COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion

Frank L. van de Veerdonk, Roger J.M. Brüggemann, Shoko Vos, Gert De Hertogh, Joost Wauters, Monique H.E. Reijers, Mihai G. Netea, Jeroen A. Schouten, Paul E. Verweij

Onderzoeksoutput: Bijdrage aan tijdschriftArtikel recenserenpeer review

51 Citaten (Scopus)


Invasive pulmonary aspergillosis is emerging as a secondary infection in patients with COVID-19, which can present as alveolar disease, airway disease (ie, invasive Aspergillus tracheobronchitis), or both. Histopathology of invasive Aspergillus tracheobronchitis in patients with severe COVID-19 confirms tracheal ulcers with tissue invasion of Aspergillus hyphae but without angioinvasion, which differs from patients with severe influenza, where early angioinvasion is observed. We argue that aggregation of predisposing factors (eg, factors that are defined by the European Organisation for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium or genetic polymorphisms), viral factors (eg, tropism and lytic effects), immune defence factors, and effects of concomitant therapies will determine whether and when the angioinvasion threshold is reached. Management of invasive Aspergillus tracheobronchitis should include reducing viral lytic effects, rebalancing immune dysregulation, and systemic and local antifungal therapy. Future study designs should involve approaches that aim to develop improved diagnostics for tissue invasion and airways involvement and identify the immune status of the patient to guide personalised immunotherapy.

Originele taal-2Engels
Pagina's (van-tot)795-802
Aantal pagina's8
TijdschriftThe Lancet Respiratory Medicine
Nummer van het tijdschrift7
StatusGepubliceerd - jul. 2021
Extern gepubliceerdJa


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