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[Aspergillosis following influenza A infection]
Y Funabiki1, K Ishii, S Kusaka
1Department of Geriatric Medicine, Faculty of Medicine, Kyoto University.
Abstract:
An 83-year-old man had an influenza-like upper respiratory infection that progressed to pneumonia and respiratory insufficiency during a period two weeks. After admission, anti-influenza A antibody increased 32-fold and antibiotic treatment had little effect on the pneumonia. Aspergillus antigen was detected from his serum and pleural effusion, however, culture of sputum was negative for aspergillus. Administration of amphotericin B reduced the serum level of aspergillus antigen, however he died due to the progression of respiratory insufficiency and bloody sputum. Aspergillus infection is generally thought to occur in immunocompromised hosts, but this patient had no apparent immunosuppressive conditions except for his age before the influenza A infection. His WBC and lymphocyte count temporally decreased to 2,000 x 10(6)/L (lymphocytes 160 x 10(6)/L) followed by aspergillus infection. This temporally reduction of lymphocytes is thought to have been responsible for the aspergillus infection. Complications of influenza infection are sometimes fatal and vaccination against influenza seems necessary in high risk individuals such as elderly people.
Insights
An elderly man developed severe pneumonia after influenza A infection. A subsequent Aspergillus infection, linked to a temporary drop in lymphocytes, proved fatal despite treatment, highlighting influenza complication risks.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Influenza A virus infections can lead to severe respiratory complications.
- Aspergillus infections typically affect immunocompromised individuals.
- Elderly individuals are at higher risk for severe influenza and its complications.
Observation:
- An 83-year-old man presented with influenza-like illness progressing to pneumonia and respiratory insufficiency.
- Despite antibiotic treatment, pneumonia worsened, and Aspergillus antigen was detected in serum and pleural effusion.
- The patient experienced a significant decrease in white blood cell and lymphocyte counts preceding the Aspergillus infection.
Findings:
- Anti-influenza A antibody titers increased significantly, indicating a primary influenza infection.
- Amphotericin B treatment reduced Aspergillus antigen levels but did not prevent fatal respiratory failure.
- A temporary lymphopenia, possibly triggered by influenza, is hypothesized to have facilitated the secondary Aspergillus infection.
Implications:
- This case suggests that influenza infection can precipitate secondary Aspergillus infections, even in the absence of traditional immunosuppressive conditions.
- Transient lymphopenia during severe infections may represent a critical window for opportunistic pathogen invasion.
- Influenza vaccination is crucial for high-risk populations, including the elderly, to prevent severe outcomes and potential secondary infections.