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One for All and All for One: Multikingdom Interplay in Severe Viral Pneumonia

Summary

This editorial discusses how bacteria, viruses, and fungi interact in the lungs during severe pneumonia from COVID-19 or influenza. When mechanically ventilated patients with COVID-19 had bacterial infections detected, their immune systems released more inflammatory chemicals. However, the same pattern was not observed in influenza patients. Understanding how all these microorganisms work together may help doctors better treat these serious lung infections.

Background

The lung microbiome has been increasingly recognized as important in respiratory diseases. During the COVID-19 pandemic, fungal superinfections complicating viral disease have been observed, prompting research into host-virus-fungus interactions and virus-induced immune dysregulation.

Objective

This editorial discusses a new study investigating the multikingdom interplay and relevance of bacterial lung microbiota compositions in association with viral and fungal infections, immune response, and disease outcome in mechanically ventilated patients.

Results

Bacterial pathogen detection was more common in COVID-19 patients and predicted 90-day mortality in influenza but not COVID-19 patients. Aspergillosis was more common in influenza patients. Bacterial pathogen detection in COVID-19 was associated with increased proinflammatory cytokine release, but not in influenza patients.

Conclusion

Poor outcome in severe COVID-19 may be driven by hyperinflammation, while in severe influenza it may be driven by bacterial and/or fungal superinfection. A holistic multikingdom approach considering all microbiota is necessary for understanding severe viral pneumonia pathogenesis.
  • Published in:American Journal of Respiratory and Critical Care Medicine,
  • Study Type:Editorial/Review,
  • Source: PMID: 39078170, DOI: 10.1164/rccm.202406-1237ED
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