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Review Papers | Medicine | India | Volume 12 Issue 9, September 2023
Navigating Influenza Complications: The Enigma of Aspergillus Tamarii-Induced IAPA
Namburi Prashanth Sai Sanjeev Nikhil | Praneeth Ulavala [14] | Narapaneni Sravanthi [4] | C. Prabhakar Raju [11]
Abstract: Influenza is a devastating respiratory illness that spreads quickly and causes yearly pandemics as well as significant morbidity and mortality worldwide. While majority of influenza illnesses go away without serious problems, some people may develop post - influenza complications such subsequent bacterial or fungal infections. Among these, invasive pulmonary aspergillosis (IPA) has been recognised as a serious condition that can result in higher fatality rates, especially in individuals with impaired immune systems. However, there is not enough information on certain fungi infections, such as Influenza - Associated Invasive Pulmonary Aspergillosis (IAPA), especially regarding the COVID - 19 and H1N1 pandemic influenza strains from 2009 that caused the illness. [1] This article presents a unique and rare occurrence of IAPA caused by the infrequent pathogen Aspergillus tamarii in a 33 - year - old male with a history of asthma. The patient's clinical course was noteworthy, as it was preceded by a 50 - day hospitalisation for COVID - 19 pneumonia in August 2020, requiring mechanical ventilation for 37 days. Surprisingly, the patient had no lingering respiratory symptoms after recovering from COVID - 19. In April 2022, the patient was re - admitted to the hospital with fever, cough, and dyspnea, following exposure to a cold environment after a temple visit. High - resolution computed tomography (HRCT) scans revealed progressive lung abnormalities since the previous scan in August 2020, with ground glass opacities (GGOs), crazy paving, nodules, and traction bronchiectasis evident. Subsequent examination identified pandemic (H1N1) 2009 infection through nasopharyngeal swab, and further analysis of expectorated sputum showed thin septate hyphae with acute angle branching, resembling Aspergillus species. Serum galactomannan was also positive, leading to a probable diagnosis of IAPA. The patient received Posaconazole (PCZ) treatment following confirmation of Aspergillus tamariias the causative agent, determined through sputum fungal culture and MALDI TOF MS analysis. Aspergillus tamarii is an infrequent human pathogen, with previous case reports documenting its involvement in eyelid infections, keratitis, invasive sinonasalinfections, and onychomycosis. Sensititre Minimum Inhibitory Concentrations (MICs) for anti - fungal drugs, Itraconazole, Voriconazole, Posaconazole, and Isavuconazole, were determined. Based on therapeutic drug monitoring (TDM) results, Posaconazole (PCZ) was continued to ensure adequate drug exposure and the patient's clinical improvement. In patients with a history of severe influenza infections, particularly those with underlying respiratory conditions or a history of COVID - 19, this case report emphasizes the importance of considering fungal infections like IAPA into consideration. Given IAPA's rapid progress and high rates of morbidity and mortality, it is crucial to recognize the condition early. In these rare and serious cases of IAPA, on time identification, appropriate diagnostic testing, and targeted anti - fungal medication adapted to the identified pathogen are crucial for improving patient outcomes. Further, more investigation and data gathering are needed to fully recognise the epidemiology, risk factors, and optimal management approaches of IAPA, both in India and internationally. Increased awareness and knowledge sharing among medical professionals can help with quick identification and efficient treatment of this serious illness.
Keywords: Influenza, COVID - 19, Aspergillus tamarii, Antifungals
Edition: Volume 12 Issue 9, September 2023,
Pages: 1080 - 1082