ABSTRACT
BACKGROUND: Inborn errors of immunity manifest with a greater susceptibility to infections, autoimmunity, autoinflammatory diseases, allergies, or malignancies. One of these is the mendelian susceptibility to mycobacterial disease. The most frequent etiology is the complete autosomal recessive deficiency of the ß1 subunit of the interleukin 12 receptor. CASE REPORT: A female patient who, by the age of six months, started with a nodular lesion in the right shoulder and ipsilateral axillary adenitis after the bacillus Calmette-Guérin vaccine was applied. Later, she developed a cutaneous fistula in the anterior thorax, the inframammary region, and chronic recidivant suppurative lymphadenitis. A disseminated infection caused by Mycobacterium bovis was diagnosed, therefore, individualized pharmacological treatment was required due to failure with the primary treatment. The patient was diagnosed with deficiency in the ß1 subunit of the interleukin 12 receptor at age six. During her last hospitalization, she presented fever, cough, and tachypnea, and SARS-CoV-2 was detected by quantitative polymerase chain reaction. The patient has had a favorable evolution. CONCLUSION: In patients with disseminated infections caused by bacillus Calmette-Guérin vaccination or by environmental mycobacteria, there should be suspicion of an inborn error of immunity and the patient should be referred to a third level hospital for an early immunological assessment.
Antecedentes: Los errores innatos de la inmunidad se manifiestan con una mayor susceptibilidad a infecciones, autoinmunidad, enfermedades autoinflamatorias, alergia o malignidad. Uno de estos es la susceptibilidad mendeliana a infecciones micobacterianas. La etiología más frecuente es la deficiencia completa autosómica recesiva de la subunidad ß1 del receptor de interleucina 12. Caso clínico: Paciente que comenzó a los seis meses de edad con una lesión nodular en hombro derecho y adenitis axilar ipsolateral posterior a la vacuna con bacilo de Calmette-Guérin. Posteriormente desarrolló una fistula cutánea en tórax anterior, región inframamaria y linfadenitis supurativa crónica recidivante. Se diagnosticó infección diseminada por Mycobacterium bovis, por lo que requirió tratamiento farmacológico individualizado debido al fracaso con el tratamiento primario. La paciente fue diagnosticada con deficiencia de la subunidad ß1 del receptor de interleucina 12 a los seis años. Durante su última hospitalización presentó fiebre, tos y taquipnea, detectándose SARS-CoV-2 por reacción en cadena de la polimerasa cuantitativa. La paciente evolucionó favorablemente. Conclusión: En los pacientes con infecciones diseminadas por la vacuna con bacilo de Calmette-Guérin o micobacterias ambientales, debe sospecharse un error innato de la inmunidad y derivarlos a tercer nivel de atención para la evaluación inmunológica temprana.
Subject(s)
BCG Vaccine/adverse effects , COVID-19/complications , Interleukin-12 Subunit p40/deficiency , Mycobacterium bovis/pathogenicity , SARS-CoV-2 , Tuberculosis/etiology , Candidiasis, Oral/complications , Child , Coinfection , Cutaneous Fistula/etiology , Female , Genetic Predisposition to Disease , Humans , Immunocompromised Host , Interleukin-12 Subunit p40/genetics , Tuberculosis, Lymph Node/etiology , Vasculitis, Leukocytoclastic, Cutaneous/complicationsABSTRACT
In this paper we propose a theoretical model including a susceptible-infected-recovered-dead (SIRD) model of epidemic in a dynamic macroeconomic general equilibrium framework with agents' mobility. The latter affect both their income (and consumption) and their probability of infecting and of being infected. Strategic complementarities among individual mobility choices drive the evolution of aggregate economic activity, while infection externalities caused by individual mobility affect disease diffusion. Rational expectations of forward looking agents on the dynamics of aggregate mobility and epidemic determine individual mobility decisions. The model allows to evaluate alternative scenarios of mobility restrictions, especially policies dependent on the state of epidemic. We prove the existence of an equilibrium and provide a recursive construction method for finding equilibrium(a), which also guides our numerical investigations. We calibrate the model by using Italian experience on COVID-19 epidemic in the period February 2020 - May 2021. We discuss how our economic SIRD (ESIRD) model produces a substantially different dynamics of economy and epidemic with respect to a SIRD model with constant agents' mobility. Finally, by numerical explorations we illustrate how the model can be used to design an efficient policy of state-of-epidemic-dependent mobility restrictions, which mitigates the epidemic peaks stressing health system, and allows for trading-off the economic losses due to reduced mobility with the lower death rate due to the lower spread of epidemic.
Subject(s)
COVID-19 , Cutaneous Fistula , Brain Death , DeathABSTRACT
Background: International population mobility is a significant challenge for the management of the coronavirus (COVID-19) pandemic. The suspension of flights and other traffic has been adopted to avoid more cases of imported infection by many countries, but these measures mean that most migrant populations, including immigrants, migrant and seasonal workers, international students, and others, have to stay in their host places. Therefore, equitable access to health services in the host places is crucial for them. Immigrant-receiving areas may encounter a dilemma when considering whether to extend health coverage of COVID-19 testing and treatment to immigrants. In this context, it is vital to understand public attitudes towards this issue since they explain and validate the policy responses. Methods: The data used in this study came from an survey conducted in March 2020. The survey targeted adults aged 18 and older who were local residents of nine cities in Guangdong province, China. The sample size was 1,040, and STATA 15.0 was used in the statistical analysis.Results: The results show that individuals with higher health security ratings, lower demand for health services, and greater concern about the risk of infectious diseases are more supportive of extending health services to immigrants. In addition, individuals who rate immigrants’ home place as more immigrant-friendly are also more supportive of it.Conclusions: Public support for health coverage for immigrants in the COVID-19 Pandemic is influenced by infection externalities and impression of immigrants’ home countries. This study attempts to contribute to the body of literature related to welfare attitudes and immigration. It also outlines a series of crucial implications for the global task of managing COVID-19.