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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.
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