Linna Huang1, Nannan Zhang1,2, Xu Huang1, Shuyu Xiong1, Yingying Feng1, Yi Zhang1, Min Li1, Qingyuan Zhan1. 1. Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, P.R. China. 2. Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China.
Abstract
INTRODUCTION: There has been a rapid increase in the number of influenza and invasive pulmonary aspergillosis (IPA) co-infection. OBJECTIVES: To explore the risk factors and predictors of a poor prognosis in influenza and IPA co-infection. METHODS: We included patients with confirmed influenza during the 2017-2018 influenza season and cases of influenza and IPA co-infection in the literature. RESULTS: A total of 64 patients with influenza infection were admitted to ICU. Of these patients, 18 were co-infected with IPA. Others were assigned to the control group (n = 46). A total of 45 patients from the literature were added to the IPA group (n = 63). A multivariate logistic regression suggested that influenza patients who were given steroids after ICU admission, who had a white blood count (WBC) of more than 10*109 /L on ICU admission and whose CT findings manifested as multiple nodules and cavities might have a higher risk of developing IPA. Compared to survivors, non-survivors had higher sequential organ failure assessment (SOFA) scores (16 ± 4 points vs 8 ± 4 points, P < 0.001), lower CD4+ T cell counts on ICU admission [315 (83-466) cells/μL vs 152 (50-220) cells/μL, P = 0.031] and more requirement extracorporeal membrane oxygenation (ECMO) support [13 (50%) vs 7 (18.9%), P = 0.015]. CONCLUSIONS: Influenza patients who are given steroids after ICU admission, who have WBCs of greater than 10*109 /L on ICU admission, and whose CT imaging shows multiple nodules and cavities might have a high risk of IPA. Higher SOFA scores, CD4+ T cell counts lower than 200 cells/μL on ICU admission and more ECMO requirement might be predictors of a poor prognosis.
INTRODUCTION: There has been a rapid increase in the number of influenza and invasive pulmonary aspergillosis (IPA) co-infection. OBJECTIVES: To explore the risk factors and predictors of a poor prognosis in influenza and IPA co-infection. METHODS: We included patients with confirmed influenza during the 2017-2018 influenza season and cases of influenza and IPA co-infection in the literature. RESULTS: A total of 64 patients with influenza infection were admitted to ICU. Of these patients, 18 were co-infected with IPA. Others were assigned to the control group (n = 46). A total of 45 patients from the literature were added to the IPA group (n = 63). A multivariate logistic regression suggested that influenza patients who were given steroids after ICU admission, who had a white blood count (WBC) of more than 10*109 /L on ICU admission and whose CT findings manifested as multiple nodules and cavities might have a higher risk of developing IPA. Compared to survivors, non-survivors had higher sequential organ failure assessment (SOFA) scores (16 ± 4 points vs 8 ± 4 points, P < 0.001), lower CD4+ T cell counts on ICU admission [315 (83-466) cells/μL vs 152 (50-220) cells/μL, P = 0.031] and more requirement extracorporeal membrane oxygenation (ECMO) support [13 (50%) vs 7 (18.9%), P = 0.015]. CONCLUSIONS: Influenza patients who are given steroids after ICU admission, who have WBCs of greater than 10*109 /L on ICU admission, and whose CT imaging shows multiple nodules and cavities might have a high risk of IPA. Higher SOFA scores, CD4+ T cell counts lower than 200 cells/μL on ICU admission and more ECMO requirement might be predictors of a poor prognosis.
Authors: Joshua M Tobin; Kara L Nickolich; Krishnaveni Ramanan; Matthew J Pilewski; Kristina D Lamens; John F Alcorn; Keven M Robinson Journal: J Immunol Date: 2020-06-10 Impact factor: 5.422
Authors: Luis David Chora-Hernández; Beatriz Sereno-Gómez; Francisco Ruiz-Martínez; Juan Manuel Barajas-Magallon; Miguel Ruiz-Jiménez; Dora E Corzo-Leon Journal: Med Mycol Case Rep Date: 2020-07-17
Authors: George R Thompson Iii; Oliver A Cornely; Peter G Pappas; Thomas F Patterson; Martin Hoenigl; Jeffrey D Jenks; Cornelius J Clancy; M Hong Nguyen Journal: Open Forum Infect Dis Date: 2020-06-19 Impact factor: 3.835
Authors: Juergen Prattes; Thomas Valentin; Martin Hoenigl; Emina Talakic; Alexander C Reisinger; Philipp Eller Journal: Med Mycol Case Rep Date: 2020-05-11
Authors: Mitsuru Toda; Susan E Beekmann; Philip M Polgreen; Tom M Chiller; Brendan R Jackson; Karlyn D Beer Journal: Emerg Infect Dis Date: 2020-04 Impact factor: 6.883