A Review of COVID-19-Associated Pulmonary Aspergillosis and Mechanisms of Infection Through Oxylipins

Katherine Rockhold


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.

Slides are included in a separate attachment below.