immunological response to covid-19 and its role as a predisposing factor in invasive aspergillosis

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.