355. Invasive pulmonary aspergillosis (IPA) complicating respiratory viral infections in patients with hematological malignancies
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Data regarding respiratory viral infections (RVIs) in patients (pts) with leukemia and/or stem cell transplantation (LSCT) and their predisposition to invasive pulmonary aspergillosis (IPA) are limited. To that end, we conducted a case control study of post- RVI-IPA in LSCT pts.

Methods: We analyzed all consecutive adult pts (2006-2016) with culture-documented IPA (EORTC/MSG criteria). Cases were pts with confirmed (either by nasal wash and/or BAL PCR and/or respiratory viral culture) RVIs [respiratory syncytial virus (RSV), Influenza A/B (INFA/B), or parainfluenza virus (PIV)] followed by IPA up to 5 weeks after. Controls were pts with IPA without evidence of RVIs.

Results: We identified 54 cases (proven 1, probable 53), and 142 pts with IPA (proven 12, probable 130) as controls. The distribution of viruses were 34 PIV (52%), 18 INFA/B (27%), and 14 RSV (21%). The median days of post-RVIs-IPA infection was 8(-6-57) days. Among cases, the most common hematological malignancies were AML (34%), and CLL (26%). Most cases had prior allogeneic SCT (57%). Non-fumigatus Aspergillus species were the cause of IPA in 58% of cases. In univariate analysis, pts with post-RVs-IPA infection were more likely to be in complete or partial remission (43.9% vs 22.3% p=0.007), to have prior allogeneic SCT (57% vs 31%, p=0.0009) and an absolute lymphocyte count between 500-1000/mm3 at RVI diagnosis (41% vs 27%, p=0.04). In addition, co-infections within 2 weeks after viral infection (58% vs 18%, p=0.0001), especially of the lower respiratory tract (37% vs 18%, p=0.004) were more common in pts with post-RVIs-IPA. RVIs-IPA pts were less likely to have an absolute neutrophil count <100mm3 at IPA diagnosis (17% vs 37%, p=0.005). Need for ICU post-RVIs-IPA disease (31% vs 26% p=0.5), and 42d crude mortality (22% vs 27%, p=0.45) were no different between cases and controls.

Conclusion: Post-RVIs-IPA occurs more frequently in patients with prior transplantation and is less associated with leukemia relapse and neutropenia. Although co-infections are common, this entity does not appear to be associated with worse outcome compared to IPA without preceding RVI.

Eleni Magira, MD PhD, First Department of Critical Care Medicine, Medical School of National and Kapodistrian University of Athens, Athens, Greece; Department of Infectious Disease, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, Roy F. Chemaly, MD, MPH, FIDSA, FACP, Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, Ying Jiang, MS, Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX and Dimitrios P. Kontoyiannis, MD, ScD, PhD (Hon), FACP, FIDSA, FECMM, FAAM, Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

E. Magira, None

R. F. Chemaly, None

Y. Jiang, None

D. P. Kontoyiannis, Merck: Consultant , Research support and Speaker honorarium . Pfizer: Consultant , Research support . Astellas: Consultant , Research support and Speaker honorarium . Gilead: Speaker's Bureau , Speaker honorarium . F2G Inc: Speaker's Bureau , Speaker honorarium . Cidara Inc: Speaker's Bureau , Speaker honorarium . Jazz Pharmaceuticals: Speaker's Bureau , Speaker honorarium .

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