Aspergillus Tracheobronchitis in Influenza B
A 56-year-old woman with no relevant medical history was admitted to the hospital with progressive dyspnea and high fever. Thoracic radiography on admission to the intensive care unit showed bilateral infiltrates, and polymerase chain reaction confirmed influenza B infection (Yamagata subtype). Severe acute respiratory distress syndrome (ARDS) developed very rapidly. Cultures demonstrated Aspergillus fumigatus in bronchial secretions only 48 h after admission. Aspergillus galactomannan was highly positive in the bronchoalveoloar lavage fluid. Bronchoscopy showed an extensive yellowish coating of almost the whole bronchial mucosa that was resistant to rinsing (Figure). Histological examination of biopsy samples revealed invasive Aspergillus infection. Despite antimycotic treatment and the full range of intensive care measures (including extracorporeal membrane oxygenation) the patient died 52 days later after developing refractory multiple organ failure. Recent years have seen increasingly frequent reports of invasive pulmonary aspergillosis in patients requiring intensive care for influenza infection without the classic risk factors. The occurrence of this complication increases the patient’s risk of death.
Dr. med. Daniel Peter Frings, Dr. med. Marcel Simon, Prof. Dr. med. Stefan Kluge, Universitätsklinikum Hamburg-Eppendorf, firstname.lastname@example.org
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Frings DP, Simon M, Kluge S: Aspergillus tracheobronchitis in influenza B. Dtsch Arztebl Int 2019; 116: 100. DOI: 10.3238/arztebl.2019.0100b