Immunological response to COVID-19 and its role as a predisposing factor in invasive aspergillosis

Mohammad   Mohammadi; Mahin   Tavakoli; Tahereh  Shokohi; Cornelia   Lass-Flörl; Mohammad Taghi   Hedayati; Martin  Hoenigl

doi:10.18502/cmm.6.4.5442

Mohammad Mohammadi
Mahin Tavakoli Invasive Fungi Research Center, Communicable Diseases Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
Tahereh Shokohi Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Cornelia Lass-Flörl Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
Mohammad Taghi Hedayati Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Martin Hoenigl Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, California

DOI: https://doi.org/10.18502/cmm.6.4.5442

Keywords: Aspergillosis Aspergillus fumigatus Immune responses SARS-CoV-2

Abstract

The world is involved with a pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The clinical manifestations of reported COVID-19-associated pulmonary impairments range from asymptomatic infections to a pneumonia-induced acute respiratory distress syndrome that requires mechanical ventilation. Fungal superinfections complicating the clinical course remain underexplored. Angiotensin-converting enzyme 2, the receptor for COVID-19 that is mainly expressed in airway epithelia and lung parenchyma, is considered an important regulator of innate immunity. With regard to the viral-cell interaction, imbalanced immune regulation between protective and altered responses caused by the exacerbation of inflammatory responses should be considered a major contributor to secondary pulmonary aspergillosis. In addition, the complex inherited factors, age-related changes, and lifestyle may also affect immune responses. The complication and persistence of invasive aspergillosis have been well described in patients with severe influenza or COVID-19. However, there is a scarcity of information about the immunological mechanisms predisposing patients with COVID-19 to fungal co-infections. Therefore, this study was conducted to investigate the aforementioned domain.