{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:02:30Z","timestamp":1792245750920,"version":"4.4.0"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,5]],"date-time":"2021-09-05T00:00:00Z","timestamp":1630800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>A previously healthy 9-year-old girl developed fulminant myocarditis due to severe influenza A infection complicated with methicillin-resistant Staphylococcus aureus pneumonia, requiring extracorporeal membrane oxygenation (ECMO) support. Twelve days after admission, Aspergillus fumigatus was isolated in tracheal aspirate, and 12 h later she suddenly developed anisocoria. Computed tomography (CT) of the head showed fungal brain lesions. Urgent decompressive craniectomy with lesion drainage was performed; histopathology found hyphae in surgical samples, culture-positive for Aspergillus fumigatus (susceptible to azoles, echinocandins, and amphotericin B). Extension workup showed disseminated aspergillosis. After multiple surgeries and combined antifungal therapy (isavuconazole plus liposomal amphotericin B), her clinical course was favorable. Isavuconazole therapeutic drug monitoring was performed weekly. Extensive immunological study ruled out primary immunodeficiencies. Fluorine-18 fluorodeoxyglucose positron emission tomography\/CT (18F-FDG PET\/CT) follow-up showed a gradual decrease in fungal lesions. Influenza-associated pulmonary aspergillosis is well-recognized in critically ill adult patients, but pediatric data are scant. Clinical features described in adults concur with those of our case. Isavuconazole, an off-label drug in children, was chosen because our patient had severe renal failure. To conclude, influenza-associated pulmonary aspergillosis is uncommon in children admitted to intensive care for severe influenza, but pediatricians should be highly aware of this condition to enable prompt diagnosis and treatment.<\/jats:p>","DOI":"10.3390\/jof7090726","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T13:15:56Z","timestamp":1630934156000},"page":"726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Influenza-Associated Disseminated Aspergillosis in a 9-Year-Old Girl Requiring ECMO Support"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-8291","authenticated-orcid":false,"given":"Natalia","family":"Mendoza-Palomar","sequence":"first","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Infection in the Immunosuppressed Paediatric Patient Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Melendo-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Infection in the Immunosuppressed Paediatric Patient Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8341-6508","authenticated-orcid":false,"given":"Joan","family":"Balcells","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Clinical Research\/Innovation in Pneumonia and Sepsis (CRIPS) Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8352-4691","authenticated-orcid":false,"given":"Jaume","family":"Izquierdo-Blasco","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Mart\u00edn-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Microbiology Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Velasco-Nu\u00f1o","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Molecular Medical Imaging Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1055-2063","authenticated-orcid":false,"given":"Jacques G.","family":"Rivi\u00e8re","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Infection in the Immunosuppressed Paediatric Patient Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0346-5570","authenticated-orcid":false,"given":"Pere","family":"Soler-Palacin","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Infection in the Immunosuppressed Paediatric Patient Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,5]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/QCO.0000000000000504","article-title":"Invasive pulmonary aspergillosis complicating severe influenza: Epidemiology, diagnosis and treatment","volume":"31","author":"Vanderbeke","year":"2018","journal-title":"Curr. 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