Universität zu Köln

Arastehfar, Amir, Carvalho, Agostinho ORCID: 0000-0001-8935-8030, van de Veerdonk, Frank L., Jenks, Jeffrey D., Koehler, Philipp ORCID: 0000-0002-7386-7495, Krause, Robert, Cornely, Oliver A., Perlin, David S., Lass-Floerl, Cornelia and Hoenigl, Martin ORCID: 0000-0002-1653-2824 (2020). COVID-19 Associated Pulmonary Aspergillosis (CAPA)-From Immunology to Treatment. J. Fungi, 6 (2). BASEL: MDPI. ISSN 2309-608X

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Abstract

Like severe influenza, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome (ARDS) has emerged as an important disease that predisposes patients to secondary pulmonary aspergillosis, with 35 cases of COVID-19 associated pulmonary aspergillosis (CAPA) published until June 2020. The release of danger-associated molecular patterns during severe COVID-19 results in both pulmonary epithelial damage and inflammatory disease, which are predisposing risk factors for pulmonary aspergillosis. Moreover, collateral effects of host recognition pathways required for the activation of antiviral immunity may, paradoxically, contribute to a highly permissive inflammatory environment that favors fungal pathogenesis. Diagnosis of CAPA remains challenging, mainly because bronchoalveolar lavage fluid galactomannan testing and culture, which represent the most sensitive diagnostic tests for aspergillosis in the ICU, are hindered by the fact that bronchoscopies are rarely performed in COVID-19 patients due to the risk of disease transmission. Similarly, autopsies are rarely performed, which may result in an underestimation of the prevalence of CAPA. Finally, the treatment of CAPA is complicated by drug-drug interactions associated with broad spectrum azoles, renal tropism and damage caused by SARS-CoV-2, which may challenge the use of liposomal amphotericin B, as well as the emergence of azole-resistance. This clinical reality creates an urgency for new antifungal drugs currently in advanced clinical development with more promising pharmacokinetic and pharmacodynamic profiles.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Arastehfar, Amir UNSPECIFIED UNSPECIFIED UNSPECIFIED Carvalho, Agostinho UNSPECIFIED orcid.org/0000-0001-8935-8030 UNSPECIFIED van de Veerdonk, Frank L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jenks, Jeffrey D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehler, Philipp UNSPECIFIED orcid.org/0000-0002-7386-7495 UNSPECIFIED Krause, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Perlin, David S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lass-Floerl, Cornelia UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoenigl, Martin UNSPECIFIED orcid.org/0000-0002-1653-2824 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-331229
DOI:	10.3390/jof6020091
Journal or Publication Title:	J. Fungi
Volume:	6
Number:	2
Date:	2020
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2309-608X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL; INVASIVE ASPERGILLOSIS; DIAGNOSIS; DISEASE; SUSCEPTIBILITY; INFLAMMATION; INFECTIONS; SPECTRUM; MICE Multiple languages Microbiology; Mycology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33122