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Aspergillus-SARS-CoV-2 Coinfection: What Is Known?
Carlos Alberto Castro-Fuentes1, María Del Rocío Reyes-Montes1, María Guadalupe Frías-De-León2
1Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico.
Abstract:
COVID-19-associated pulmonary aspergillosis (CAPA) has had a high incidence. In addition, it has been associated with prolonged hospital stays, as well as several predisposing risk factors, such as fungal factors (nosocomial organism, the size of the conidia, and the ability of the Aspergillus spp. of colonizing the respiratory tract), environmental factors (remodeling in hospitals, use of air conditioning and negative pressure in intensive care units), comorbidities, and immunosuppressive therapies. In addition to these factors, SARS-CoV-2 per se is associated with significant dysfunction of the patient's immune system, involving both innate and acquired immunity, with reduced CD4+ and CD8+ T cell counts and cytokine storm. Therefore, this review aims to identify the factors influencing the fungus so that coinfection with SARS-CoV-2 can occur. In addition, we analyze the predisposing factors in the fungus, host, and the immune response alteration due to the pathogenicity of SARS-CoV-2 that causes the development of CAPA.
Insights
COVID-19-associated pulmonary aspergillosis (CAPA) is common and linked to longer hospital stays. This review identifies fungal, environmental, and host factors, plus SARS-CoV-2
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- COVID-19-associated pulmonary aspergillosis (CAPA) presents a significant clinical challenge with high incidence and prolonged hospitalizations.
- Numerous factors contribute to CAPA development, including fungal characteristics, hospital environment, host comorbidities, and immunosuppressive treatments.
- SARS-CoV-2 infection itself severely impairs both innate and adaptive immunity, characterized by reduced T cell counts and cytokine storm.
Purpose of the Study:
- To identify factors influencing fungal coinfection in SARS-CoV-2 patients.
- To analyze predisposing factors related to the fungus, host, and immune response alterations in CAPA development.
- To elucidate the complex interplay leading to CAPA.
Main Methods:
- This is a review article.
- Literature search and synthesis of existing studies on CAPA.
- Analysis of fungal, host, and viral (SARS-CoV-2) related factors.
Main Results:
- Fungal factors include organism virulence and colonization ability.
- Environmental factors in hospitals and patient comorbidities play a role.
- SARS-CoV-2 induced immune dysfunction, including T cell reduction and cytokine storm, is a critical predisposing factor.
Conclusions:
- Understanding the multifactorial nature of CAPA is crucial for clinical management.
- Targeting fungal, host, and immune response factors may mitigate CAPA risk.
- Further research is needed to develop effective prevention and treatment strategies for CAPA.
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