Study confirms the impact of aspergillosis on the prognosis of critically ill patients with viral pneumonia

Researchers from ICVS published a study in the American Journal of Respiratory and Critical Care Medicine, which assesses the influence of the lung microbiota on the incidence and clinical course of patients diagnosed with influenza-associated aspergillosis (IAPA) or COVID-19 (CAPA), or bacterial superinfections.

Recent studies show that around 20% of patients in intensive care with influenza or severe COVID-19 have co-infections caused by the fungus Aspergillus. These fungal superinfections are associated with mortality rates of around 50%, largely due to late diagnosis and compromise of antifungal therapy.

Based on the analysis of more than 400 patients, in collaboration with the University Hospitals of Leuven, Belgium, the team of researchers from the ICVS, which includes Samuel Gonçalves and Cristina Cunha under the coordination of Agostinho Carvalho, found that aspergillosis is more frequent than bacterial superinfections.

Although the analysis of the lung microbiota revealed limited changes in its composition, the presence of specific bacterial communities, particularly in patients with IAPA, was significantly associated with a more pronounced pulmonary inflammatory profile as well as higher mortality rates.

Aspergillosis thus proved to be a more clinically relevant complication than bacterial superinfections in critically ill patients with severe influenza. On the other hand, influenza inhibits the immune response to secondary infections more significantly than COVID-19.

These analyses thus reveal new important mechanisms in the pathophysiology of IAPA and CAPA and support future studies of the immunological dynamics of interactions between viruses, bacteria and fungi in critically ill patients.