Coronavirus & Fungi Coinfections – Part 2

Coronavirus infections make lungs more susceptible to mold infections.

The Covid-19 Coronavirus is a single stranded RNA virus with high levels of human infectivity and virulence (1). Covid 19 infections make the lung more susceptible to other lung infections of viruses, bacteria, and fungi by a number of mechanisms (2)including: 1) causing alveolo- interstitial lung lesions which make coinfections more likely (3), and 2) lowering levels of T lymphocytes, CD4+T, and CD8+T cells which play a major role in immunity (4).

COINFECTION WITH COVID 19 AND FUNGI COMMON

Preliminary research suggests that coinfection of Covid-19 and fungi is common and may be associated with higher mortality than either infection alone (2). Yang reported that 5 out of 52 (10%) Covid-19 patients had coinfection with molds including Aspergillus flavus, Aspergillus fumigatus, and Candida albicans (5).  Chen’s study of 99 Covid patients reported that 3 patients also had Candida alibcans infections, 1 had Candida glabrata, and 1 had Aspergillus flavus (6).

Coinfection of Covid-19 with the RNA virus influenza, is also common (7, 8), with 3 studies in Belgium and the Netherlands reporting Aspergillus coinfection in 18-23% of patients hospitalized in the ICU for influenza (9).

CORONAVIRUS INFECTION LINKED TO PARTICULATE POLLUTION IN AIR.

Exposure to indoor and outdoor air particulates and other air pollutants may increase human susceptibility to Covid-19, influenza and other respiratory viruses. Several studies in China and Italy have linked higher outdoor levels of fine particulates with higher rates of Covid-19 (10-12).

Good Nutrition may be helpful to reduce risk of Coronavirus and influenza.

Several studies have reported that good nutrition, including supplements of vitamins C and D and N-acetyl-cysteine may be useful in preventing Covid-19 and influenza infections and reducing mortality rates (13-15).

If you missed Part 1 of this 2 Part series please view it here.

Research and References:

1. Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. Journal of medical virology. 2020;92(4):418-23.

2. Gangneux JP, Bougnoux ME, Dannaoui E, Cornet M, Zahar JR. Invasive fungal diseases during COVID-19: We should be prepared. Journal de mycologie medicale. 2020:100971.

3. He F, Deng Y, Li W. Coronavirus disease 2019: What we know? Journal of medical virology. 2020.

4. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020.

5. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory medicine. 2020.

6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

7. Harish MM, Ruhatiya RS. Influenza H1N1 infection in immunocompromised host: A concise review. Lung India : official organ of Indian Chest Society. 2019;36(4):330-6.

8. Schauwvlieghe A, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. The Lancet Respiratory medicine. 2018;6(10):782-92.

9. Verweij PE, Bruggemann RJM, Wauters J, Rijnders BJA, Chiller T, van de Veerdonk F. Influenza coinfection: be(a)ware of invasive aspergillosis. Clin Infect Dis. 2019.

10. Zhu Y, Xie J, Huang F, Cao L. Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China. The Science of the total environment. 2020;727:138704.

11. Martelletti L, Martelletti P. Air Pollution and the Novel Covid-19 Disease: a Putative Disease Risk Factor. SN comprehensive clinical medicine. 2020:1-5.

12. Frontera A, Martin C, Vlachos K, Sgubin G. Regional air pollution persistence links to COVID-19 infection zoning. The Journal of infection. 2020.

13. Curtis L. More Research and Clinical Attention is Needed on Nutrition to Prevent Influenza Incidence and Mortality- In Press. Eur J Intern Med. 2020;In Press:1-4.

14. Rhodes JM, Subramanian S, Laird E, Anne Kenny R. Editorial: low population mortality from COVID-19 in countries south of latitude 35 degrees North – supports vitamin D as a factor determining severity. Aliment Pharmacol Ther. 2020.

15. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020;12(4).