Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Infection. 2018 Aug;46(4):555-558. doi: 10.1007/s15010-018-1138-0. Epub 2018 Apr 7.
Increased risk of invasive pulmonary aspergillosis after influenza infection has been reported; however data are limited.
To describe Invasive fungal infections (IFI) associated with preceding respiratory viral infection at a large referral center.
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.
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.
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.
流感感染后侵袭性肺曲霉病的风险增加已有报道；然而，数据有限。
描述在大型转诊中心中与先前呼吸道病毒感染相关的侵袭性真菌感染（IFI）。
我们回顾了 2015 年 10 月至 2016 年 12 月期间流感和/或 RSV 鼻咽/下呼吸道 PCR 阳性患者的所有 IFI 病例。根据 EORTC-MSG 定义，肺部 IFI 病例分为可能、可能和确诊。
我们确定了 8 例（4 例流感，4 例 RSV）；3 例可能为曲霉病，1 例可能为曲霉病，1 例可能为组织胞浆菌病，1 例可能为毛霉病，2 例可能为 IFI（具有一致的临床和影像学表现）。我们的患者中有一半是男性，平均年龄为 64 岁（标准差 8），Charlson 合并症评分中位数为 3.5（四分位距 3-7）。最常见的危险因素是干细胞移植（75%）和中性粒细胞减少（62.5%）。4 名患者在出现时接受了抗真菌预防治疗。所有患者均接受了抗病毒治疗（奥司他韦/利巴韦林），50%接受了经验性抗生素治疗。从病毒感染发病到 IFI 诊断的中位时间为 8.5 天（四分位距 2.5-14），75%在同一住院期间诊断。所有患者均接受了抗真菌治疗；62.5%需要 ICU 护理，37.5%在住院期间死亡。
我们的研究支持更早的观察结果，即在免疫功能低下宿主中，呼吸道病毒感染后会发生 IFI。继发性 IFI 发生在我们队列的 1.4%，大多数发生在指数住院期间。病毒疾病后发生的 IFI 与高死亡率相关，早期检测和治疗可能改善结局。
