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SARS-CoV-2 Associated Immune Dysregulation and COVID-Associated Pulmonary Aspergilliosis (CAPA): A Cautionary Tale

Dominic Adam Worku1,2

  • 1Infectious Diseases and Microbiology Department, Morriston Hospital, Swansea University Health Board, Swansea SA6 6NL, UK.

International Journal of Molecular Sciences
|March 25, 2022
PubMed

Insights

Opportunistic fungal infections like Covid-Associated Pulmonary Aspergillosis (CAPA) are a significant cause of death in SARS-CoV-2 patients. This review explores how COVID-19 and its treatments increase CAPA risk and improve diagnosis.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Critical Care Medicine

Background:

  • The SARS-CoV-2 pandemic has highlighted the role of opportunistic pathogens in severe COVID-19 outcomes.
  • Covid-Associated Pulmonary Aspergillosis (CAPA) is a critical concern, often occurring without typical risk factors like neutropenia.
  • Diagnosing CAPA presents significant challenges for clinicians managing COVID-19 patients.

Purpose of the Study:

  • To review the immunopathology of SARS-CoV-2 and its role in potentiating CAPA.
  • To examine the impact of COVID-19 treatments (corticosteroids, IL-6 inhibitors) on CAPA development.
  • To discuss improved diagnostic strategies and treatment protocols for CAPA.

Main Methods:

  • Literature review focusing on immunopathology and clinical data related to SARS-CoV-2 and aspergillosis.
  • Analysis of immune dysregulation in COVID-19 patients.
  • Evaluation of treatment effects on opportunistic infections.

Main Results:

  • SARS-CoV-2 infection dysregulates local and systemic immunity, creating an environment conducive to Aspergillus.
  • Approved COVID-19 treatments, such as corticosteroids and IL-6 inhibitors, can inadvertently increase CAPA risk.
  • Understanding these mechanisms can aid in diagnosing CAPA in challenging cases.

Conclusions:

  • The immunopathology of COVID-19 and its treatments significantly contributes to the incidence of CAPA.
  • Enhanced diagnostic approaches are needed to identify CAPA earlier.
  • Timely and appropriate treatment is crucial for managing probable and confirmed CAPA cases.
Keywords:
CAPACOVIDSARS-CoV-2aspergillosisfungal

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