Multiple Infections By Aspergillus And Influenza

Fungal infections such as Candida and Aspergillus frequently occur in combination with bacterial and/or viral infections. Such infections by multiple classes of organisms are particularly difficult for the body to fight off and are associated with significantly higher mortality than those infected with single pathogens. Fungal infections are often overlooked in hospitalized patients and some researchers believe that death certificates often overlook fungal infection as a cause of death.

A recent study of 2,712 Intensive Care Unit (ICU) patients in Taiwan reported that 54 were diagnosed with severe influenza virus infection (Yu, Liu et al. 2016). Of these 54 patients tested, 33 (61%) had positive Aspergillus galactomannan tests indicative of Aspergillus bloodstream infections. Followup reported that 10 of 17 (59%) of these patients with concurrent influenza and Aspergillus infections died in spite of intense hospital treatment and anti-fungal drugs. This study also reported that rates of concurrent Aspergillus and influenza infection were significantly higher during periods of high outdoor particulate levels (periods when outdoor levels of particulates smaller than 2.5 microns or PM2.5 was 54 microns per cubic meter or less). This suggests that high levels of outdoor particulates may increase risk of many respiratory infections including Aspergillus and influenza.

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Other studies report that infections of fungi such as Candida and/ or Aspergillus frequently occur in the respiratory tract in association with pathogenic bacteria such as Pseudomonas, Staphylococcus, and Tuberculosis (Leclair and Hogan 2010). Such co-infections are often associated with greater disability and mortality as compared to infections with single organisms. Fungi and bacteria mixtures frequently form biofilms on the respiratory tract which are more resistant to both the immune system and to antibiotics than single free-living pathogens. In addition, infections with fungi and bacteria can lower the body’s immune response to other pathogens by a number of mechanisms.

References / Sources

Leclair, L. W. and D. A. Hogan (2010). “Mixed bacterial-fungal infections in the CF respiratory tract.” Med Mycol 48 Suppl 1: S125-132.

Yu, W. L., et al. (2016). “High-level ambient particulate matter before influenza attack with increased incidence of Aspergillus antigenemia in Southern Taiwan, 2016.” J Microbiol Immunol Infect.

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