A Review of COVID-19-Associated Pulmonary Aspergillosis and Mechanisms of Infection Through Oxylipins
Invasive pulmonary aspergillosis (IPA) is the most common invasive fungal infection leading to death in severely immunocompromised patients. Aspergillus is a slow-growing pathogen capable of compromising the lung, making it easier for viruses to infect. In turn, respiratory viruses tend to cause direct damage to airway epithelium, which favors a state of immunosuppression, or reduced macrophage activity, enabling fungal invasion of tissues. There is a remarkable synergy between respiratory viruses and Aspergillus, with many examples showing how the two together exacerbate the disease process. In late 2019, when the SARS-CoV-2 pandemic began, a new pulmonary aspergillosis appeared; COVID-associated pulmonary aspergillosis, or CAPA. The nonspecific nature of CAPA symptoms coupled with a lack of adequate imaging tools to diagnose made it extremely difficult/complex to differentiate between COVID-19 pneumonias and invasive aspergillosis, impacting treatment and leading to statistically significant increases in mortality rates. Immunosuppression, orotracheal ventilation (intubation), non-invasive ventilation, and corticosteroid use all proved to be risk factors increasing the susceptibility of patients to CAPA; preliminary statistics at the start of the COVID-19 pandemic showed that of ventilated COVID-19 patients, up to 30% were affected by CAPA. Immunosuppression, corticosteroids, and Aspergillus virulence via immunomodulators called oxylipins are intertwined in a complicated relationship that took the stage during the height of the COVID-19 pandemic.
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