COVID-19 in patients with Pulmonary Alveolar Proteinosis A European multicenter study

Background: Interruption of GM-CSF signaling leads to Pulmonary Alveolar Proteinosis (PAP), occasionally to lung infections and relates to the impaired ability of lung macrophages to catabolize phagocytized surfactant and handle microbes. COVID-19 is associated with worse prognosis in lung disorders. We hypothesized that PAP patients would be at increased risk for COVID-19 and poor outcome. Aim and objectives: This multi-center, retrospective, European study aimed to investigate prevalence and clinical consequences of COVID-19 in PAP and the impact of iGM-CSF treatment on hospitalization or death. Method(s): All patients with PAP and COVID-19 diagnosed and followed-up in 11 referral European centers from January 24th 2020 to August 31st 2021 were included. Prevalence, clinical course and outcome were investigated. Result(s): COVID-19 developed in 34/255 (13.3%) of patients, mostly adults (91.2%), all with autoimmune (a)PAP;all patients were infected before the preventive option of vaccination was available;11 (35.5%) were hospitalized, of whom almost half were in the ICU;3 (27%) of hospitalized patients either died or underwent lung-transplant;these three patients had worse DLCO% predicted (p=0.019) and had more often arterial hypertension (AH) (p=0.012), and a smoking history (p=0.002). All patients with mild disease treated at home survived. Among children, 3 developed COVID-19 with good outcome. Conclusion(s): PAP patients experienced similar rates of COVID-19 with the general population but increased rates of hospitalizations and deaths, underscoring the vulnerability of this population and the necessity of preventive measures to avoid infection. If infected, secondary prophylaxis with monoclonal antibodies and the impact of iGM-CSF must be considered.

Reduced immunogenicity of the mRNA vaccine BNT162b2 in patients with IPF

Introduction: Immunocompromised individuals including solid organ transplants recipients present with blunted immune responses to two doses of SARS-CoV-2 mRNA vaccine. Studies have shown that patients with Idiopathic Pulmonary Fibrosis (IPF) present with disrupted cellular and humoral immune response. Aim and objectives: To investigate immune response following SARS-CoV-2 mRNA vaccine in patients with IPF. Method(s): We compared anti-SARS-CoV-2 antibodies three months after the second dose of the mRNA vaccine BNT162b2 in: 1) patients with IPF receiving antifibrotics, 2) patients with IPF under no treatment, 3) aged-matched controls. Result(s): Sixty-seven (n=67) subjects were included in the analysis (patients with IPF receiving antifibrotics: 32, patients with IPF under no treatment: 10, controls: 25). Groups were age and gender balanced. Both groups of patients with IPF whether receiving or not antifibrotic compounds exhibited similarly reduced levels of anti-SARSCoV- 2 antibodies after two doses of the mRNA vaccine BNT162b2 compared to general population [IPF/treatment: 666.1, (95%: 540.1 to 900.0) vs IPF/no treatment: 579.5 (95% CI: 232.4 to 4054.2) vs controls: 2118.6 (95% CI: 1248.3 to 4035.5), p=0.002]. The prevalence of anti-SARS-CoV-2 antibodies above the suggested cut-off threshold of 1000 AU/ml was 21.9%, 40% and 72% in the IPF/treatment, IPF/no treatment and control groups, respectively. Conclusion(s): Patients with IPF did not mount appreciable antispike antibody responses to two doses of the mRNA vaccine BNT162b2 compared to general population. National authorities should prioritize patients with IPF for booster doses.

Mortality of hospitalized COVID-19 patients that were residents of nursing homes

Introduction: During the COVID-19 pandemic many outbreaks in nursing homes were reported. Aim(s): To determine the clinical characteristics and outcomes of hospitalized COVID-19 patients previously living in nursing homes. Method(s): This prospective study collected and evaluated data related to demographics, comorbidities, laboratory findings and outcomes of hospitalized COVID-19 patients from 4 clinics in Greece. Result(s): 185 patients (74.1% female), median age of 85(IQR 77-90) years were recruited. 29.7% of patients died. Parameters that influenced the high mortality rate were older age, the presence of dementia and atrial fibrillation. Furthermore, delay admission, fever >=38oC, dyspnea, low lymphocytes, high neutrophils, elevated LDH and DDimers were reported. Cardiovascular events, acute kidney and liver injury were more frequent in the group of patients who did not survive (40%vs14.6%, p<0.001, 50.9%vs13.1%, p<0.001, and 18.2%vs1.5%,p<0.001 respectively). In cox regression analysis independent risk factors for fatal outcome were dementia [HR (95%CI):5.067(1.512-16.981),p=0.009] and cardiovascular events [HR(95%CI):2.709(1.191-6.165),p=0.018]. Conclusion(s): Mortality rate is high in COVID-19 patients, residents of nursing homes. Comorbidities with predominance dementia and cardiovascular diseases, specific laboratory findings and delayed hospital referral were the main aspects contributing to adverse outcomes.

A case of influenza A and COVID-19 co-infection in a patient with severe asthma Similarities and differences between the two viruses

A novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in an acute respiratory illness has been recently emerged to a pandemic. COVID-19 pandemic developed in a season when influenza was prevalent. Influenza is well known to cause respiratory infection with other respiratory pathogens, however, limited data exists concerning COVID-19 and influenza co-infection. Both viruses seem to share transmission characteristics and clinical manifestations. Asthma, on the other hand, a chronic inflammatory condition involving the airways seems to be a risk factor for severe COVID-19 illness. It is important for pulmonologists to be aware of such potential co-infections in order to be able to early recognize them and prevent disease progression and death. We report the case of a patient with severe asthma, receiving biologic treatment, with a history of a recent travel abroad, who presented co-infection of influenza A and SARS-COV-2, reviewing as well the literature concerning the similarities and differences between the two viruses.