Please use this identifier to cite or link to this item: https://hdl.handle.net/1822/65814

TitleCOVID-19 Associated Pulmonary Aspergillosis (CAPA)—From immunology to treatment
Author(s)Arastehfar, Amir
Carvalho, Agostinho
van de Veerdonk, Frank L.
Jenks, Jeffrey D.
Koehler, Philipp
Krause, Robert
Cornely, Oliver A.
S. Perlin, David
Lass-Flörl, Cornelia
Hoenigl, Martin
KeywordsSARS-COV-2
Aspergillus
novel coronavirus
superinfection
co-infection
risk factors
prevalence
challenges
immune response
expert statement
European Confederation of Medical Mycology
COVID-19
Issue date24-Jun-2020
PublisherMultidisciplinary Digital Publishing Institute
JournalJournal of Fungi
CitationArastehfar, A.; Carvalho, A.; van de Veerdonk, F.L.; Jenks, J.D.; Koehler, P.; Krause, R.; Cornely, O.A.; S. Perlin, D.; Lass-Flörl, C.; Hoenigl, M., on behalf of the ECMM Working Group Immunologic Markers for Treatment Monitoring and Diagnosis in Invasive Mold Infection; COVID-19 Associated Pulmonary Aspergillosis (CAPA)—From Immunology to Treatment. J. Fungi 2020, 6, 91.
Abstract(s)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.
TypeArticle
URIhttps://hdl.handle.net/1822/65814
DOI10.3390/jof6020091
e-ISSN2309-608X
Publisher versionhttps://www.mdpi.com/2309-608X/6/2/91
Peer-Reviewedyes
AccessOpen access
Appears in Collections:ICVS - Artigos em revistas internacionais / Papers in international journals

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