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.
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 .