New coronavirus infection SARS-CoV-2 in adult patients with inborn errors of immunity
Roppelt A.A. Mаrkina U.A. Bobrikova E.N. Кruglova T.S. Мukhina O.A. Lebedkina M.S. Andrenova G.V. Chernov A.A. Alekseeva E.I. Karaulov A.V. Lysenko M.A. Fomina D.S.
2024Pharmarus Print Media
Russian Journal of Allergy
2024#21Issue 2216 - 229 pp.
BACKGROUND: Diagnosis and treatment of COVID-19 in patients with primary immunodeficiency, or inborn errors of immunity, are often challenging. AIM: Description of the COVID-19 course and therapy of adult patients with primary immunodeficiency treated in medical organizations of Moscow Healthcare Department. MATERIALS AND METHODS: We analyzed a cohort of 68 patients over 18 years (median ― 35 years) with primary immunodeficiency; 91% of patients have primary immunodeficiency with predominantly antibody deficiencies. Altogether 90 cases of the new СOVID-19 were analyzed: in 68 cases infection occurred for the first time, in 22 cases it recurred. The duration of the disease ranged from 3 to 80 days. Duration of PCR-positivity ranged from 0 to 59 days, median 8 days. RESULTS: Patients with Wuhan and Delta strains had more severe inflammatory signs according to C-reactive protein and lactate dehydrogenase, in patients with Wuhan lung involvement on CT-scam was larger. In demonstrated group of patients higher C-reactive protein correlated with larger lung involvement, longer duration of the disease and PCR-positivity, significant lymphopenia also correlated with higher C-reactive protein. To our data regularity of intravenous immunoglobulin therapy and IgG trough level didn’t correlate with infection severity and duration of the disease and virus-carriage. Indirectly, the change in the spectrum of medicine used in patients of the analyzed group coincided with the virus strain evolution. Anti-inflammatory therapy was mainly presented by dexamethasone and antagonists to interleukin 6 or its receptor (anti-IL-6): 55% and 73% for Wuhan, 63% and 50% for Delta, 17% and 39% for Omicron. Then, preference was gradually given to the target anti-cytokine medicine. Etiotropic antiviral therapy was more often used to treat infection caused by Wuhan and Delta strains ― 32% and 38%, respectively (in 17% for Omicron). With shifting toward immunotherapy by specific against COVID-19 immunoglobulins and monoclonal antibody to SARS-CoV-2: 5% and 9% for Wuhan, 0% and 75% for Delta, 48% and 83% for Omicron, respectively. Immune and etiotropic therapy was not carried out in Wuhan in 39%, in Delta in 43%, in Omicron in 41% of cases. The overall mortality rate from COVID-19 in the analyzed group was 3%. CONCLUSION: Patients with primary immunodeficiency represent a vulnerable group to the SARS-CoV-2 virus with a high risk of not only severe, but also a protracted and undulating course of infection, what must be taken into account for the correct interpretation of the patients condition and the timely administration of the appropriate therapy.
adults , inborn errors of immunity , new coronavirus infection SARS-CoV-2 , primary immunodeficiency , treatment
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Moscow City Hospital 52, Moscow, Russian Federation
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
The First Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
National Medical Research Center for Childrens Health, Moscow, Russian Federation
The Russian National Research Medical University named after N.I. Pirogov, Moscow, Russian Federation
Astana Medical University, Astana, Kazakhstan
Moscow City Hospital 52
Dmitry Rogachev National Medical Research Center of Pediatric Hematology
The First Sechenov Moscow State Medical University (Sechenov University)
National Medical Research Center for Childrens Health
The Russian National Research Medical University named after N.I. Pirogov
Astana Medical University
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