tetano
Editor, Senior Moderator
Infection. 2018 Apr 7. doi: 10.1007/s15010-018-1138-0. [Epub ahead of print]
[h=1]Invasive fungal infections associated with prior respiratory viral infections in immunocompromised hosts.[/h] Ajmal S[SUP]1[/SUP], Mahmood M[SUP]2[/SUP], Abu Saleh O[SUP]2[/SUP], Larson J[SUP]2[/SUP], Sohail MR[SUP]2,[/SUP][SUP]3[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Increased risk of invasive pulmonary aspergillosis after influenza infection has been reported; however data are limited.
[h=4]PURPOSE:[/h] To describe Invasive fungal infections (IFI) associated with preceding respiratory viral infection at a large referral center.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] Fungal infection; Immunocompromised host; Influenza; Pulmonary invasive fungal infection; RSV
PMID: 29627936 DOI: 10.1007/s15010-018-1138-0
[h=1]Invasive fungal infections associated with prior respiratory viral infections in immunocompromised hosts.[/h] Ajmal S[SUP]1[/SUP], Mahmood M[SUP]2[/SUP], Abu Saleh O[SUP]2[/SUP], Larson J[SUP]2[/SUP], Sohail MR[SUP]2,[/SUP][SUP]3[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Increased risk of invasive pulmonary aspergillosis after influenza infection has been reported; however data are limited.
[h=4]PURPOSE:[/h] To describe Invasive fungal infections (IFI) associated with preceding respiratory viral infection at a large referral center.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] Fungal infection; Immunocompromised host; Influenza; Pulmonary invasive fungal infection; RSV
PMID: 29627936 DOI: 10.1007/s15010-018-1138-0