Wang Jiayin, Ji Xufeng, Yang Chun, Xu Jiancheng
Department of Laboratory, The First Hospital of Jilin University, Changchun, China.
Center of Infectious Diseases and Pathogen Biology, The First Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2025 May 9;104(19):e42363. doi: 10.1097/MD.0000000000042363.
The incidence rate of COVID-19-associated pulmonary aspergillosis (CAPA) is rising. However, the pathogenesis of CAPA remains unclear. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection disrupts pathways related to type I interferon and Toll-like receptors, key components in innate immunity, thereby elevating the incidence of CAPA. Additionally, SARS-CoV-2 infection results in T and B cell functional deficiencies or exhaustion within adaptive immunity, weakening the defense against invasive Aspergillus. Furthermore, SARS-CoV-2 infection enhances the replication of cytomegalovirus and alters the gut microbiota, factors that may aid in diagnosing CAPA. Immunosuppressive therapy in COVID-19 patients is also believed to heighten the risk of invasive aspergillosis. Therefore, this review, examines the immune response to SARS-CoV-2 infection combined with invasive aspergillosis, and explores the pathogenesis and susceptibility factors of CAPA. We propose that variations in an individual's immune response significantly determine susceptibility to CAPA. The aim of this paper is to deepen clinical understanding of CAPA's pathogenesis, thereby aiding in mitigating susceptibility risk and advancing novel treatment approaches.
新型冠状病毒肺炎相关肺曲霉病（CAPA）的发病率正在上升。然而，CAPA的发病机制仍不清楚。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染会破坏与I型干扰素和Toll样受体相关的途径，这些是固有免疫的关键组成部分，从而提高了CAPA的发病率。此外，SARS-CoV-2感染会导致适应性免疫中T细胞和B细胞功能缺陷或耗竭，削弱对侵袭性曲霉菌的防御能力。此外，SARS-CoV-2感染会增强巨细胞病毒的复制并改变肠道微生物群，这些因素可能有助于CAPA的诊断。COVID-19患者的免疫抑制治疗也被认为会增加侵袭性曲霉病的风险。因此，本综述研究了对SARS-CoV-2感染合并侵袭性曲霉病的免疫反应，并探讨了CAPA的发病机制和易感因素。我们认为个体免疫反应的差异显著决定了对CAPA的易感性。本文的目的是加深临床对CAPA发病机制的理解，从而有助于降低易感性风险并推进新的治疗方法。
