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[Invasive pulmonary aspergillosis following influenza A infection]
H Matsushima1, N Takayanagi, M Ubukata
1Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
Abstract:
A 55-year-old man with arc welder's pneumoconiosis who presented with bilateral pneumonia was admitted to our hospital. Streptococcus pneumoniae and Aspergillus fumigatus were cultured from sputum on admission. The patient was treated with antibiotics and an anti-fungal agent, but his chest radiograph shadows became exacerbated, and he died of respiratory failure on the fourth day of hospitalization. Histological examination of postmortem lung tissue revealed necrotizing aspergillous pneumonia. The results of hemagglutination inhibition tests for influenza A (H3 N2) were x16 in September 1999, and x512 on the third day of hospitalization. We diagnosed this patient's condition as invasive pulmonary aspergillosis associated with influenza A viral infection. The suppression of cellular immunity, lymphocytopenia, and destruction of airways-mucociliary transport induced by influenza A viral infection were suspected to have predisposed him to aspergillus superinfection.
Insights
This case report highlights a fatal instance of invasive pulmonary aspergillosis in a patient with pneumoconiosis. Influenza A viral infection likely predisposed the patient to this severe Aspergillus superinfection.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Pathology
Background:
- Pneumoconiosis, a lung disease from dust inhalation, can compromise respiratory health.
- Influenza A viral infections can lead to immunosuppression and airway damage.
- Aspergillus fumigatus is an opportunistic pathogen causing aspergillosis.
Observation:
- A 55-year-old man with arc welder's pneumoconiosis presented with bilateral pneumonia.
- Sputum cultures revealed Streptococcus pneumoniae and Aspergillus fumigatus.
- Despite treatment with antibiotics and antifungals, the patient's condition worsened.
Findings:
- Postmortem lung examination showed necrotizing aspergillous pneumonia.
- Influenza A (H3 N2) viral titers significantly increased during hospitalization.
- The patient died of respiratory failure, diagnosed as invasive pulmonary aspergillosis.
Implications:
- Influenza A infection may predispose individuals with underlying lung disease to severe fungal superinfections.
- Compromised cellular immunity and impaired mucociliary transport are potential mechanisms.
- This case underscores the critical need to consider opportunistic fungal infections in immunocompromised patients with viral respiratory illnesses.