Saccaro Luigi Francesco, Galfo Valentina, Ferranti Simone, Russo Alessandro, Menichetti Francesco
Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
Infez Med. 2020 Jun 1;28(2):263-267.
Invasive pulmonary aspergillosis (IPA) is a life-threatening condition that usually occurs in immunocompromised hosts. However, according to recent reports it can affect immunocompetent hosts with severe influenza infection due to viral-dependent disruption of respiratory immune defenses. We present the case of a 61-year-old Caucasian man admitted to the Emergency Department with respiratory failure and fever, who was diagnosed with H1N1 influenza and IPA. Because of his poor general conditions, he was treated with a double antifungal scheme, although this lies outside the suggested treatment guidelines. This choice turned out to be extremely effective. He was discharged after one month and his clinical conditions showed rapid improvement, with nearly complete normalization of the radiological pattern in three months. IPA remains a life-threatening condition, even in immunocompetent hosts, and should therefore always be suspected; if necessary, a combined treatment should rapidly be started. We report this case as the interest in influenza-associated IPA is high, both due to the clinical severity of this condition, which is treatable if identified early, and the emerging importance of respiratory infections caused by viruses belonging to the SARS family, such as SARS-CoV-2.
侵袭性肺曲霉病（IPA）是一种危及生命的疾病，通常发生在免疫功能低下的宿主中。然而，根据最近的报告，由于病毒依赖的呼吸道免疫防御破坏，它也可能影响患有严重流感感染的免疫功能正常的宿主。我们报告一例61岁的白种男性，因呼吸衰竭和发热入住急诊科，被诊断为H1N1流感和IPA。由于他的一般状况较差，尽管这超出了建议的治疗指南，但他接受了双重抗真菌方案治疗。这一选择被证明非常有效。他在一个月后出院，临床状况迅速改善，三个月后影像学表现几乎完全恢复正常。即使在免疫功能正常的宿主中，IPA仍然是一种危及生命的疾病，因此应始终予以怀疑；如有必要，应迅速开始联合治疗。我们报告此病例是因为流感相关IPA的关注度很高，这既是由于该疾病的临床严重性（如果早期识别是可治疗的），也是由于属于SARS家族的病毒（如SARS-CoV-2）引起的呼吸道感染的重要性日益凸显。
