{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:33:06Z","timestamp":1779183186972,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","award":["Project no. MISP #57760 and no. MISP #57761"],"award-info":[{"award-number":["Project no. MISP #57760 and no. MISP #57761"]}],"id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>An increase in fungal spores in ambient air is reported during a spike in particulate matter (PM2.5 and PM10) aerosols generated during dust or smog events. However, little is known about the impact of ambient bioaerosols on fungal infections in humans. To identify the correlation between the incidence of pulmonary aspergillosis and PM-associated bioaerosols (PM2.5 and PM10), we retrospectively analyzed data between 2015 and 2018 (first stage) and prospectively analyzed data in 2019 (second stage). Patient data were collected from patients in three medical institutions in Tainan, a city with a population of 1.88 million, located in southern Taiwan. PM data were obtained from the Taiwan Air Quality Monitoring Network. Overall, 544 non-repeated aspergillosis patients (first stage, n = 340; second stage, n = 204) were identified and enrolled for analysis. The trend of aspergillosis significantly increased from 2015 to 2019. Influenza A (H1N1) and ambient PMs (PM2.5 and PM10) levels had significant effects on aspergillosis from 2015 to 2018. However, ambient PMs and influenza A (H1N1) in Tainan were correlated with the occurrence of aspergillosis in 2018 and 2019, respectively. Overall (2015\u20132019), aspergillosis was significantly correlated with influenza (p = 0.002), influenza A (H1N1) (p &lt; 0.001), and PM2.5 (p = 0.040) in Tainan City. Using a stepwise regression model, influenza A (H1N1) (p &lt; 0.0001) and Tainan PM10 (p = 0.016) could significantly predict the occurrence of aspergillosis in Tainan. PM-related bioaerosols and influenza A (H1N1) contribute to the incidence of pulmonary aspergillosis.<\/jats:p>","DOI":"10.3390\/jof7030227","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T11:18:38Z","timestamp":1616152718000},"page":"227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Epidemiological Correlation of Pulmonary Aspergillus Infections with Ambient Pollutions and Influenza A (H1N1) in Southern Taiwan"],"prefix":"10.3390","volume":"7","author":[{"given":"Jien-Wei","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Taoyuan 333323, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yee-Huang","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Ming","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsuan-Fu","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center, Chiali, Tainan 72263, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5925-8477","authenticated-orcid":false,"given":"Chung-Han","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan"},{"name":"Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy &amp; Science, Tainan 71710, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khee-Siang","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7345-800X","authenticated-orcid":false,"given":"Wen-Liang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan"},{"name":"Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4879","DOI":"10.1016\/j.atmosenv.2004.05.039","article-title":"Increased levels of ambient fungal spores in Taiwan are associated with dust events from China","volume":"38","author":"Wu","year":"2004","journal-title":"Atmos. Environ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1021\/es4048472","article-title":"Inhalable microorganisms in Beijing\u2019s PM2.5 and PM10 pollutants during a severe smog event","volume":"48","author":"Cao","year":"2014","journal-title":"Environ. Sci. Technol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00484-011-0413-x","article-title":"The effects of transported Asian dust on the composition and concentration of ambient fungi in Taiwan","volume":"56","author":"Chao","year":"2012","journal-title":"Int. J. Biometeorol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.envpol.2015.04.020","article-title":"The spatiotemporal distributions and determinants of ambient fungal spores in the Greater Taipei area","volume":"204","author":"Kallawicha","year":"2015","journal-title":"Environ. Pollut."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.jinf.2012.07.007","article-title":"A strategy based on galactomannan antigen detection and PCR for invasive pulmonary aspergillosis following influenza A (H1N1) pneumonia","volume":"65","author":"Guervilly","year":"2012","journal-title":"J. Infect"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1007\/s00134-012-2673-2","article-title":"Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: A retrospective study","volume":"38","author":"Wauters","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jfma.2017.06.002","article-title":"Higher mortality of severe influenza patients with probable aspergillosis than those with and without other coinfections","volume":"116","author":"Ku","year":"2017","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jmii.2016.09.001","article-title":"High-level ambient particulate matter before influenza attack with increased incidence of Aspergillus antigenemia in southern Taiwan, 2016","volume":"51","author":"Yu","year":"2018","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s13054-016-1326-1","article-title":"Does galactomannan testing increase diagnostic accuracy for IPA in the ICU? A prospective observational study","volume":"20","author":"Schroeder","year":"2016","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e00023-19","DOI":"10.1128\/AAC.00023-19","article-title":"Randomized noninferiority trial of cefoperazone-sulbactam versus cefepime in the treatment of hospital-acquired and healthcare-associated pneumonia","volume":"63","author":"Liu","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/crj.13036","article-title":"Aspergillosis related to severe influenza: A worldwide phenomenon?","volume":"13","author":"Liu","year":"2019","journal-title":"Clin. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.chemosphere.2006.03.043","article-title":"Source identifications of PM10 aerosols depending on hourly measurements of soluble components characterization among different events in Taipei Basin during spring season of 2004","volume":"65","author":"Chang","year":"2006","journal-title":"Chemosphere"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jenvman.2018.08.066","article-title":"Quantifying PM2.5 from long-range transport and local pollution in Taiwan during winter monsoon: An efficient estimation method","volume":"227","author":"Chuang","year":"2018","journal-title":"J. Environ. Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1007\/s10661-020-8158-9","article-title":"Ambient bioaerosol distribution and associated health risks at a high traffic density junction at Dehradun city, India","volume":"192","author":"Madhwal","year":"2020","journal-title":"Environ. Monit. Assess."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15554","DOI":"10.1007\/s11356-018-1743-6","article-title":"The relationship between urban form and air pollution depends on seasonality and city size","volume":"25","author":"Liu","year":"2018","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1093\/cid\/ciaa007","article-title":"High rates of influenza-associated invasive pulmonary aspergillosis may not be universal: A retrospective cohort study from Alberta, Canada","volume":"71","author":"Schwartz","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13054-020-2808-8","article-title":"International survey on influenza-associated pulmonary aspergillosis (IAPA) in intensive care units: Responses suggest low awareness and potential underdiagnosis outside Europe","volume":"24","author":"Thevissen","year":"2020","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"809","DOI":"10.3201\/eid2604.190953","article-title":"Knowledge of infectious disease specialists regarding aspergillosis complicating influenza, United States","volume":"26","author":"Toda","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jmii.2020.11.002","article-title":"A mysterious surge of aspergillosis among non-SARS-CoV-2 patients during COVID-19 pandemic","volume":"54","author":"Lai","year":"2021","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1007\/s00134-020-06091-6","article-title":"Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: An expert opinion","volume":"46","author":"Verweij","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"140","DOI":"10.15537\/smj.2019.2.22940","article-title":"A novel diagnosis scoring model to predict invasive pulmonary aspergillosis in the intensive care unit","volume":"40","author":"Rozaliyani","year":"2019","journal-title":"Saudi Med. J."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/7\/3\/227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:38:07Z","timestamp":1760161087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/7\/3\/227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,19]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["jof7030227"],"URL":"https:\/\/doi.org\/10.3390\/jof7030227","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,19]]}}}