P91 | Respiratory viruses and pulmonary aspergillosis: a fearful combination even in immunocompetent patient

Premises: Aspergillus species can cause a spectrum of clinical syndrome and respiratory cultures positive in critically ill patients, particularly those with underlying Influenza/SARS-Cov-2 infection, shouldn’t necessarily be considered contaminants or colonizers. There is increasing evidence that microbiome plays a role in immunopathogenesis of Aspergillus-related disease.Description of the Case report: A 34-year-old woman, smoker, recent SARS-CoV2 infection, was admitted for hypoxemic respiratory failure and radiological signs of interstitial pneumonia. Empiric therapy with piperacillin/ tazobactam and oseltamivir was introduced. Atypical bacteria and SARS-CoV2 molecular swab were negative while nasopharyngeal swab for influenza resulted positive for H3N2 subtype. In the following days, High Flow Nasal Cannula and pronation were introduced because of the progressive clinical worsening. Sputum culture was positive for Aspergillus spp. and then voriconazole was introduced. The patient improved till a complete remission.Conclusions: With the recent H1N1 influenza and COVID-19 pandemics, the incidence and clinical spectrum of pulmonary aspergillosis have increased even in immunocompetent. The microbiome could play a role in host immune response, susceptibility and severity of Aspergillus-related disease. We are inclined to believe that the recent SARS-CoV-2 infection and the current H3N2 have modified the microbiological composition of the normal flora in the respiratory tract and the immunological state of the host causing a predisposition to co-infection with aspergillosis.