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[Preprint]. 2021 Apr 23:rs.3.rs-380803. [Version 1] doi: 10.21203/rs.3.rs-380803/v1

Figure 7: Mechanistic hypothesis of secondary bacterial pneumonia susceptibility in patients with COVID-19.

Figure 7:

Individual immune responses to SARS-CoV-2 infection drive a restructuring of the microbial community and increase susceptibility to VAP. Those predisposed to VAP have increased type I interferon responses and dysregulated antibacterial immune signaling characterized by impaired macrophage, neutrophil and T cell activity, decreased TLR signaling and impaired activation of key cytokines important for pathogen defense including IL-1, IL-6, IL-8, TNF, and IL-17. This state of suppressed immunity disrupts the lower respiratory tract microbiome, predisposing to outgrowth of bacterial pathogens and VAP.