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Med (N Y) ; 2(10): 1163-1170.e2, 2021 Oct 08.
Article in English | MEDLINE | ID: covidwho-1433668


Background: Prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding has been described in immunocompromised coronavirus disease 2019 (COVID-19) patients, resulting in protracted disease and poor outcome. Specific therapy to improve viral clearance and outcome for this group of patients is currently unavailable. Methods: Five critically ill COVID-19 patients with severe defects in cellular immune responses, high SARS-CoV-2 viral RNA loads, and no respiratory improvement were treated with interferon gamma, 100 µg subcutaneously, thrice weekly. Bronchial secretion was collected every 48 h for routine diagnostic SARS-CoV-2 RT-PCR and viral culture. Findings: Interferon gamma administration was followed by a rapid decline in SARS-CoV-2 load and a positive-to-negative viral culture conversion. Four patients recovered, and no signs of hyperinflammation were observed. Conclusions: Interferon gamma may be considered as adjuvant immunotherapy in a subset of immunocompromised COVID-19 patients. Funding: A.v.L. and R.v.C. are supported by National Institutes of Health (R01AI145781). G.J.O. and R.P.v.R. are supported by a VICI grant (016.VICI.170.090) from the Dutch Research Council (NWO). W.F.A. is supported by a clinical fellowship grant (9071561) of Netherlands Organization for Health Research and Development. M.G.N. is supported by an ERC advanced grant (833247) and a Spinoza grant of the Netherlands Organization for Scientific Research.

Neurology ; 97(11): 557, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1406738
Neurology ; 96(10): e1437-e1442, 2021 03 09.
Article in English | MEDLINE | ID: covidwho-1027729


OBJECTIVE: We report a case series of patients with prolonged but reversible unconsciousness after coronavirus disease 2019 (COVID-19)-related severe respiratory failure. METHODS: A case series of patients who were admitted to the intensive care unit due to COVID-19-related acute respiratory failure is described. RESULTS: After cessation of sedatives, the described cases all showed a prolonged comatose state. Diagnostic neurologic workup did not show signs of devastating brain injury. The clinical pattern of awakening started with early eye opening without obeying commands and persistent flaccid weakness in all cases. Time between cessation of sedatives to the first moment of being fully responsive with obeying commands ranged from 8 to 31 days. CONCLUSION: Prolonged unconsciousness in patients with severe respiratory failure due to COVID-19 can be fully reversible, warranting a cautious approach for prognostication based on a prolonged state of unconsciousness.

COVID-19/complications , Coma/etiology , Respiratory Insufficiency/complications , Adult , Aged , Coma/diagnostic imaging , Coma/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Respiratory Insufficiency/etiology , Time Factors , Treatment Outcome , White Matter/diagnostic imaging , White Matter/pathology