Invasive Aspergillus Fumigatus in Immunocompetent Host Complicating Influenza B Infection

A. Mittal1, R. G. Sangani2, M. Poling3;

Author address: 

1Department of Internal Medicine, West Virginia University, Morgantown, WV, United States, 2Dept of Pulmonary & Critical Care Medicine, West Virginia University, Morgantown, WV, United States, 3Department of Nephrology, West Virginia University, Morgantown, WV, United States.

Abstract: 

Introduction: We present a case of an immunocompetent host with Influenza B infection who developed invasive aspergillosis complicated by multi-organ failure and death. Invasive aspergillosis is an uncommon entity in immunocompetent hosts, and while coinfection with Influenza A and H1N1 has been reported, very few cases have implicated Influenza B coinfection.
Case Presentation: 76 year old male initially admitted for COPD exacerbation is transferred to our facility for management of accidental placement of central venous catheter into right subclavian artery successfully remedied by our vascular surgery. Admission CT scan shows evidence of extensive airspace consolidations, multifocal pneumonia, and cavitary nodules. Patient was started on broad spectrum antibiotics but continued to decline with worsening respiratory failure, thrombocytopenia, and hypotension requiring pressor support. Bronchoscopy grew Aspergillus fumigatus and PCR revealed Influenza B. We felt that the aspergillusmold is unlikely the inciting event for the patient’s respiratory failure, but is likely an underlying and compounding factor. More likely, a COPD exacerbation likely from Influenza B infection lead to superinfection with aspergillus pneumonitis. Infectious disease agreed and recommended prolonged antifungal and antimicrobial therapy, however the patient declined with multi-organ dysfunction. Given his poor prognosis, family opted to pursue comfort measures only.
Conclusion: Invasive aspergillosis is traditionally thought of as a disease preying on immunocompromised patients. There is a small number of case reports that detail Influenza A and H1N1 coinfections with Aspergillus. Influenza viruses replicate in respiratory epithelial cells causing inflammation and can also depress cell mediated immunity. Unlike Influenza A, Influenza B undergoes antigenic drift more slowly with no antigenic shift at all - meaning it does not cause pandemics like Influenza A or H1N1. In addition, given its structure, Influenza B likely only affects the upper respiratory tract but can still strip bronchial ciliary epithelium to cause local hemorrhages and necrosis. Invasive aspergillosis is becoming more recognized as an entity that has the potential to afflict immunocompetent hosts, often in the context of co- or superinfections. Influenza B is traditionally thought of as less pathogenic than Influenza A. Our patient developed respiratory failure, cardiovascular collapse, metabolic and respiratory acidosis, coagulopathy, and encephalopathy - serving as a reminder of the devastation that can follow a simple Influenza B infection. This case highlights the need to re-assess the notion that Influenza B is a less virulent disease and the dangerous potential for aspergillus coinfection.

Tables: 

2018

abstract No: 

A3286 / P450

Full conference title: 

The American Thoracic Society Conference 2018
    • ATS 2018