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A Pathophysiological Perspective on COVID-19's Lethal Complication: From Viremia to Hypersensitivity Pneumonitis-like Immune Dysregulation

Infection & Chemotherapy 2020년 52권 3호 p.335 ~ 344
Sanchez-Gonzalez Marcos A., Moskowitz Dave, Issuree Priya D., Yatzkan George, Rizvi Syed A. A., Day Kenneth,
소속 상세정보
 ( Sanchez-Gonzalez Marcos A. ) - Larkin Health System Division of Clinical and Translational Research
 ( Moskowitz Dave ) - GenoMed
 ( Issuree Priya D. ) - University of Iowa Roy J. and Lucille A. Carver College of Medicine Inflammation Program
 ( Yatzkan George ) - Larkin Health System Intensive and Critical Care Unit
 ( Rizvi Syed A. A. ) - Larkin Health System Division of Clinical and Translational Research
 ( Day Kenneth ) - Zymo Research Corporation

Abstract


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus responsible for our recent coronavirus disease 2019 pandemic, is driving a lung immunopathology that strongly resembles a severe form of hypersensitivity pneumonitis (HP). A review of recent Severe acute respiratory syndrome-related coronavirus (SARS-CoV) and SARS-CoV-2 medical reports, as well as described characteristics of HP, lead us to postulate a theory for SARS-CoV-2 severe disease. We propose that the novel SARS-CoV-2 can act as a trigger and substrate of an HP-like severe immune reaction especially in genetically vulnerable individuals in addition to those with immune senescence and dysregulation. Accordingly, the purpose of our letter is to shift the emphasis of concern surrounding immune activity from viral infection to an HP-like severe immune reaction. We review similarities in disease presentation between infection and allergy, relevant immunopathology, and outline phases of SARS-CoV-2 disease with perspectives on therapy and critical care. Altogether, the favored course is to begin treatments that address the disease at the earliest phase before immune dysregulation leading to uncontrolled pulmonary inflammation.

키워드

Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus 2; Hypersensitivity pneumonitis; Genetic Susceptibility; Immune Dysregulation

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