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- Title
Invasive fungal infections associated with prior respiratory viral infections in immunocompromised hosts.
- Authors
Ajmal, Saira; Mahmood, Maryam; Abu Saleh, Omar; Larson, Jenifer; Sohail, M. Rizwan
- Abstract
Background: Increased risk of invasive pulmonary aspergillosis after influenza infection has been reported; however data are limited.Purpose: To describe Invasive fungal infections (IFI) associated with preceding respiratory viral infection at a large referral center.Methods: 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.Results: 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.Conclusions: 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.
- Subjects
INFLUENZA diagnosis; RESPIRATORY disease diagnosis; RIBAVIRIN; ANTIVIRAL agents; ANTIFUNGAL agents; NEUTROPENIA; NASOPHARYNX diseases; STEM cell transplantation; OSELTAMIVIR; ASPERGILLOSIS; HISTOPLASMOSIS; HOSPITAL care; INTENSIVE care units; MYCOSES; POLYMERASE chain reaction; RESPIRATORY infections; IMMUNOCOMPROMISED patients; INVASIVE candidiasis; DISEASE complications; DIAGNOSIS; THERAPEUTICS; DISEASE risk factors
- Publication
Infection, 2018, Vol 46, Issue 4, p555
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-018-1138-0