Russo Alessandro, Morrone Helen Linda, Rotundo Salvatore, Trecarichi Enrico Maria, Torti Carlo
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
Diagnostics (Basel). 2022 Jun 1;12(6):1364. doi: 10.3390/diagnostics12061364.
During the SARS-CoV-2 pandemic, a higher incidence of invasive pulmonary aspergillosis was observed in patients affected by Coronavirus disease 2019 (COVID-19), leading to the delineation of a new entity named COVID-19 associated pulmonary aspergillosis (CAPA). A predisposition to invasive infection caused by spp. in SARS-CoV-2 infected patients can be ascribed either to the direct viral-mediated damage of the respiratory epithelium, as already observed in influenza H1N1 virus infections, or to the dysregulated immunity associated with COVID-19. This narrative review focuses on the impact of immune impairment, particularly due to cytokine dysregulation caused by spp. superinfection in COVID-19 for a more in-depth understanding of the molecular pathways implicated in CAPA. As immune competence has proven to be essential in protecting against CAPA onset, a role already threatened by SARS-CoV-2 infection itself, preventive strategies should focus on reducing factors that could further target the host immune system. We also aimed to focus on well-known and less-known risk factors for IPA in COVID-19 patients, related to the main causes of immune suppression, both virus-mediated and iatrogenic, including treatments currently indicated for COVID-19. Lastly, possible preventive strategies aimed at reducing morbidity and mortality due to CAPA could be implemented.
在严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）大流行期间，2019冠状病毒病（COVID-19）患者侵袭性肺曲霉病的发病率较高，从而明确了一种名为COVID-19相关肺曲霉病（CAPA）的新实体。SARS-CoV-2感染患者中由曲霉属物种引起侵袭性感染的易感性，要么归因于呼吸道上皮的直接病毒介导损伤，正如在甲型H1N1流感病毒感染中已经观察到的那样，要么归因于与COVID-19相关的免疫失调。这篇叙述性综述聚焦于免疫损伤的影响，特别是由于COVID-19中曲霉属物种二重感染导致的细胞因子失调，以便更深入地了解CAPA中涉及的分子途径。由于免疫能力已被证明在预防CAPA发病中至关重要，而这一作用已受到SARS-CoV-2感染本身的威胁，预防策略应侧重于减少可能进一步靶向宿主免疫系统的因素。我们还旨在关注COVID-19患者侵袭性肺曲霉病（IPA）的已知和未知危险因素，这些因素与免疫抑制的主要原因有关，包括病毒介导和医源性的原因，其中包括目前针对COVID-19的治疗方法。最后，可以实施旨在降低CAPA所致发病率和死亡率的可能预防策略。
