Tuberc Respir Dis.  2014 Sep;77(3):141-144. 10.4046/trd.2014.77.3.141.

Fatal Clinical Course of Probable Invasive Pulmonary Aspergillosis with Influenza B Infection in an Immunocompetent Patient

• Park DW
• Yhi JY
• Koo G
• Jung SJ
• Kwak HJ
• Moon JY
• Kim SH
• Kim TH
• Sohn JW
• Shin DH
• Park SS
• Yoon HJ

• KMID: 2320561
• DOI: http://doi.org/10.4046/trd.2014.77.3.141

Abstract

Invasive pulmonary aspergillosis (IPA) is rarely reported in patients who have normal immune function. Recently, IPA risk was reported in nonimmunocompromised hosts, such as patients with chronic obstructive pulmonary disease and critically ill patients in intensive care units. Moreover, influenza infection is also believed to be associated with IPA among immunocompetent patients. However, most reports on IPA with influenza A infection, including pandemic influenza H1N1, and IPA associated with influenza B infection were scarcely reported. Here, we report probable IPA with a fatal clinical course in an immunocompetent patient with influenza B infection. We demonstrate IPA as a possible complication in immunocompetent patients with influenza B infection. Early clinical suspicion of IPA and timely antifungal therapy are required for better outcomes in such cases.

Keyword

Invasive Pulmonary Aspergillosis; Influenza B Virus; Immunocompetence

MeSH Terms

Critical Illness
Humans
Immunocompetence
Influenza B virus
Influenza, Human*
Intensive Care Units
Invasive Pulmonary Aspergillosis*
Pandemics
Pulmonary Disease, Chronic Obstructive

Figure

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  Figure 1 (A) Normal chest radiograph on 3 days before admission. (B) Chest radiograph on admission showing bilateral pulmonary infiltrates and consolidations.

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  Figure 2 (A-C) A chest computed tomography scan on admission revealed multifocal patchy consolidation, ground-glass opacities, and centrilobular nodules in both lungs.

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  Figure 3 Gomori's methenamine silver stain of bronchoalveolar lavage fluid specimen revealing characteristic septate hyphae branching at less than 45° (×400).

Reference

1. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008; 46:1813–1821.

2. Meersseman W, Lagrou K, Maertens J, Van Wijngaerden E. Invasive aspergillosis in the intensive care unit. Clin Infect Dis. 2007; 45:205–216.

3. Trof RJ, Beishuizen A, Debets-Ossenkopp YJ, Girbes AR, Groeneveld AB. Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients. Intensive Care Med. 2007; 33:1694–1703.

4. Stevens DA, Melikian GL. Aspergillosis in the 'nonimmunocompromised' host. Immunol Invest. 2011; 40:751–766.

5. Clancy CJ, Nguyen MH. Acute community-acquired pneumonia due to Aspergillus in presumably immunocompetent hosts: clues for recognition of a rare but fatal disease. Chest. 1998; 114:629–634.

6. Lat A, Bhadelia N, Miko B, Furuya EY, Thompson GR 3rd. Invasive aspergillosis after pandemic (H1N1) 2009. Emerg Infect Dis. 2010; 16:971–973.

7. Wauters J, Baar I, Meersseman P, Meersseman W, Dams K, De Paep R, et al. Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study. Intensive Care Med. 2012; 38:1761–1768.

8. Kwon OK, Lee MG, Kim HS, Park MS, Kwak KM, Park SY. Invasive pulmonary aspergillosis after influenza a infection in an immunocompetent patient. Tuberc Respir Dis. 2013; 75:260–263.

9. Hasejima N, Yamato K, Takezawa S, Kobayashi H, Kadoyama C. Invasive pulmonary aspergillosis associated with influenza B. Respirology. 2005; 10:116–119.

10. Ohnishi T, Andou K, Kusumoto S, Sugiyama H, Hosaka T, Ishida H, et al. Two cases of successfully treated invasive pulmonary aspergillosis following influenza virus infection. Nihon Kokyuki Gakkai Zasshi. 2007; 45:349–355.

11. Labella AM, Merel SE. Influenza. Med Clin North Am. 2013; 97:621–645.

12. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008; 46:327–360.

13. Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis. 2005; 5:609–622.

14. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002; 347:408–415.