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Pulmonary Hypertension Secondary to Fungal Infections: Underexplored Pathological Links
Andrea Jazel Rodríguez-Herrera1, Sabrina Setembre Batah1, Maria Júlia Faci do Marco1
1Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP), University of São Paulo (USP), Ribeirão Preto 14049-900, SP, Brazil.
Background/Objective:
Pulmonary fungal infections are a significant diagnostic challenge, primarily affecting immunocompromised individuals, such as those with HIV, cancer, or organ transplants, and they often lead to substantial morbidity and mortality if untreated. These infections trigger acute inflammatory and immune responses, which may progress to chronic inflammation. This process involves myofibroblast recruitment, the deposition of extracellular matrix, and vascular remodeling, ultimately contributing to pulmonary hypertension. Despite its clinical relevance, pulmonary hypertension secondary to fungal infections remains under-recognized in practice and poorly studied in research.
Results/Conclusion:
This narrative mini-review explores three key mechanisms underlying vascular remodeling in this context: (1) endothelial injury caused by fungal emboli or autoimmune reactions, (2) direct vascular remodeling during chronic infection driven by inflammation and fibrosis, and (3) distant vascular remodeling post-infection, as seen in granulomatous diseases like paracoccidioidomycosis. Further research and clinical screening for pulmonary hypertension in fungal infections are crucial to improving patient outcomes.
Insights
Pulmonary fungal infections can cause pulmonary hypertension through vascular remodeling. Early recognition and research are vital for managing this under-recognized complication in immunocompromised patients.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Cardiology
Background:
- Pulmonary fungal infections pose diagnostic challenges, particularly in immunocompromised individuals.
- Untreated infections can lead to significant morbidity, mortality, and chronic inflammation.
- This chronic inflammation can result in vascular remodeling and pulmonary hypertension.
Purpose of the Study:
- To review the mechanisms of vascular remodeling in pulmonary hypertension secondary to fungal infections.
- To highlight the under-recognized clinical and research gap regarding this condition.
Main Methods:
- This is a narrative mini-review.
- It synthesizes information on inflammatory and immune responses to fungal infections.
- It focuses on mechanisms leading to vascular remodeling and pulmonary hypertension.
Main Results:
- Fungal infections trigger inflammatory responses that promote myofibroblast recruitment and extracellular matrix deposition.
- Vascular remodeling occurs through endothelial injury, direct inflammation-driven remodeling, and distant remodeling in granulomatous diseases.
- Pulmonary hypertension is a significant but under-recognized consequence.
Conclusions:
- Three primary mechanisms contribute to vascular remodeling: endothelial injury, chronic infection-driven remodeling, and post-infection remodeling.
- Increased clinical awareness and research are needed for pulmonary hypertension in fungal infections.
- Screening for pulmonary hypertension in affected patients is recommended to improve outcomes.
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