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.	劉玲, 代靜泓, 邱玉英. 間質性肺疾病繼發肺孢子菌肺炎50例患者的臨床分析. 中國呼吸與危重監護雜志, 2023, 22(11): 789-795.
16.	中國研究型醫院學會呼吸病學專業委員會. 新型冠狀病毒感染背景下間質性肺疾病患者臨床管理中國專家共識(2023年版). 中華結核和呼吸雜志, 2023, 46(12): 1204-1218.

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. 中華醫學會呼吸病學分會間質性肺疾病學組. 特發性肺纖維化診斷和治療中國專家共識. 中華結核和呼吸雜志, 2016, 39(6): 427-432.
4. 中國醫師協會風濕免疫科醫師分會風濕病相關肺血管/間質病學組. 2018中國結締組織病相關間質性肺病診斷和治療專家共識. 中華內科雜志, 2018, 57(8): 558-565.
5. 中華醫學會呼吸病學分會間質性肺病學組, 中國醫師協會呼吸醫師分會間質性肺疾病工作委員會. 特發性肺纖維化急性加重診斷和治療中國專家共識. 中華醫學雜志, 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. 劉玲, 代靜泓, 邱玉英. 間質性肺疾病繼發肺孢子菌肺炎50例患者的臨床分析. 中國呼吸與危重監護雜志, 2023, 22(11): 789-795.
16. 中國研究型醫院學會呼吸病學專業委員會. 新型冠狀病毒感染背景下間質性肺疾病患者臨床管理中國專家共識(2023年版). 中華結核和呼吸雜志, 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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