Association between severe RSV pneumonia and invasive pulmonary aspergillosis

Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection, most often seen in severely immunocompromised patients. In patients without classical host factors such as neutropenia, IPA has been described in critically ill patients with influenza and COVID-19. In past years, associations between IPA and other respiratory viruses have been made, especially in immunocompromised hosts. In our institute, we have recently observed multiple critically ill patients with respiratory syncytial virus (RSV) infection and IPA, mostly in patients who had undergone allogeneic hematological stem cell transplantation (HSCT). We evaluated the prevalence and potential risk factors of IPA in critically ill patients with an RSV infection. In a retrospective cohort study between January 1st 2016 and December 31st 2024 patients who had been admitted to the intensive care unit (ICU) for respiratory support and underwent a bronchoalveolar lavage that was positive for RSV of whom clinical information was available, were included. Data regarding underlying disease, radiology, mycological tests, and mortality were analyzed. We identified 16 ICU patients that received respiratory support due to an RSV pneumonia. Of these, five patients (31%) had probable IPA, all of whom had undergone an allogeneic SCT. The 30-day mortality of IPA in these patients was 100%. Patients with an allogeneic HSCT and severe RSV had increased prevalence of IPA compared to RSV negative patients, albeit non-significantly (56% vs. 23%, p = 0.10). IPA associated with RSV appears to occur limited to post-allogeneic HSCT recipients and carries a dismal prognosis.