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1.
Am J Case Rep ; 21: e927812, 2020 Oct 03.
Artículo en Inglés | MEDLINE | ID: covidwho-854653

RESUMEN

BACKGROUND This is a case report of an immunocompromised patient with a history of non-Hodgkin lymphoma and persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was seronegative and successfully treated with convalescent plasma. CASE REPORT A 63-year-old woman with a past medical history of non-Hodgkin lymphoma in remission while on maintenance therapy with the anti-CD20 monoclonal antibody, obinutuzumab, tested positive for SARS-CoV-2 via nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) testing over 12 weeks and persistently tested seronegative for immunoglobulin G (IgG) antibodies using SARS-CoV-2 IgG chemiluminescent microparticle immunoassay technology. During this time, the patient experienced waxing and waning of symptoms, which included fever, myalgia, and non-productive cough, but never acquired severe respiratory distress. She was admitted to our hospital on illness day 88, and her symptoms resolved after the administration of convalescent plasma. CONCLUSIONS As the understanding of the pathogenesis of SARS-CoV-2 continues to evolve, we can currently only speculate about the occurrence of chronic infection vs. reinfection. The protective role of antibodies and their longevity against SARS-CoV-2 remain unclear. Since humoral immunity has an integral role in SARS-CoV-2 infection, various phase 3 vaccine trials are underway. In the context of this pandemic, the present case demonstrates the challenges in our understanding of testing and treating immunocompromised patients.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Huésped Inmunocomprometido , Linfoma no Hodgkin/inmunología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Antineoplásicos Inmunológicos/administración & dosificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/terapia , Femenino , Estudios de Seguimiento , Humanos , Inmunización Pasiva/métodos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/tratamiento farmacológico , Persona de Mediana Edad , Pandemias , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Pruebas Serológicas/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
2.
Front Immunol ; 11: 2086, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-771524

RESUMEN

Immunosuppressive therapies increase the susceptibility of patients to infections. The current pandemic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compels clinicians to develop recommendations for successful clinical management and surveillance of immunocompromised patients at high risk for severe disease progression. With only few case studies published on SARS-CoV-2 infection in patients with rheumatic diseases, we report a 25-year-old male who developed moderate coronavirus disease 2019 (COVID-19) with fever, mild dyspnea, and no major complications despite having received high-dose prednisolone, cyclophosphamide, and rituximab for the treatment of highly active, life-threatening eosinophilic granulomatosis with polyangiitis (EGPA).


Asunto(s)
Betacoronavirus/genética , Síndrome de Churg-Strauss/complicaciones , Síndrome de Churg-Strauss/tratamiento farmacológico , Infecciones por Coronavirus/complicaciones , Ciclofosfamida/uso terapéutico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Neumonía Viral/complicaciones , Adulto , Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Humanos , Huésped Inmunocomprometido , Masculino , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Prednisolona/uso terapéutico , ARN Viral/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Rituximab/uso terapéutico , Resultado del Tratamiento
3.
J Am Soc Nephrol ; 31(10): 2413-2423, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-732955

RESUMEN

BACKGROUND: COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. METHODS: We enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform. RESULTS: Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19-positive patients. CONCLUSIONS: Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.


Asunto(s)
Comorbilidad , Infecciones por Coronavirus/epidemiología , Huésped Inmunocomprometido/inmunología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Neumonía Viral/epidemiología , Adulto , Anciano , Estudios de Cohortes , Infecciones por Coronavirus/prevención & control , Femenino , Francia , Humanos , Incidencia , Control de Infecciones/organización & administración , Fallo Renal Crónico/epidemiología , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , Estudios Prospectivos , Medición de Riesgo , Análisis de Supervivencia , Receptores de Trasplantes/estadística & datos numéricos
5.
Viruses ; 12(9)2020 08 23.
Artículo en Inglés | MEDLINE | ID: covidwho-727450

RESUMEN

RNA interference (RNAi) provides the means for alternative antiviral therapy. Delivery of RNAi in the form of short interfering RNA (siRNA), short hairpin RNA (shRNA) and micro-RNA (miRNA) have demonstrated efficacy in gene silencing for therapeutic applications against viral diseases. Bioinformatics has played an important role in the design of efficient RNAi sequences targeting various pathogenic viruses. However, stability and delivery of RNAi molecules have presented serious obstacles for reaching therapeutic efficacy. For this reason, RNA modifications and formulation of nanoparticles have proven useful for non-viral delivery of RNAi molecules. On the other hand, utilization of viral vectors and particularly self-replicating RNA virus vectors can be considered as an attractive alternative. In this review, examples of antiviral therapy applying RNAi-based approaches in various animal models will be described. Due to the current coronavirus pandemic, a special emphasis will be dedicated to targeting Coronavirus Disease-19 (COVID-19).


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Interferencia de ARN , Animales , Antivirales/uso terapéutico , Biología Computacional , Silenciador del Gen , Humanos , Huésped Inmunocomprometido , Pandemias
8.
Am J Case Rep ; 21: e926464, 2020 Aug 16.
Artículo en Inglés | MEDLINE | ID: covidwho-721634

RESUMEN

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Infecciones por Coronavirus/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Neumonía Bacteriana/microbiología , Neumonía Viral/complicaciones , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Betacoronavirus , Deterioro Clínico , Coinfección , Infecciones por Coronavirus/tratamiento farmacológico , Resultado Fatal , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Stenotrophomonas maltophilia , Receptores de Trasplantes , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación
9.
Pan Afr Med J ; 36: 81, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-709537

RESUMEN

Sickle cell disease is a major concern of public health significance in Africa. Nearly 2/3rd of the global burden of sickle cell disease (SCD) is found to be in sub-Saharan Africa. There is increased mortality risk in sickle cell disease patients in Africa due to associated complications such as acute chest syndrome, asthma, pulmonary emboli and sepsis. Sickle cell disease management is the major contributor of financial burden on the government. Moreover, there is a shortage of medical specialists in Africa. COVID-19 pandemic has further led to devastating impact on economy and health globally. The chances of SCD patient contracting COVID-19 infections are higher as these patients are immunocompromised and may be at a higher risk of mortality. Practicing preventive measures including isolation and social distancing by these patients will prevent mortality rates as well as economic burden on government in the present unprecedented COVID-19 pandemic.


Asunto(s)
Anemia de Células Falciformes/epidemiología , Infecciones por Coronavirus/epidemiología , Costo de Enfermedad , Neumonía Viral/epidemiología , África del Sur del Sahara/epidemiología , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/mortalidad , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/prevención & control , Humanos , Huésped Inmunocomprometido , Pandemias/economía , Pandemias/prevención & control , Neumonía Viral/economía , Neumonía Viral/prevención & control , Salud Pública , Aislamiento Social
10.
J Immunother Cancer ; 8(2)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-691258

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic placed unprecedented pressure on various healthcare systems, including departments that use immunotherapies such as chimeric antigen receptor (CAR) T-cell therapy and immunosuppression therapy in organ transplantation units. The true impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on immunocompromised CAR T-cell therapy recipients and kidney transplant recipients (KTRs) has not yet been established. CASE PRESENTATION: In this report, we compare two patients with severe COVID-19 pneumonia in either the humoral or cell-mediated immunodeficient states. The first patient was a man in his early 30s who was diagnosed with refractory multiple myeloma. He received fully humanized, anti-B-cell maturation antigen, CAR T-cell therapy before 4 months and achieved strict complete remission. He was infected with SARS-CoV-2 starting on January 26, 2019 and gradually progressed to severe pneumonia. Throughout the clinical progression of the disease, SARS-CoV-2 could not be cleared due to his humoral immunodeficient state. During this period of his severe COVID-19 pneumonia, elevated cytotoxic T-cells were observed in this patient's peripheral blood while elevated plasma levels of interleukin (IL)-2R, IL-6, tumor necrosis factor α, and ferritin were observed in his cytokine profiles. This patient eventually progressed into acute respiratory distress syndrome and recieved non-invasive ventilatory support. He failed to generate specific SARS-CoV-2 antibodies and died of respiratory failure on day 33 (d33). The second patient was a 52-year-old kidney transplant recipient (KTR) who took ciclosporin after renal transplantation for more than 7 years. He confirmed SARS-CoV-2 infection on January 20, 2019 and gradually progressed into severe pneumonia on d16 with a slightly elevated B-cell percentage and normal T-lymphocyte subsets. Viral clearance occurred together with the generation of specific anti-immunoglobulin G-SARS-CoV-2 antibodies after 2 weeks of treatment. He was symptom-free and discharged from the hospital on d42. CONCLUSION: We report a CAR T-cell therapy recipient diagnosed with COVID-19 for the first time. His virus clearance failure and life-threating cytokine storm during SARS-CoV-2 infection suggested that any decision to proceed CAR T-cell therapy during COVID-19 pandemics will require extensive discussion of potential risks and benefits. Immunosuppressant treatment based on ciclosporin could be relatively safe for KTRs diagnosed with COVID-19. TRIAL REGISTRATION NUMBER: ChiCTR-OPN-1800018137.


Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Huésped Inmunocomprometido , Neumonía Viral/inmunología , Linfocitos T Citotóxicos/inmunología , Adulto , Anticuerpos Antivirales/metabolismo , Ciclosporina/uso terapéutico , Citocinas/metabolismo , Resultado Fatal , Humanos , Inmunidad Celular , Inmunidad Humoral , Masculino , Persona de Mediana Edad , Pandemias
13.
Front Immunol ; 11: 1548, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-687591

RESUMEN

Background: The COVID-19 pandemic has been causing varying severities of illness. Some are asymptomatic and some develop severe disease leading to mortality across ages. This contrast triggered us explore the causes, with the background that a vaccine for effective immunization or a drug to tackle COVID-19 is not too close to reality. We have discussed strategies to combat COVID-19 through immune enhancement, using simple measures including nutritional supplements. Discussion: A literature search on mortality-related comorbid conditions was performed. For those conditions, we analyzed the pro-inflammatory cytokines, which could cause the draining of the immune reservoir. We also analyzed the immune markers necessary for the defense mechanism/immune surveillance against COVID-19, especially through simple means including immune enhancing nutritional supplement consumption, and we suggest strategies to combat COVID-19. Major comorbid conditions associated with increased mortality include cardiovascular disease (CVD), diabetes, being immunocompromised by cancer, and severe kidney disease with a senile immune system. Consumption of Aureobasidium pullulans strain (AFO-202) beta 1,3-1,6 glucan supported enhanced IL-8, sFAS macrophage activity, and NK cells' cytotoxicity, which are major defense mechanisms against viral infection. Conclusion: People with co-morbid conditions who are more prone to COVID-19-related deaths due to immune dysregulation are likely to benefit from consuming nutritional supplements that enhance the immune system. We recommend clinical studies to validate AFO-202 beta glucan in COVID-19 patients to prove its efficacy in overcoming a hyper-inflammation status, thus reducing the mortality, until a definite vaccine is made available.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Diabetes Mellitus/epidemiología , Suplementos Dietéticos , Neoplasias/epidemiología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Insuficiencia Renal Crónica/epidemiología , Actinobacteria/química , Biomarcadores/sangre , Enfermedades Cardiovasculares/inmunología , Comorbilidad , Infecciones por Coronavirus/dietoterapia , Infecciones por Coronavirus/mortalidad , Citocinas/sangre , Diabetes Mellitus/inmunología , Humanos , Huésped Inmunocomprometido , Neoplasias/inmunología , Pandemias , Neumonía Viral/dietoterapia , Neumonía Viral/mortalidad , Insuficiencia Renal Crónica/inmunología , beta-Glucanos/farmacología , beta-Glucanos/uso terapéutico
14.
Front Immunol ; 11: 1648, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-685338

RESUMEN

Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.


Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/inmunología , Cuidados Críticos/métodos , Citocinas/sangre , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/inmunología , Corticoesteroides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Relación CD4-CD8 , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica , Células Endoteliales/metabolismo , Femenino , Humanos , Huésped Inmunocomprometido , Interleucina-6/antagonistas & inhibidores , Inhibidores de las Cinasas Janus/uso terapéutico , Masculino , Pandemias , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Factores Sexuales , Trombosis
16.
Neurologia ; 35(6): 357-362, 2020.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-680554

RESUMEN

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.


Asunto(s)
Algoritmos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Inmunosupresores/administración & dosificación , Esclerosis Múltiple/tratamiento farmacológico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Atención Ambulatoria , Enfermedades Asintomáticas , Lista de Verificación , Técnicas de Laboratorio Clínico , Contraindicaciones de los Medicamentos , Infecciones por Coronavirus/diagnóstico , Susceptibilidad a Enfermedades , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Tamizaje Masivo/métodos , Nasofaringe/virología , Neumonía Viral/diagnóstico , Reacción en Cadena de la Polimerasa , Quimioterapia por Pulso , Cuarentena , Medición de Riesgo , Evaluación de Síntomas , Telemedicina
17.
AIDS Res Ther ; 17(1): 46, 2020 07 23.
Artículo en Inglés | MEDLINE | ID: covidwho-671088

RESUMEN

BACKGROUND: The COVID-19 has been a severe pandemic all around the world. Nowadays the patient with co-infection of HIV and SARS-CoV-2 was rarely reported. Here we reported a special case with HIV and SARS-CoV-2 co-infection, which showed a prolonged viral shedding duration. CASE PRESENTATION: The patient was infected with HIV 8 years ago through sexual transmission and had the normal CD4+T cell count. She was found SARS-CoV-2 positive using real-time Polymerase Chain Reaction (RT-PCR) during the epidemic. Most importantly, the patient had a prolonged viral shedding duration of SARS-CoV-2 about 28 days. CONCLUSION: The viral shedding duration may be prolonged in people living with HIV. The 14 days isolation strategy might not be long enough for them. The isolation or discharge of these patients needs further confirmation for preventing epidemics.


Asunto(s)
Antirretrovirales/uso terapéutico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por VIH/complicaciones , Neumonía Viral/diagnóstico , Esparcimiento de Virus , Benzoxazinas/administración & dosificación , Betacoronavirus/genética , Betacoronavirus/inmunología , Proteína C-Reactiva/análisis , Recuento de Linfocito CD4 , Escalofríos , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/tratamiento farmacológico , Fatiga , Femenino , Fiebre , VIH/crecimiento & desarrollo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Humanos , Huésped Inmunocomprometido , Inmunoglobulina M/sangre , Lamivudine/administración & dosificación , Persona de Mediana Edad , Pandemias , Faringitis , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/tratamiento farmacológico , Reacción en Cadena en Tiempo Real de la Polimerasa , Esputo/virología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Esparcimiento de Virus/inmunología , Zidovudina/administración & dosificación
18.
Int J Oncol ; 57(2): 533-539, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-667782

RESUMEN

Severe acute respiratory syndrome (SARS) coronavirus­2 (SARS­CoV2) is the cause of a new disease (COVID­19) which has evolved into a pandemic during the first half of 2020. Older age, male sex and certain underlying diseases, including cancer, appear to significantly increase the risk for severe COVID­19. SARS­CoV­2 infection of host cells is facilitated by the angiotensin­converting enzyme 2 (ACE­2), and by transmembrane protease serine 2 (TMPRSS2) and other host cell proteases such as cathepsin L (CTSL). With the exception of ACE­2, a systematic analysis of these two other SARS­CoV2 infection mediators in malignancies is lacking. Here, we analysed genetic alteration, RNA expression, and DNA methylation of TMPRSS2 and CTSL across a wide spectrum of tumors and controls. TMPRSS2 was overexpressed in cervical squamous cell carcinoma and endocervical adenocarcinoma, colon adenocarcinoma, prostate adenocarcinoma (PRAD), rectum adenocarcinoma (READ), uterine corpus endometrial carcinoma and uterine carcinosarcoma, with PRAD and READ exhibiting the highest expression of all cancers. CTSL was upregulated in lymphoid neoplasm diffuse large B­cell lymphoma, oesophageal carcinoma, glioblastoma multiforme, head and neck squamous cell carcinoma, lower grade glioma, pancreatic adenocarcinoma, skin cutaneous melanoma, stomach adenocarcinoma, and thymoma. Hypo­methylation of both genes was evident in most cases where they have been highly upregulated. We have expanded on our observations by including data relating to mutations and copy number alterations at pan­cancer level. The novel hypotheses that are stemming out of these data need to be further investigated and validated in large clinical studies.


Asunto(s)
Betacoronavirus/patogenicidad , Biomarcadores de Tumor/genética , Catepsina L/genética , Infecciones por Coronavirus/virología , Neoplasias/genética , Infecciones Oportunistas/virología , Neumonía Viral/virología , Serina Endopeptidasas/genética , Internalización del Virus , Infecciones por Coronavirus/enzimología , Infecciones por Coronavirus/inmunología , Metilación de ADN , Bases de Datos Genéticas , Femenino , Interacciones Huésped-Patógeno , Humanos , Huésped Inmunocomprometido , Masculino , Neoplasias/enzimología , Neoplasias/inmunología , Infecciones Oportunistas/enzimología , Infecciones Oportunistas/inmunología , Pandemias , Neumonía Viral/enzimología , Neumonía Viral/inmunología , Factores de Riesgo
19.
J Neurol Sci ; 417: 117053, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: covidwho-665223

RESUMEN

BACKGROUND: The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation. CASE DESCRIPTION: We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange. CONCLUSION: Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Miastenia Gravis/complicaciones , Pandemias , Neumonía Viral/complicaciones , Adulto , Anciano , Azitromicina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Hipertensión/complicaciones , Hipotiroidismo/complicaciones , Huésped Inmunocomprometido , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Lopinavir/uso terapéutico , Masculino , Miastenia Gravis/tratamiento farmacológico , Miastenia Gravis/terapia , Plasmaféresis , Neumonía Viral/tratamiento farmacológico , Ritonavir/uso terapéutico , Resultado del Tratamiento
20.
J Infect Dis ; 222(7): 1103-1107, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-663915

RESUMEN

The antiviral drug remdesivir has been shown clinically effective for treatment of COVID-19. We here demonstrate suppressive but not curative effect of remdesivir in an immunocompromised patient. A man in his fifties treated with chemoimmunotherapy for chronic lymphocytic leukemia experienced a 9-week course of COVID-19 with high fever and severe viral pneumonia. During two 10-day courses of remdesivir starting 24 and 45 days after fever onset, pneumonia and spiking fevers remitted, but relapsed after discontinuation. Kinetics of temperature, C-reactive protein, and lymphocyte counts mirrored the remitting/relapsing SARS-CoV-2 infection. Combination therapy or longer treatment duration may be needed in immunocompromised patients.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/complicaciones , Neumonía Viral/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Fiebre/tratamiento farmacológico , Fiebre/virología , Humanos , Huésped Inmunocomprometido , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Síndrome Respiratorio Agudo Grave/virología , Factores de Tiempo , Resultado del Tratamiento
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