Dear colleague,

On behalf of a collaborative research network on Influenza-Associated Aspergillosis (IAA), we would like to invite you to participate in a short survey aiming to evaluate the burden of severe influenza and the awareness of IAA in adult critically ill patients. We also aim to assess the use of galactomannan in the diagnosis of IAA.

Participation is expected to take approximately 5 minutes. Your participation is completely voluntary, and you can stop answering the questions at any time. The questionnaire is anonymous and we will not store personal data, nor will we store metadata.

Background:
Aspergillosis usually occurs in people with severely weakened immune systems. However, several reports describe fatal Aspergillus lung infections in previously healthy patients who were hospitalized with a severe influenza virus infection. The Aspergillus infections involved pneumonia or severe tracheobronchitis (infection of the lung’s airways) (1–4). A retrospective cohort study at seven ICUs in Belgium and the Netherlands found that invasive pulmonary aspergillosis occurred in 19% of patients with severe influenza requiring admission to the ICU. Approximately half of the patients with IAA did not have an immunocompromising condition (1). Also we did not observe characteristic signs of invasive aspergillosis on radiology in contrast to patients with neutropenia.

Severe lung infections caused by influenza and other viruses can damage the respiratory epithelium. Some researchers suspect that this damage can allow Aspergillus to invade and cause infection (5). This process may be similar to how some bacteria, for example Streptococcus pneumoniae and Staphylococcus aureus, cause pneumonia in patients with severe influenza.

On behalf of the research network on IAA, we would like to thank you in advance for your participation.

Yours sincerely,

Prof. dr. Joost Wauters, UZLeuven, Belgium
dr. Michelle Holtappels, UZLeuven, Belgium
Prof. dr. Frank Van de Veerdonk, RadboudUMC, the Netherlands
Prof. dr. Paul Verweij, RadboudUMC, the Netherlands
Endorsed by the Mycotic Diseases Branch of the Center for Disease Control (CDC, US), the INF section of ESICM and the European Confederation of Medical Mycology (ECMM).

 

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* 1. What is your role at the ICU?

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* 2. Place of practice.

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* 3. How many ICU beds does your hospital have?

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* 4. Approximately how many cases of severe influenza (i.e., requiring ICU admission) do you see at your ICU per influenza season?

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* 5. Are neuraminidase inhibitors (NAIs, such as zanamivir or oseltamivir) part of the standardized treatment for severe influenza at your ICU?

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* 6. For patients with influenza requiring ICU admission at your hospital, how commonly are lower respiratory specimens (e.g. bronchoalveolar lavage (BAL), bronchial wash) obtained?

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* 7. When treating patients with severe influenza in the intensive care unit and worsening respiratory function, how often do you order galactomannan testing of serum?

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* 8. When treating patients with severe influenza in the intensive care unit and worsening respiratory function, how often do you order galactomannan testing of BAL fluid or bronchial washing?

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* 9. Have you seen or heard about cases of aspergillosis in the setting of severe influenza* at your place of work in the past 5 years (since 2013/14 influenza season)?
* https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(18)30274-1/fulltext

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* 10. If you are interested in collaborating on a more detailed survey, please provide your name, email, and preferred contact information.

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* 11. Any comments on aspergillosis in the setting of severe influenza infection.

References

1. Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Tienen CV, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med [Internet]. 2018 Jul 31 [cited 2018 Aug 1];0(0). Available from: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(18)30274-1/abstract
2. Van de Veerdonk FL, Kolwijck E, Lestrade PPA, Hodiamont CJ, Rijnders BJA, van Paassen J, et al. Influenza-associated aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2017 Apr 7;196(4):524–7.

3. Alshabani K, Haq A, Miyakawa R, Palla M, Soubani AO. Invasive pulmonary aspergillosis in patients with influenza infection: report of two cases and systematic review of the literature. Expert Rev Respir Med. 2015 Jan 2;9(1):89–96.
4. Wauters J, Baar I, Meersseman P, Meersseman W, Dams K, Paep RD, et al. Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study. Intensive Care Med. 2012 Nov 1;38(11):1761–8.
5. Crum-Cianflone NF. Invasive aspergillosis associated with severe influenza infections. Open Forum Infect Dis [Internet]. 2016 May 1 [cited 2018 Jan 27];3(3). Available from: https://academic.oup.com/ofid/article/3/3/ofw171/2593326

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