Bianca Ilie

Infectious Diseases Department

Date… 2019
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Relationship between Influenza
and invasive pulmonary
aspergillosis

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 Man 60y, parisian

The reasons for his admission were:

3 days onset of shortness of breath, fever, cough,

and whitish sputum

He was initially brought by ambulance for malaise

with cranial traumatism without loss of consciousness

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 Past History
• Ancient hepatitis C ( 1977) controlled
• COPD poorly controlled
• IV drugs abuse ( heroin), deprivation in prison
(1978)
• Psychotic disorder treated with TERCIAN 15 mg
and XEOQUEL 250 mg

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 Physical examination findings
HR 125 bpm
RR 35/ min
Normal blood pressure
T° 38,5 °C
Sa O2 79%

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 Physical examination findings
• wheezing and crackles in both lower lung
fields were heard
• Glasgow 15
• Oriented in the time, but not in the space
• Agitation and tremor

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 Laboratory findings in the ED
Protein C reactive 191 mg/l (reference range, 0-3
mg/dL)
Severe lymphopenia at 0.30 × 109 /l (normal
range 1.0–4.0)

CPK 2300 iu/L (normal range 21 to 232 IU/L)

Sputum PCR on admission was positive for

Influenza A
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Chest Rx

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 Evolution

Presumptive diagnosis was a severe hypoxemic

pneumonia due to Influenza A => 75mg bid of
Oseltamivir rapidly initiated

But his condition was deteriorating so he was

transferred in the
ICU department.
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Chest Rx

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 Evolution-24h later
Ventilatory exhaustion with hypercapnic
acidosis

Noradrenaline up to 1.5 mg /h

Mechanical ventilation

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 Bronchoscopy on HD 4

Bronchial alveolar fluid:

PCR + for Influenza A H1N3

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 Bronchoscopy on HD 4

Micological examination + for Aspergillus fumigatus

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 Bronchoscopy on HD 4

BAL galactomannan antigen was elevated to 1.011

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Chest CT

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 Treatment
One month of mechanical ventilation in the
intensive care unit

Antifungal Voriconazole ( TDM surveillance)

started on HD 4 for 5 weeks in total

The medication for the psychotic disorder was

interrupted due to the interaction with voriconazole

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Follow up at 1 month

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 Follow up
Bronchial fibroscopy with biopsies: no
Aspergillus. No acid-alcohol-resistant bacilli.
No arguments for a pulmonary tumor.

Aspergillary serology (IgG) positive.

No inflammatory syndrome

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 Therapeutic approach
Due to the clinical stability and the regression of
the images we did not reintroduce antifungal
treatment.

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Follow up at 3 months

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Follow up at 3 months

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Follow up at 3 months

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Not out of the blue

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• no relationship between invasive pulmonary aspergillosis
and Influenza was described
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• no relationship between invasive pulmonary aspergillosis
and Influenza was described
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Aspergillosis in patients with flu?

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# influenza #aspergillosis

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Aspergillosis – a disease with many faces

Thank you.

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