Clinical characteristics and management of co-infected patients of influenza A and Aspergillus: Case series in the Southern China.

RATIONALE: Influenza and Aspergillus co-infection is a topic of significant interest.

PATIENT CONCERNS AND DIAGNOSES: We report 5 patients with influenza and Aspergillus co-infection of. Upon admission, all patients were diagnosed with influenza A virus infection and had elevated levels of inflammatory markers, including C-reactive protein and serum amyloid A.

INTERVENTIONS: The patients were treated with antiviral therapy upon admission. Computed tomography imaging 5 to 10 days later detected no improvement. Further investigation indicated that these patients exhibited signs of acute Aspergillus infection, showing halo signs and solidification along the bronchi. One patient was diagnosed with a co-infection by biopsy, while the remaining patients were diagnosed clinically based on at least 2 diagnostic markers (such as blood/BALF GM, tNGS, and sputum culture). After co-infection diagnosis, treatment was supplemented by the antifungal voriconazole.

OUTCOMES: Follow-up computed tomography scans in 4 patients revealed improvement after 7 to 14 days of antifungal treatment.

LESSONS: It is important to note that Aspergillus infection should be considered as a potential risk factor among patients with influenza who fail to improve or worsen despite receiving full antiviral treatment.