ABSTRACT
Introduction: COVID-19 patients can develop autoantibodies against a variety of secreted and membrane proteins, including some expressed on lymphocytes. However, it is unclear what proportion of patients might develop anti-lymphocyte antibodies (ALAb) and what functional relevance they might have. Methods: We evaluated the presence and lytic function of ALAb in the sera of a cohort of 85 COVID-19 patients (68 unvaccinated and 17 vaccinated) assigned to mild (N=63), or moderate/severe disease (N=22) groups. Thirty-seven patients were followed-up after recovery. We also analyzed in vivo complement deposition on COVID-19 patients' lymphocytes and examined its correlation with lymphocyte numbers during acute disease. Results: Compared with healthy donors (HD), patients had an increased prevalence of IgM ALAb, which was significantly higher in moderate/severe disease patients and persisted after recovery. Sera from IgM ALAb+ patients exhibited complement-dependent cytotoxicity (CDC) against HD lymphocytes. Complement protein C3b deposition on patients' CD4 T cells was inversely correlated with CD4 T cell numbers. This correlation was stronger in moderate/severe disease patients. Discussion: IgM ALAb and complement activation against lymphocytes may contribute to the acute lymphopenia observed in COVID-19 patients.
Subject(s)
Autoantibodies , COVID-19 , Complement Activation , Immunoglobulin M , SARS-CoV-2 , Humans , COVID-19/immunology , COVID-19/blood , Immunoglobulin M/blood , Immunoglobulin M/immunology , Male , Female , Middle Aged , Autoantibodies/blood , Autoantibodies/immunology , Complement Activation/immunology , SARS-CoV-2/immunology , Aged , Adult , Lymphocytes/immunology , Prevalence , CD4-Positive T-Lymphocytes/immunology , Lymphopenia/immunology , Lymphopenia/blood , Complement C3b/immunologyABSTRACT
Objetivo: describir y revisar los hallazgos relevantes en imágenes diagnósticas del abordaje prenatal de pacientes con diagnóstico de acretismo placentario. Materiales y métodos: presentamos los casos de tres mujeres que fueron atendidas en un centro hospitalario de alta complejidad, con factores de riesgo para acretismo placentario y evaluación prenatal por ultrasonido (US) y resonancia magnética (RM), cuyo diagnóstico fue corroborado con estudio anatomopatológico. Se describen los aspectos clínicos, los hallazgos por imágenes y su correlación histológica. Se realizó una búsqueda de la literatura a través de PubMed, Lilacs y EBSCO, se incluyeron artículos originales, revisiones de tema y reportes de casos sobre la utilidad y los aspectos más importantes del US y la RM en el diagnóstico prenatal de acretismo placentario. Resultados: se incluyeron 11 artículos originales, 8 de revisión y 1 reporte caso. La placenta previa asociada a lagunas placentarias en ultrasonido y en RM a bandas hipointensas placentarias y el abombamiento del útero son considerados como los principales signos de acretismo. El US asociado a Doppler color tiene una sensibilidad de 97 % y una especificidad del 92 %. La RM puede definir el compromiso uterino y de los órganos vecinos, con una sensibilidad que varía entre el 77 y el 89,6 %, la especificidad es cercana al 92 %. Conclusiones: el abordaje prenatal precoz a través de las imágenes diagnósticas no invasivas brinda información de utilidad a los clínicos del compromiso y la extensión en la evaluación de pacientes con factores de riesgo para acretismo placentario.
Objective: To describe and review the relevant findings of the prenatal diagnostic imaging approach in patients placenta accreta diagnosis. Materials and methods: We present 3 cases of women with risk factors for placenta accreta assessed prenatally at a high-complexity hospital, using ultrasound (US) and magnetic resonance imaging (MRI), with histopathological confirmation of the diagnosis. Clinical and imaging findings are described, together with their histological correlation. A search of the literature was conducted through PubMed, LILACS, and Ebsco, including original papers, topic reviews and case reports on the use and more important aspects of US and MRI in the prenatal diagnosis of placenta accreta. Results: 11 Original articles, 8 Review articles and 1 case report from our country were included. Placenta accreta is an obstetric pathology that threatens the health of the mother and fetus. Placenta previa associated to placental gaps in US and intraplacental hypointense bands and uterine bulge in MRI are considered as the major signs of accretism. US with color Doppler has 97 % of sensitivity and 92 % of specificity, MRI defines uterine and neighboring organs compromise (s = 77-89.6 %, e = 92 %). Conclusion: Early prenatal approach through noninvasive diagnostic imaging plays a usefull role providing information about the compromise and extention in patients with risk factors for placental accretism.
