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Invasive pulmonary aspergillosis associated with viral pneumonitis

Intan Mw Dewi1, Nico Af Janssen2, Diletta Rosati2

  • 1Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Microbiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands.

Current Opinion in Microbiology
|May 25, 2021
PubMed

Insights

Invasive pulmonary aspergillosis (IPA) in critically ill patients with viral pneumonia, including influenza-associated (IAPA) and COVID-19-associated (CAPA), is a growing concern. Understanding its pathogenesis and exploring immunotherapy are crucial for improving outcomes.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Mycology

Background:

  • Invasive pulmonary aspergillosis (IPA) is increasingly reported in critically ill patients with viral pneumonitis.
  • Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are common, often fatal, even in immunocompetent individuals.
  • The exact pathogenesis of IAPA and CAPA, involving complex interactions between viral, fungal, and host factors, remains incompletely understood.

Purpose of the Study:

  • To review the current understanding of IAPA and CAPA.
  • To discuss potential therapeutic strategies, including immunotherapy.
  • To identify future research challenges in managing these fungal infections.

Main Methods:

  • Literature review and synthesis of existing research on IAPA and CAPA.
  • Discussion of pathogenetic mechanisms.
  • Exploration of immunotherapeutic approaches.

Main Results:

  • IPA, particularly IAPA and CAPA, presents a significant mortality risk in critically ill patients with viral pneumonia.
  • Pathogenesis involves a complex interplay of viral, fungal, and host immune responses.
  • Immunotherapy is being explored as a potential treatment modality.

Conclusions:

  • IAPA and CAPA are serious complications of viral pneumonitis with high mortality.
  • Further research into pathogenesis is needed to develop effective treatments.
  • Immunotherapy holds promise but requires further investigation for optimal use in managing these fungal infections.

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