A Fatal Aspergillus Infection during Influenza Season

Introduction: A case with influenza- associated aspergillosis is presented here. Isolating Aspergillus from respiratory cultures of immunocompetent hosts can be unclear. However, cases of influenza-associated Aspergillosis have been reported with increasing frequency during influenza season.
 

Case Presentation: A 70-year-old man, with COPD, was admitted to emergency department with 1 weeks of productive cough and fever and hospitalised our clinic with COPD acute exacerbation. He developed worsening despite received oseltamivir and broad-spectrum antibiotic therapy. He was transferred to the ICU and subsequently required intubation for refractory hypoxia and severe bronchospasm. Nasopharyngeal swab PCR was positive for Influenza A on admission and the endotracheal aspirate and sputum had light growth of Aspergillus fumigatus, repeatedly. Chest computed tomography scan didn’t show any pathological infitration. The initial result was believed to be a false positive. Septic shock developed on maximal medical therapy and finally started liposomal amphotericin B on 20 days later of admission. But, the patient died from respiratory failure.
 

Conclusion: Delayed diagnosis of influenza associated pulmonary aspergillosis in the ICU and delayed antifungal therapy might have contributed to this high mortality.