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1.
BMJ Case Rep ; 14(3)2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1150215

ABSTRACT

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.


Subject(s)
Brain Diseases/etiology , Seizures/etiology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/therapeutic use , Anticonvulsants/therapeutic use , Antiviral Agents/therapeutic use , Brain Diseases/diagnosis , Brain Diseases/therapy , /therapy , Confusion/complications , Humans , Immunization, Passive/methods , Magnetic Resonance Imaging/methods , Male , Polymerase Chain Reaction , Radiography/methods , Seizures/therapy , Treatment Outcome
4.
Medicina (Kaunas) ; 57(3)2021 Mar 11.
Article in English | MEDLINE | ID: covidwho-1124742

ABSTRACT

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.


Subject(s)
/therapy , Adult , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , C-Reactive Protein/metabolism , /physiopathology , Critical Illness , Glucocorticoids/therapeutic use , Humans , Immunization, Passive/methods , Interleukin-6/blood , Leukocyte Count , Male , Middle Aged , Pilot Projects , Romania , Treatment Outcome
5.
PLoS Med ; 18(3): e1003415, 2021 03.
Article in English | MEDLINE | ID: covidwho-1115283

ABSTRACT

BACKGROUND: Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. METHODS AND FINDINGS: The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. CONCLUSIONS: In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. TRIAL REGISTRATION: NCT04375098.


Subject(s)
/therapy , Early Medical Intervention/methods , Time-to-Treatment , Adult , Aged , Aged, 80 and over , /mortality , Chile , Disease Progression , Early Medical Intervention/statistics & numerical data , Female , Hospital Mortality , Humans , Immunization, Passive/methods , Immunization, Passive/mortality , Length of Stay/statistics & numerical data , Male , Middle Aged , Mortality , Respiration, Artificial/mortality , Respiration, Artificial/statistics & numerical data , Time-to-Treatment/standards , Treatment Outcome
6.
mBio ; 12(2)2021 03 02.
Article in English | MEDLINE | ID: covidwho-1115097

ABSTRACT

Antibody therapies such as convalescent plasma and monoclonal antibodies have emerged as major potential therapeutics for coronavirus disease 2019 (COVID-19). Immunoglobulins differ from conventional antimicrobial agents in that they mediate direct and indirect antimicrobial effects that work in concert with other components of the immune system. The field of infectious diseases pioneered antibody therapies in the first half of the 20th century but largely abandoned them with the arrival of conventional antimicrobial therapy. Consequently, much of the knowledge gained from the historical development and use of immunoglobulins such as serum and convalescent antibody therapies was forgotten; principles and practice governing their use were not taught to new generations of medical practitioners, and further development of this modality stalled. This became apparent during the COVID-19 pandemic in the spring of 2020 when convalescent plasma was initially deployed as salvage therapy in patients with severe disease. In retrospect, this was a stage of disease when it was less likely to be effective. Lessons of the past tell us that antibody therapy is most likely to be effective when used early in respiratory diseases. This article puts forth three principles of antibody therapy, namely, specificity, temporal, and quantitative principles, connoting that antibody efficacy requires the administration of specific antibody, given early in course of disease in sufficient amount. These principles are traced to the history of serum therapy for infectious diseases. The application of the specificity, temporal, and quantitative principles to COVID-19 is discussed in the context of current use of antibody therapy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).


Subject(s)
/therapy , Antibodies, Viral/immunology , /prevention & control , Humans , Immunization, Passive/methods , Pandemics
7.
J Immunol Res ; 2021: 6680337, 2021.
Article in English | MEDLINE | ID: covidwho-1109683

ABSTRACT

COVID-19 is a pandemic caused by SARS-CoV-2. In Chile, half a million people have been infected and more than 16,000 have died from COVID-19. As part of the clinical trial NCT04384588, we quantified IgG against S1-RBD of SARS-CoV-2 (anti-RBD) in recovered people in Santiago and evaluated their suitability as COVID-19 convalescent plasma donors. ELISA and a luminescent SARS-CoV-2 pseudotype were used for IgG and neutralizing antibody quantification. 72.9% of the convalescent population (468 of 639) showed seroconversion (5-55 µg/mL anti-RBD IgG) and were suitable candidates for plasma donation. Analysis by gender, age, and days after symptom offset did not show significant differences. Neutralizing activity correlated with an increased concentration of anti-RBD IgG (p < 0.0001) and showed a high variability between donors. We confirmed that the majority of the Chilean patients have developed anti-SARS-CoV-2 antibodies. The quantification of anti-RBD IgG in convalescent plasma donors is necessary to increase the detection of neutralizing antibodies.


Subject(s)
/immunology , /physiology , Spike Glycoprotein, Coronavirus/immunology , Adolescent , Adult , Antibodies, Neutralizing/blood , Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/blood , Antibodies, Viral/therapeutic use , Chile , Female , Humans , Immunization, Passive/methods , Immunoglobulin G/blood , Male , Middle Aged , Pandemics , Seroconversion , Young Adult
8.
Virology ; 557: 70-85, 2021 05.
Article in English | MEDLINE | ID: covidwho-1108783

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged into the human population in late 2019 and caused the global COVID-19 pandemic. SARS-CoV-2 has spread to more than 215 countries and infected many millions of people. Despite the introduction of numerous governmental and public health measures to control disease spread, infections continue at an unabated pace, suggesting that effective vaccines and antiviral drugs will be required to curtail disease, end the pandemic, and restore societal norms. Here, we review the current developments in antibody and vaccine countermeasures to limit or prevent disease.


Subject(s)
Antibodies, Viral/biosynthesis , /prevention & control , Pandemics , /immunology , Animals , /immunology , /virology , /biosynthesis , Clinical Trials as Topic , Disease Models, Animal , Genetic Vectors/chemistry , Genetic Vectors/immunology , Humans , Immunity, Innate/drug effects , Immunization, Passive/methods , Immunogenicity, Vaccine , Patient Safety , /pathogenicity , Vaccines, Attenuated , Vaccines, DNA , Vaccines, Subunit , Vaccines, Virus-Like Particle/administration & dosage , Vaccines, Virus-Like Particle/biosynthesis , Vaccines, Virus-Like Particle/immunology
9.
Cell Rep ; 34(10): 108837, 2021 03 09.
Article in English | MEDLINE | ID: covidwho-1095904

ABSTRACT

Passive transfer of convalescent plasma or serum is a time-honored strategy for treating infectious diseases. Human convalescent plasma containing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently being used to treat patients with coronavirus disease 2019 where clinical efficacy trials are ongoing. Here, we assess therapeutic passive transfer in groups of SARS-CoV-2-infected African green monkeys with convalescent sera containing either high or low anti-SARS-CoV-2 neutralizing antibody titers. Differences in viral load and pathology are minimal between monkeys that receive the lower titer convalescent sera and untreated controls. However, lower levels of SARS-CoV-2 in respiratory compartments, reduced severity of virus-associated lung pathology, and reductions in coagulopathy and inflammatory processes are observed in monkeys that receive high titer sera versus untreated controls. Our data indicate that convalescent plasma therapy in humans may be an effective strategy provided that donor sera contain high anti-SARS-CoV-2 neutralizing titers given in early stages of the disease.


Subject(s)
/therapy , Primate Diseases/therapy , Primate Diseases/virology , /immunology , Animals , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , /virology , Chlorocebus aethiops/immunology , Female , Immunization, Passive/methods , Immunization, Passive/veterinary , Male , Primate Diseases/immunology , Primates/immunology , Viral Load
10.
Curr Opin Pulm Med ; 27(3): 169-175, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1091192

ABSTRACT

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) is an acute multisystem disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Investigations are ongoing in the search for effective therapeutics, with clinical approaches evolving based upon such evidence. RECENT FINDINGS: The antiviral agent, remdesivir, and the immunomodulator, dexamethasone, are the first therapeutics for which there is evidence of efficacy from randomized trials. Subgroup analyses suggest remdesivir is beneficial in hospitalized patients whose severity of illness falls at the lower end of the spectrum, while dexamethasone is more beneficial in hospitalized patients whose severity of illness falls at the higher end of the spectrum. We recommend that inpatients who require supplemental oxygen but are not mechanically ventilated receive both remdesivir and dexamethasone, and inpatients who require mechanical ventilation receive dexamethasone monotherapy. Additional evidence regarding anti-SARS-CoV-2 antibodies, convalescent plasma, and a variety of antiinterleukin therapies is forthcoming. SUMMARY: The body of evidence related to COVID-19 therapeutics continues to evolve and, as a result, management is likely to change with time. As new evidence is generated and published, the optimal approach to managing patients with COVID-19 should be reconsidered.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Dexamethasone/pharmacology , Respiration, Artificial/methods , Adenosine Monophosphate/pharmacology , Alanine/pharmacology , Antiviral Agents/pharmacology , Humans , Immunization, Passive/methods , Immunologic Factors/pharmacology , Patient Selection , /drug effects
11.
Clin J Oncol Nurs ; 25(1): 28-32, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1082805

ABSTRACT

Convalescent plasma has emerged as a treatment that merits consideration for COVID-19-positive patients requiring hospitalization. With millions of cases of COVID-19 being reported worldwide, nurses across specialties are caring for infected patients and are often the primary patient educators about convalescent plasma treatment. Keeping abreast of current clinical guidelines and evidence-based practice allows nurses to identify patients who should be considered for treatment, understand the administration guidelines, and be aware of the toxicity profile to provide safe and high-quality care to patients. The purpose of this article is to provide information on convalescent plasma as a treatment for COVID-19.


Subject(s)
Antibodies, Viral/administration & dosage , Antibodies, Viral/therapeutic use , /therapy , Health Personnel/education , Immunization, Passive/standards , Plasma/immunology , Adult , Aged , Aged, 80 and over , Female , Humans , Immunization, Passive/methods , Male , Middle Aged , Practice Guidelines as Topic , Treatment Outcome
12.
Eur J Cancer ; 147: 154-160, 2021 04.
Article in English | MEDLINE | ID: covidwho-1077873

ABSTRACT

The worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious coronavirus disease (COVID-19) has posed a unique challenge to medical staff, patients and their families. Patients with cancer, particularly those with haematologic malignancies, have been identified to be at high risk to develop severe COVID-19. Since publication of our previous guideline on evidence-based management of COVID-19 in patients with cancer, research efforts have continued and new relevant data has come to light, maybe most importantly in the field of vaccination studies. Therefore, an update of our guideline on several clinically important topics is warranted. Here, we provide a concise update of evidence-based recommendations for rapid diagnostics, viral shedding, vaccination and therapy of COVID-19 in patients with cancer. This guideline update was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology by critically reviewing the currently available data on these topics applying evidence-based medicine criteria.


Subject(s)
/standards , Neoplasms , Virus Shedding/physiology , Antiviral Agents/therapeutic use , /epidemiology , /virology , Evidence-Based Medicine/standards , Evidence-Based Medicine/statistics & numerical data , Germany/epidemiology , Hematologic Neoplasms/diagnosis , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Hematologic Neoplasms/virology , Hematology/organization & administration , Hematology/standards , Humans , Immunization, Passive/methods , Immunization, Passive/standards , Infectious Disease Medicine/organization & administration , Infectious Disease Medicine/standards , Medical Oncology/organization & administration , Medical Oncology/standards , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/therapy , Neoplasms/virology , Societies, Medical/standards , Vaccination/methods , Vaccination/standards
13.
Cell Rep ; 34(9): 108790, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1077816

ABSTRACT

Characterization of the humoral response to SARS-CoV-2, the etiological agent of COVID-19, is essential to help control the infection. The neutralization activity of plasma from patients with COVID-19 decreases rapidly during the first weeks after recovery. However, the specific role of each immunoglobulin isotype in the overall neutralizing capacity is still not well understood. In this study, we select plasma from a cohort of convalescent patients with COVID-19 and selectively deplete immunoglobulin A, M, or G before testing the remaining neutralizing capacity of the depleted plasma. We find that depletion of immunoglobulin M is associated with the most substantial loss of virus neutralization, followed by immunoglobulin G. This observation may help design efficient antibody-based COVID-19 therapies and may also explain the increased susceptibility to SARS-CoV-2 of autoimmune patients receiving therapies that impair the production of immunoglobulin M (IgM).


Subject(s)
/therapy , Immunoglobulin M/immunology , Immunoglobulin M/therapeutic use , /immunology , Adult , Aged , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , /immunology , Canada/epidemiology , Cohort Studies , Female , Humans , Immunity, Humoral/immunology , Immunization, Passive/methods , Immunoglobulin A/immunology , Immunoglobulin G/immunology , Immunoglobulin M/blood , Male , Middle Aged , Spike Glycoprotein, Coronavirus/immunology , Young Adult
14.
Mo Med ; 118(1): 74-80, 2021.
Article in English | MEDLINE | ID: covidwho-1068429

ABSTRACT

Convalescent plasma is an old treatment for a new disease. The coronavirus disease 2019 (COVID-19) pandemic caused the analysis of convalescent plasma to reemerge as a possible treatment. First, a systematic review summarizes the available research examining the use of convalescent plasma for the treatment of patients with COVID-19. Second, we describe our experience in establishing a single-center convalescent plasma donation program.


Subject(s)
Blood Donors/supply & distribution , Immunization, Passive/methods , Adult , Aged , Aged, 80 and over , Blood Donors/statistics & numerical data , /epidemiology , Donor Selection/methods , Female , Humans , Male , Middle Aged , /isolation & purification , Treatment Outcome
15.
Viruses ; 13(1)2021 Jan 19.
Article in English | MEDLINE | ID: covidwho-1059784

ABSTRACT

Coronavirus research has gained tremendous attention because of the COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus (nCoV or SARS-CoV-2). In this review, we highlight recent studies that provide atomic-resolution structural details important for the development of monoclonal antibodies (mAbs) that can be used therapeutically and prophylactically and for vaccines against SARS-CoV-2. Structural studies with SARS-CoV-2 neutralizing mAbs have revealed a diverse set of binding modes on the spike's receptor-binding domain and N-terminal domain and highlight alternative targets on the spike. We consider this structural work together with mAb effects in vivo to suggest correlations between structure and clinical applications. We also place mAbs against severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses in the context of the SARS-CoV-2 spike to suggest features that may be desirable to design mAbs or vaccines capable of conferring broad protection.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/therapeutic use , /immunology , Spike Glycoprotein, Coronavirus/immunology , Antibodies, Monoclonal/immunology , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , Epitope Mapping , Epitopes/immunology , Humans , Immunization, Passive/methods , Middle East Respiratory Syndrome Coronavirus/immunology , SARS Virus/immunology , Severe Acute Respiratory Syndrome/therapy , Spike Glycoprotein, Coronavirus/genetics , Viral Vaccines/immunology , Virus Internalization/drug effects
16.
Trials ; 22(1): 112, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1058265

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infection with possible serious consequences. The plasma of recovered patients might serve as treatment, which we aim to assess in the form of a prospective meta-analysis focusing on mortality, multi-organ failure, duration of intensive care unit stay, and adverse events. METHODS: A systematic search was conducted to find relevant registered randomized controlled trials in five trial registries. A comprehensive search will be done continuously on a monthly basis in MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science to find the results of previously registered randomized controlled trials. The selection will be done by two independent authors. Data extraction will be carried out by two other independent reviewers. Disagreements will be resolved by a third investigator. An update of the search of the registries and the first search of the databases will be done on the 21st of July. Data synthesis will be performed following the recommendations of the Cochrane Collaboration. In the case of dichotomous outcomes (mortality and organ failure), we will calculate pooled risk ratios with a 95% confidence interval (CI) from two-by-two tables (treatment Y/N, outcome Y/N). Data from models with multivariate adjustment (hazard ratios, odds ratio, risk ratio) will be preferred for the analysis. P less than 0.05 will be considered statistically significant. In the case of ICU stay, weighted mean difference with a 95% confidence interval will be calculated. Heterogeneity will be tested with I2, and χ2 tests. Meta-analysis will be performed if at least 3 studies report on the same outcome and population. DISCUSSION: Convalescent plasma therapy is a considerable alternative in COVID-19, which we aim to investigate in a prospective meta-analysis.


Subject(s)
/therapy , /mortality , Humans , Immunization, Passive/methods , Immunization, Passive/mortality , Intensive Care Units , Length of Stay , Meta-Analysis as Topic , Prospective Studies , Randomized Controlled Trials as Topic , Treatment Outcome
17.
BMJ Case Rep ; 14(1)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1054634

ABSTRACT

Convalescent plasma, which contains antibodies from recovered individuals, has been used as an effective treatment for infectious diseases in the past and is currently being used as a potential treatment option for COVID-19. Multiple studies have reported this treatment to be safe. We report a case of a patient who developed acute respiratory distress syndrome (ARDS) with features suggestive of transfusion-related acute lung injury after being treated with convalescent plasma for COVID-19. We emphasise the need to be aware of the potential risk of transfusion reactions and disease worsening with convalescent plasma administration and to weigh the risk and benefits of this therapy before administration to patients and propose that further study be done regarding the potential risks of convalescent plasma.


Subject(s)
/complications , /complications , Transfusion-Related Acute Lung Injury/complications , Adult , Diagnosis, Differential , Female , Humans , Immunization, Passive/methods , Pregnancy , Treatment Outcome
18.
Sci Rep ; 11(1): 2062, 2021 01 21.
Article in English | MEDLINE | ID: covidwho-1042516

ABSTRACT

In order to support vaccine development, and to aid convalescent plasma therapy, it would be important to understand the kinetics, timing and persistence of SARS-CoV-2 neutralizing antibodies (NAbs), and their association with clinical disease severity. Therefore, we used a surrogate viral neutralization test to evaluate their levels in patients with varying severity of illness, in those with prolonged shedding and those with mild/asymptomatic illness at various time points. Patients with severe or moderate COVID-19 illness had earlier appearance of NAbs at higher levels compared to those with mild or asymptomatic illness. Furthermore, those who had prolonged shedding of the virus, had NAbs appearing faster and at higher levels than those who cleared the virus earlier. During the first week of illness the NAb levels of those with mild illness was significantly less (p = 0.01), compared to those with moderate and severe illness. At the end of 4 weeks (28 days), although 89% had NAbs, 38/76 (50%) in those with > 90 days had a negative result for the presence of NAbs. The Ab levels significantly declined during convalescence (> 90 days since onset of illness), compared to 4 to 8 weeks since onset of illness. Our data show that high levels of NAbs during early illness associated with clinical disease severity and that these antibodies declined in 50% of individuals after 3 months since onset of illness.


Subject(s)
Antibodies, Neutralizing/immunology , /immunology , Adaptive Immunity/immunology , Adult , Antibodies, Neutralizing/analysis , Antibodies, Viral/immunology , /therapy , Convalescence , Female , Humans , Immunization, Passive/methods , Male , Middle Aged , Neutralization Tests/methods , Severity of Illness Index , Sri Lanka/epidemiology
19.
JCI Insight ; 6(4)2021 02 22.
Article in English | MEDLINE | ID: covidwho-1039949

ABSTRACT

Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as a treatment for coronavirus disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200 mL of CCP with a spike protein IgG titer ≥ 1:2430 (median 1:47,385) within 72 hours of admission with propensity score-matched controls cared for at a medical center in the Bronx, between April 13 and May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroid use, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared with matched controls, CCP recipients less than 65 years had 4-fold lower risk of mortality and 4-fold lower risk of deterioration in oxygenation or mortality at day 28. For CCP recipients, pretransfusion spike protein IgG, IgM, and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients less than 65 years, but data from controlled trials are needed to validate this finding and establish the effect of aging on CCP efficacy.


Subject(s)
Antibodies, Neutralizing/administration & dosage , Antibodies, Viral/administration & dosage , /immunology , Adult , Age Factors , Aged , Aged, 80 and over , Antibodies, Neutralizing/blood , Antibodies, Neutralizing/immunology , Antibodies, Viral/blood , Antibodies, Viral/immunology , /mortality , Female , Hospital Mortality , Humans , Immunization, Passive/methods , Male , Middle Aged , New York City/epidemiology , Propensity Score , Retrospective Studies , Spike Glycoprotein, Coronavirus/immunology , Treatment Outcome
20.
J Korean Med Sci ; 36(2): e17, 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1021881

ABSTRACT

In April 2020, a pediatric report of an unusual inflammatory illness associated with coronavirus disease 2019 (COVID-19) led to similar cases in Europe and North America, which was referred to as multisystem inflammatory syndrome in children (MIS-C). Herein, we describe the case of a 12-year-old boy who had a history of polymerase chain reaction-confirmed COVID-19 and developed MIS-C approximately three weeks after an initial diagnosis of COVID-19. High fever with abdominal pain mimicking appendicitis was the initial manifestation of MIS-C, which could have been easily missed if the patient's history of COVID-19 was ignored. Intravenous immunoglobulin was administered twice, 24 hours apart, five days after the onset of MIS-C, and the patient fully recovered without any obvious sequelae. Early recognition by disease awareness and prompt management are the keys to saving the lives of children affected by MIS-C.


Subject(s)
/pathology , Immunoglobulins, Intravenous/therapeutic use , Systemic Inflammatory Response Syndrome , Antibodies, Viral/therapeutic use , Child , Humans , Immunization, Passive/methods , Immunoglobulins/administration & dosage , Immunoglobulins/therapeutic use , Male , Republic of Korea , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
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