Analysis of clinical radiographic features and treatment of interstitial lung disease patients infected with influenza virus_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Yin ¹ , JIANG Hanyi ¹ , HU Xiaohan ² , ZHAO Tingting ¹ , CAO Min ¹ , YAN Xin ¹ , XIAO Yonglong ¹ , HE Jian ³ , QI Rongfeng ⁴ ,  SU Xin ¹

1. Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China;
2. Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China;
3. Department of Nuclear Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China;
4. Department of Medical Imaging, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, P. R. China;

Corresponding author：

SU Xin, Email: suxinjs@163.com

Keywords：

Interstitial lung disease; Influenza virus; Clinical feature; Radiology

DOI：

10.7507/1671-6205.202406040

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Objective To analyze the clinical radiographic features and treatment of interstitial lung disease (ILD) inpatients infected with influenza virus. Methods The clinical data of ILD patients with influenza in Nanjing Drum Tower Hospital from October 2023 to January 2024 were collected. According to each patient results of influenza nucleic acid detection, they were divided into an influenza infection group and a non-infection group. Results A total of 73 patients received influenza nucleic acid detection were enrolled, 23 cases including 5 males and 18 females were positive. Twenty-one cases were infected with influenza A virus, 2 cases were infected with influenza B virus. The median age of influenza positive patients was 64.7±7.8 years. Cough (23 cases, 100.0%), sputum (23 cases, 100.0%), wheezing (20 cases, 87.0%) and fever (17 cases, 73.9%) were the most common symptoms of the patients infected with influenza. Compared with the non-infection patients, fever was more common in the influenza infection group (P<0.05). Laboratory examination indicated that lymphocytopenia were detected in the influenza infection patients. There was no statistical difference in the level of white blood cell count, neutrophil count, lactate dehydrogenase, creatine kinase, erythrocyte sedimentation rate, C-reactive protein, calcitonin, interleukin-6 and oxygenation index. Ground glass opacity in the influenza virus infection group was more common than that in the non-infection group (P<0.05). Ten ILD patients infected with influenza virus (43.5%) were co-infected with Aspergillus. The chest CT type of ILD patients with Aspergillus infection was usual interstitial pneumonia (UIP). Honeycombing was more common than those without Aspergillus infection group (P<0.05). Twenty-two patients (95.7%) received antiviral treatment, of which 20 patients (87.0%) were treated with oseltamivir, 5 patients (21.7%) were treated with mabaloxavir, and 4 patients (17.4%) were treated combined with paramivir. Seventeen patients (73.9%) were previously treated with glucocorticoids, and 16 patients did not adjust the glucocorticoids dosage; 9 patients (39.1%) were previously treated with immunosuppressants, and 2 patients stopped immunosuppressants. Four patients (17.4%) infected with influenza virus developed acute exacerbation of ILD. There was no statistically significant difference in acute exacerbation between the two groups (P>0.05). Conclusions Compared with ILD patients not infected with influenza, fever, lymphocytopenia and ground-glass opacity are the common clinical and chest CT features of ILD patients infected with influenza. Patients with UIP type combined with honeycomb were prone to be co-infected with Aspergillus infection.

Citation： LIU Yin, JIANG Hanyi, HU Xiaohan, ZHAO Tingting, CAO Min, YAN Xin, XIAO Yonglong, HE Jian, QI Rongfeng, SU Xin. Analysis of clinical radiographic features and treatment of interstitial lung disease patients infected with influenza virus. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(3): 172-178. doi: 10.7507/1671-6205.202406040 Copy

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15.	刘玲, 代静泓, 邱玉英. 间质性肺疾病继发肺孢子菌肺炎50例患者的临床分析. 中国呼吸与危重监护杂志, 2023, 22(11): 789-795.
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1. Brody H. Influenza. Nature, 2019, 573(7774): S49.
2. Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med, 2013, 188(6): 733-748.
3. 中华医学会呼吸病学分会间质性肺疾病学组. 特发性肺纤维化诊断和治疗中国专家共识. 中华结核和呼吸杂志, 2016, 39(6): 427-432.
4. 中国医师协会风湿免疫科医师分会风湿病相关肺血管/间质病学组. 2018中国结缔组织病相关间质性肺病诊断和治疗专家共识. 中华内科杂志, 2018, 57(8): 558-565.
5. 中华医学会呼吸病学分会间质性肺病学组, 中国医师协会呼吸医师分会间质性肺疾病工作委员会. 特发性肺纤维化急性加重诊断和治疗中国专家共识. 中华医学杂志, 2019, 99(26): 2014-2023.
6. Cheng Y, Zhao H, Song P, et al. Dynamic changes of lymphocyte counts in adult patients with severe pandemic H1N1 influenza A. J Infect Public Health, 2019, 12(6): 878-883.
7. Tavakolpour S, Rakhshandehroo T, Wei EX, et al. Lymphopenia during the COVID-19 infection: what it shows and what can be learned. Immunol Lett, 2020, 225: 31-32.
8. Guo Z, Zhang Z, Prajapati M, et al. Lymphopenia caused by virus infections and the mechanisms beyond. Viruses, 2021, 13(9): 1876.
9. Tan L, Wang Q, Zhang D, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther, 2020, 5(1): 33.
10. Zhou F, Li H, Gu L, et al. Risk factors for nosocomial infection among hospitalised severe influenza A (H1N1)pdm09 patients. Respir Med, 2018, 134: 86-91.
11. Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med, 2018, 6(10): 782-792.
12. Mineo G, Ciccarese F, Modolon C, et al. Post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia: role of follow-up CT. Radiol Med, 2012, 117(2): 185-200.
13. Gao J, Chu W, Duan J, et al. Six-month outcomes of post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia. Front Mol Biosci, 2021, 8: 640763.
14. Huang WJ, Tang XX. Virus infection induced pulmonary fibrosis. J Transl Med, 2021, 19(1): 496.
15. 刘玲, 代静泓, 邱玉英. 间质性肺疾病继发肺孢子菌肺炎50例患者的临床分析. 中国呼吸与危重监护杂志, 2023, 22(11): 789-795.
16. 中国研究型医院学会呼吸病学专业委员会. 新型冠状病毒感染背景下间质性肺疾病患者临床管理中国专家共识(2023年版). 中华结核和呼吸杂志, 2023, 46(12): 1204-1218.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of clinical radiographic features and treatment of interstitial lung disease patients infected with influenza virus

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