ABSTRACT
Purpose - to analyze the currently described variants of the course of COVID-19 in immunocompromised patients in order to inform the medical community and focus on this problem. Two clinical cases of different course of COVID-19 in patients with primary immunodeficiencies, both mild, asymptomatic and severe, with a fatal outcome, are presented. In the first case, in a child with Nijmegen breakage syndrome, despite lymphopenia, the course of SARS-CoV-2 was asymptomatic, which may be due to the regular administration of immunoglobulin for replacement purposes. The peculiarity of the second case was a repeated episode of COVID-19 in an immunocompromised child with APECED. The first episode of COVID-19 in September 2020 had a mild course, but led to the manifestation of immunodeficiency symptoms. The present symptoms (retinopathy, hepatitis), except for mild mucosal candidiasis, are not part of the triad of classic APECED symptoms, although along with the reaction to the live vaccine, they made it possible to suspect immunodeficiency. Immunosuppressive therapy contributed to stabilization of hepatitis, but ocular symptoms were without positive dynamics. The second episode of COVID-19 was observed in January 2022. It proceeded with prolonged fever for 2 weeks, which was resistant to treatment, with progressive cytopenia, hypoproteinemia, hypoalbuminemia, signs of active hepatitis, hyperferritinemia, elevated triglycerides;coagulopathy with low fibrinogen levels. Subsequently, signs of pneumonia were added, confirmed by radiology. Another feature of this case was the presence of a mixed infection - COVID-19 and Epstein-Barr virus infection. The cause of death in this case was not only COVID-19 pneumonia, but also progressive macrophage activation syndrome. Conclusions. Thus, the sequence of COVID-19 in patients with inborn errors of immunity can be either asymptomatic and mild or fatal, depending on the type of immune disorders, the therapy received, and concomitant conditions. SARS-CoV-2 in immunocompromised individuals requires close attention for timely diagnosis of life-threatening conditions. © 2022 Group of Companies Med Expert, LLC. All rights reserved.
ABSTRACT
Early diagnosis and timely treatment of combined immunodeficiency (CID) is extremely important for the child's future life. At birth, children often have no specific signs of the disease, Put from the first months of life CID manifests Py severe infections that can impact on the results of further treatment. Detection of T-cell lymphopenia by determining the number of T-cell receptor excision circles (TRECs) in a dry spot after the birth of a child formed the basis for newborn screening for severe CID. KREC (kappa-deleting recombination excision circle) assay is used for detection of B-cell lymphopenia. Clinical case. We report the first case of CID (T-B+NK+) suspected by detection of TREC in Ukraine in a 2.5-month-old child. Immunodeficiency was manifested by severe complicated pneumonia at the age of 2 months, which had an atypical course and was resistant to treatment. A screening study to detect T- and B-lymphopenia using the TREC/KREC assay twice showed a zero TREC value and a KREC number of 3.12×105per 106cells, indicating severe CID. Subsequent immunological studies confirmed the deficiency of T-cell immunity. Venous thrombosis and increasing multiorgan failure led to the death of the child. Thus, newborn screening using TREC assay will allow the timely detection of severe combined immunodeficiencies with further adequate therapy and measures to prevent life-threatening infections, including SARS-CoV-2. The research carried out in accordance with the principle of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. © 2022 by the Author(s).
ABSTRACT
Predisposition to venous thromboembolism is characteristic of SARS-CoV-2 infection, as thromboinflammation is one of the leading parts in the pathogenesis of COVID-19 and the cause of life-threatening conditions and death. We presented a clinical case of hepatic vein thrombosis in a 1-year-9-month-old girl with COVID-19 who met the MIS-C criteria. The girl was admitted to the hospital on the first day of the disease with complaints of repeated vomiting, fever up to 38.5-39°C, severe weakness, refusal to eat and drink, a slight cough. The severity of the patient's condition was due to fever and intoxication syndrome. There were manifestations of acute pharyngitis. In the first days we observed leukocytosis with neutrophilia, moderate lymphopenia, elevated levels of C-reactive protein, hypoalbuminemia, accelerated ESR. On admissiona rapid antigen test and PCR for SARS-CoV-2 were negative. Abdominal ultrasound revealed microthrombosis of the hepatic veins with inflammatory changes in the vessels, a small amount of free fluid in the abdominal cavity. Echocardiography detected the presence of fluid in the pericardial cavity. The level of D-dimer was increased to 943 ng/ml. Subsequently, COVID-19 was confirmed by serological testing. Conclusions. Thus, thrombosis of the veins of the internal organs, despite their rarity in childhood, can occur in COVID-19 and MIS-C and indicate thromboinflammation, which requires caution about their possible development and the correct diagnostic algorithm. Determination of the level of D-dimer and Doppler ultrasound examination of the abdominal cavity allows the diagnosis of thrombotic events in splanchnic organs in patients with COVID-19 and provide adequate treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. © 2022 Modern Pediatrics. Ukraine. All rights reserved.
ABSTRACT
Painful throat is the main symptom of pharyngitis and one of the most common reasons to refer to a primary care physician. In 60.0-70.0% of cases acute pharyngitis is caused by viruses, including rhinoviruses, adenoviruses, enteroviruses, coronaviruses and others. More then about 5.0-15.0% of pharyngitis cases in adults and around 20.0-30.0% of cases in children are caused by bacterial infections, among which group A p hemolytic Streptococcus. Among other causative agents of bacterial pharyngitis, group C and group G Streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus are also reported, although much less frequently. Severe group A