COVID-19 Cytokine Storm, Co-Infections, and Secondary Infections: Recent Information and Clinical Implications
COVID-19 Cytokine Storm, Co-Infections, and Secondary Infections: Recent Information and Clinical Implications
Ahmad Shahzaib1*, Tabish Raza2 and Aisha Areej2
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel respiratory infection that has caused the most recent epidemic of coronavirus disease 2019 (COVID-19). Although COVID-19 has a wide range of clinical manifestations, affecting many vital organs, the virus enters via the respiratory system, and the lungs are the leading site of the infection. The virus spreads primarily by respiratory droplets generated by coughing, sneezing, spitting, talking, singing, or breathing of infected people. COVID-19 infection has been linked to an intense cytokine storm (CS) and the immune-inflammatory mechanism that exacerbates disease symptoms and complications. Up to 20% of the infected people need hospitalization on account of the severity of the infection, while the rest of the patients are asymptomatic or have minor symptoms. In addition, many COVID-19 patients have co-infection or secondary infection, which exacerbate the disease. In general, it is believed that viral infections predispose patients to superinfections that have much worse consequences than the infection alone. Notably, the latest reports of high mucormycosis mortality and disease severity in India raise global concerns. Several studies have been reported that describe different levels of superinfections and disease severity in COVID-19 patients. Perhaps, there is just not enough data to distinguish between the worst outcomes of COVID-19 alone and coinfections, particularly when it comes to CS. Current clinical use of immunosuppressive therapies, including cytokine blockade, JAK, and IL-6 inhibition in severely ill COVID-19 patients, is associated with increased secondary infections. Therefore, the current review aims to collect literature on the incidence of COVID-19 co-infections and immune-inflammatory responses to such infections. A better understanding of immune-inflammatory markers of COVID-19-associated coinfections is vital to advance COVID-19 treatment and management protocols.
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