Evidence of Aspergillosis Found in Hospitalized Patients with Influenza

By Brenda L. Mooney, /alert Contributor
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Invasive aspergillosis primarily affects immunosuppressed persons, but the fungal condition also has been observed in immunocompetent patients with severe influenza, according to a presentation at ID Week.

In fact, researchers from the national Centers for Disease Control and Prevention suggested that severe influenza infection might be an under-recognized risk factor for aspergillosis.

Aspergillosis illustration. Source: Getty

To reach that conclusion, the study team examined the frequency of aspergillosis-related hospital discharge codes in a national surveillance database of influenza hospitalizations.

For the study, laboratory-confirmed influenza-associated hospitalizations reported during 2005–2017 to Centers for Disease Control and Prevention (CDC)’s Influenza Hospitalization Surveillance Network (FluSurv-NET) were analyzed. FluSurv-NET includes data from children and adults in 13 states.

Medical chart abstraction was used to obtain data on underlying conditions and clinical course.  Researchers defined invasive aspergillosis cases as influenza hospitalizations with 1 or more of the following International Classification of Diseases (ICD) 9th or 10th Clinical Modification discharge diagnosis codes: 117.3 (aspergillosis), 484.6 (pneumonia in aspergillosis), B44.0 (invasive pulmonary aspergillosis), B44.2 (tonsillar aspergillosis), and B44.7 (disseminated aspergillosis).

Over 92,671 influenza hospitalizations, the study identified 94 cases (0.1%) that had invasive aspergillosis codes. Those patients were more likely to be male, 60%, white race, 72%, and with a mean age of 58.

In terms of influenza strains, Influenza A accounted for 80% of the cases. Antiviral therapy was received by 79% in the cases.

The CDC reported that the patients had a number of comorbidities, including underlying conditions:

  • 63% had immunocompromising condition,

  • 51%  had chronic lung disease,

  • 22% had renal disease, and

  • 15% had asthma.

Of the patients with aspergillosis-related diagnoses, 48 required intensive care. At the time of discharge, 60% were diagnosed with pneumonia and 14% had died, according to the poster presentation.

“Over one third of patients with invasive aspergillosis did not have a documented immunosuppressive condition,” study authors concluded. “ICD codes are likely an imperfect way to identify invasive aspergillosis, and further studies are needed to characterize risk factors and verify diagnoses for aspergillosis among patients with severe influenza.”

The CDC explained that aspergillosis is an infection caused by Aspergillus, a common mold that lives indoors and outdoors. Most people breathe in Aspergillus spores every day without getting sick, but patients with weakened immune systems or lung diseases are at a higher risk of developing health problems due to the fungus.

In general, those health problems include allergic reactions, lung infections, and infections in other organs.