Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment
- 1 December 2018
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Infectious Diseases
- Vol. 31 (6), 471-480
- https://doi.org/10.1097/qco.0000000000000504
Abstract
Bacterial superinfection of critically ill influenza patients is well-known, but in recent years, more and more reports describe invasive aspergillosis as a frequent complication as well. This review summarizes the available literature on the association of invasive pulmonary aspergillosis (IPA) with severe influenza (influenza-associated aspergillosis, IAA), including epidemiology, diagnostic approaches and treatment options. Though IPA typically develops in immunodeficient patients, non-classically immunocompromised patients such as critically ill influenza patients are at high-risk for IPA as well. The morbidity and mortality of IPA in these patients is high and in the majority of them, the onset occurs early after intensive care unit admission. Currently, standard of care (SOC) consists of close follow-up of these critically ill influenza patients with high diagnostic awareness for IPA. As soon as there is clinical, mycological or radiological suspicion for IAA, antifungal azole-based therapy (e.g. voriconazole) is initiated, in combination with therapeutic drug monitoring (TDM). Antifungal treatment regimens should reflect local epidemiology of azole-resistant Aspergillus species and should be adjusted to clinical evolution. TDM is necessary as azoles like voriconazole are characterized by nonlinear pharmacokinetics, especially in critically ill patients. In light of the frequency, morbidity and mortality associated with influenza-associated aspergillosis in the intensive care unit (ICU), a high awareness of the diagnosis and prompt initiation of antifungal therapy is required. Further studies are needed to evaluate the incidence of IAA in a prospective multi-centric manner, to elucidate contributing host-derived factors to the pathogenesis of this superinfection, to further delineate the population at risk and to identify the preferred diagnostic and management strategy as well as the role of prophylaxis.Keywords
This publication has 104 references indexed in Scilit:
- Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: double blind randomised controlled trialBMJ, 2013
- A Case of Acute Cerebral Aspergillosis Complicating Influenza A/H1N1pdm 2009Infection & Chemotherapy, 2013
- Pharmacokinetics of Oseltamivir and Oseltamivir Carboxylate in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis and/or Extracorporeal Membrane OxygenationPharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2012
- A strategy based on galactomannan antigen detection and PCR for invasive pulmonary aspergillosis following influenza A (H1N1) pneumoniaJournal of Infection, 2012
- Impact of Extracorporeal Membrane Oxygenation and Continuous Venovenous Hemodiafiltration on the Pharmacokinetics of Oseltamivir Carboxylate in Critically Ill Patients With Pandemic (H1N1) InfluenzaTherapeutic Drug Monitoring, 2012
- Tracheobronchial Manifestations ofAspergillusInfectionsThe Scientific World Journal, 2011
- Invasive Aspergillosis after Pandemic (H1N1) 2009Emerging Infectious Diseases, 2010
- Enteric absorption and pharmacokinetics of oseltamivir in critically ill patients with pandemic (H1N1) influenzaCMAJ : Canadian Medical Association Journal, 2010
- Host adaptive immunity deficiency in severe pandemic influenzaCritical Care, 2010
- Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenationJournal of Antimicrobial Chemotherapy, 2009