Prevalence, Risk factors, Clinical features, and Outcome of Influenza-Associated Pulmonary Aspergillosis (IAPA) in Critically Ill Patients

A systematic review and meta-analysis

Lawrence Y. Lu, Hui Min Lee, Andrew Burke, Gianluigi Li Bassi, Antoni Torres, John F Fraser, Jonathon P. Fanning. J Chest DOI 10.1016/j.chest.2023.09.019

Background: Globally, up to 650,000 people are estimated to die of influenza annually. Influenza associated pulmonary aspergillosis (IAPA) is a severe complication of influenza characterized by histological evidence of lung tissue invasion by hyphae and rapid clinical progression. Its reported prevalence among critically ill influenza patients is close to 20%. It has been reported that IAPA doubles the intensive care unit (ICU) mortality of patients with influenza (45% vs 20%).

Aspergillus is a common fungus found throughout our surroundings, including healthcare settings. In addition to well-recognized risk factors for fungal infection, such as immunodeficiency, influenza is an independent risk factor predisposing otherwise healthy individuals to IAPA.