspergillosis who survived.
See this image and copyright information in PMC

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