Intensive care management of influenza-associated pulmonary aspergillosis

Koehler, P.; Bassetti, M.; Kochanek, M.; Shimabukuro-Vornhagen, A.; Cornely, O.A.

doi:10.1016/j.cmi.2019.04.031

Cited by 86Antifungal resistance and susceptibilityNosocomial Infections in ICUInfluenza Virus Research Studies

Intensive care management of influenza-associated pulmonary aspergillosis

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Koehler, P., Bassetti, M., Kochanek, M., Shimabukuro-Vornhagen, A., Cornely, O.A.·2019·Clinical Microbiology and Infection

DOI 10.1016/j.cmi.2019.04.031

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Abstract

Background Severe pulmonary infections are among the most common reasons for admission to intensive care units (ICU). Within the last decade, increasing reports of severe influenza pneumonia resulting in acute respiratory distress syndrome (ARDS) complicated by Aspergillus infection were published.Objectives To provide a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with ARDS.Sources Review of the literature pertaining to severe influenza-associated pulmonary aspergillosis. PubMed database was searched for publications from the database inception to January 2019.Content In patients with lower respiratory symptoms, development of respiratory insufficiency should trigger rapid and thorough clinical evaluation, in particular in cases of suspected ARDS, including electrocardiography and echocardiography to exclude cardiac dysfunction, arrhythmias and ischaemia. Bronchoalveolar lavage should obtain lower respiratory tract samples for galactomannan assay, direct microscopy, culture, and bacterial, fungal and viral PCR. In case of positive Aspergillus testing, chest CT is the imaging modality of choice. If influenza pneumonia is diagnosed, neuraminidase inhibitors are the preferred approved drugs. When invasive aspergillosis is confirmed, first-line therapy consists of isavuconazole or voriconazole. Isavuconazole is an alternative in case of intolerance to voriconazole, drug-drug interactions, renal impairment, or if a spectrum of activity including the majority of Mucorales is desired. Primary anti-mould prophylaxis with posaconazole is recommended in haematology patients at high-risk. It may be considered in newly diagnosed influenza and ARDS, but ideally in clinical trials.Implications The rising reports of influenza-associated pulmonary aspergillosis in patients with ARDS, who are otherwise not considered at risk for fungal pneumonia demands heightened clinical awareness. Tracheobronchitis and Aspergillus in respiratory tract samples should prompt suspicion of invasive fungal infection and further work-up. The management algorithm should comprise bronchoalveolar lavage, CT imaging, sophisticated ventilator-management, rescue extracorporeal membrane oxygenation, and antifungal and antiviral therapy. To decrease the burden of influenza-related illness, vaccination is of utmost importance, specifically in patients with co-morbidities.

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Patients with acute respiratory distress syndrome caused by influenza have been reported to be at increased risk of invasive aspergillosis, even in the absence of predisposing immunocompromising conditions.
“Patients with acute respiratory distress syndrome caused by influenza have been reported to be at increased risk of invasive aspergillosis (IA), even in the absence of predisposing immunocompromising conditions.55 , 56”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [55]

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Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
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Validation of the EQUAL Aspergillosis Score by analysing guideline-adherent management of invasive pulmonary aspergillosis
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Automatic identification of clinically important Aspergillus species by artificial intelligence-based image recognition: proof-of-concept study
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Influenza-Associated Disseminated Aspergillosis in a 9-Year-Old Girl Requiring ECMO Support
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Immune Phenotypes in Patients With Invasive Mould Infection Support the Use of PD ‐1 Inhibition as Potential Treatment Option
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Invasive Aspergillus outbreak in inhalation injury: a case presentation and literature review
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Microbiological risk factors, ICU survival, and 1-year survival in hematological patients with pneumonia requiring invasive mechanical ventilation
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Simple and sensitive diagnosis of invasive aspergillosis using triphasic DE−ZnO−APDMS microparticle composite
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Virus-associated pulmonary aspergillosis: A rising challenge in respiratory infections
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Effect of Dexamethasone on the Incidence and Outcome of COVID-19 Associated Pulmonary Aspergillosis (CAPA) in Critically Ill Patients during First- and Second Pandemic Wave—A Single Center Experience
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Knowledge Mapping of Aspergillus‐Related Research in Respiratory Medicine: A Bibliometric Analysis Based on English‐Language Articles Spanning 1975 to 2022
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The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients
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The Care Continuum of Patients With Influenza in the Post–COVID-19 Era: A Position Paper
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A 61-Year-Old Man With Influenza Pneumonia and New Onset Hemoptysis
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Candida Isolation During COVID-19: Microbiological Findings of a Prospective Study in a Regional Hospital
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Therapy of Infections
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Pilzinfektionen auf der Intensivstation
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SARS-CoV-2 and Aspergillus pneumonia in kidney transplantation: More frequent than we think?
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Invasive Pilzinfektionen bei Intensivpatienten – Was gibt es Neues?
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Invasive pulmonary aspergillosis in COVID-19. A case series at Gregorio Maranon University General Hospital
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58/m mit Fieber, Husten und schwerer Hypoxämie
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Neumonía por SARS-CoV-2 y Aspergillus en trasplante renal: ¿más frecuente de lo que pensamos?
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Fungal Infections Complicating COVID-19
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Aspergillus and Aspergillosis - Advances in Genomics, Drug Development, Diagnosis and Treatment
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A view of excellence for the future of medical mycology in Clinical Microbiology and Infection
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Burden and Determinants of Emerging and Re-emerging Fungal Pathogens: Resistance to Antifungal Drugs, Mechanisms, and Future Mitigation Strategies
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A bibliometric and visual analysis of the research status and hotspots of Pulmonary Aspergillosis based on web of science
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Pilzinfektionen auf der Intensivstation
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Additional file 1 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627854
Additional file 4 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627863
Additional file 7 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627872
Additional file 8 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627875
Additional file 3 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627860
Additional file 6 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627869
Additional file 2 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627857
Additional file 5 of Association between gut microbiota and influenza: a bidirectional two-sample mendelian randomization study
Xu, F., Gan, X., Tao, Y., Li, D., Xie, P., Liu, F., Yang, F., & Ma, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26627866
Development and Internal Validation of a Nomogram Model to Predict Invasive Pulmonary Aspergillosis Occurrence Risk in ICU Patients with Sepsis
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A nationwide analysis of hospitalised patients with lower respiratory infections in China: life-stage-specific pathogen spectra, co-detection networks, and sex disparities
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Authors: Koehler, P., Bassetti, M., Kochanek, M., Shimabukuro-Vornhagen, A., & Cornely, O. A.
Affiliations: University of Cologne (DE)
University of Udine (IT)
Corresponding author: Koehler, P.
ORCID: Koehler, P.
Bassetti, M.
Kochanek, M.
Cornely, O.A.
Venue: Clinical Microbiology and Infection
Publisher: Elsevier BV
Published: 2019-12
Volume: 25
Issue: 12
Pages: 1501-1509
ISSN: 1198-743X (ISSN-L)
DOI: 10.1016/j.cmi.2019.04.031
OpenAlex: W2946338072
Cited by: 82
References: 64
Citations by year: 2026: 5 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 11 · 2021: 23 · 2020: 12 · 2019: 2
FWCI: 9.19
Type: journal article
Language: en
Update notices: erratum (2020-04-01)
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 366 d)
Locations: Clinical Microbiology and Infection (publishedVersion)
PubMed (publishedVersion)
Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
Institutional Research Information System (University of Udine) (submittedVersion)
CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Keywords: influenza-associated pulmonary aspergillosis, invasive aspergillosis, acute respiratory distress syndrome, influenza pneumonia, intensive care management, bronchoalveolar lavage, galactomannan assay, isavuconazole, voriconazole, neuraminidase inhibitors, extracorporeal membrane oxygenation, antiviral therapy, influenza vaccination, Mucorales
MeSH terms: Algorithms, Critical Care, Female, Humans, Influenza, Human, Intensive Care Units, Middle Aged, Respiratory Distress Syndrome, Treatment Outcome, Pulmonary Aspergillosis

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Intensive care management of influenza-associated pulmonary aspergillosis

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