COVID-19 patients exhibit less pronounced immune suppression compared with bacterial septic shock patients

Kox, Matthijs; Frenzel, Tim; Schouten, Jeroen; Veerdonk, Frank L. van de; Koenen, Hans J. P. M.; Pickkers, Peter

doi:10.1186/s13054-020-02896-5

Cited by 30 publications

(24 citation statements)

References 5 publications

(12 reference statements)

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“…In two independent studies from Chinese hospitals, 27 (96.4%) of 28 [6] and 11 (16%) of 68 [7] COVID-19 patients who died had secondary infections. This is consistent with failed homeostasis between innate and adaptive responses [8] or a pronounced immune suppression [9], which is partly dependent on the loss of…”

Section: Introductionsupporting

confidence: 81%

Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report

Posteraro

Torelli

Vella

et al. 2020

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Coinfections with bacteria or fungi may be a frequent complication of COVID-19, but coinfections with Candida species in COVID-19 patients remain rare. We report the 53-day clinical course of a complicated type-2 diabetes patient diagnosed with COVID-19, who developed bloodstream infections initially due to methicillin-resistant Staphylococcus aureus, secondly due to multidrug-resistant Gram-negative bacteria, and lastly due to a possibly fatal Candida glabrata. The development of FKS-associated pan-echinocandin resistance in the C. glabrata isolated from the patient after 13 days of caspofungin treatment aggravated the situation. The patient died of septic shock shortly before the prospect of receiving potentially effective antifungal therapy. This case emphasizes the importance of early diagnosis and monitoring for antimicrobial drug-resistant coinfections to reduce their unfavorable outcomes in COVID-19 patients.

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Section: Introductionsupporting

confidence: 81%

Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report

Posteraro

Torelli

Vella

et al. 2020

JoF

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“…Four were based on values obtained using a standardized protocol and results are expressed as the number of antibodies bound per cell (AB/C). Most importantly, these independent studies from different groups located in different countries (Bern‐CH, Nijmegen‐NL, Limoges‐F, Lyon‐F) provided extremely homogenous results (27–30). Initial mHLA‐DR values for ICU COVID‐19 patients were around 10,000 AB/C, which was lower than controls (>15,000 AB/C) but not as low as that found in septic shock (around 5,000 AB/C).…”

Section: Clinical Results In Covid‐19 Patientsmentioning

confidence: 99%

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

et al. 2020

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Several months after the sudden emergence of SARS‐CoV‐2 and COVID‐19, the understanding of the appropriate host immune response to a virus totally unknown of human immune surveillance is still of major importance. By international definition, COVID‐19 falls in the scope of septic syndromes (organ dysfunction due to dysregulated host response to an infection) in which immunosuppression is a significant driver of mortality. Sepsis‐induced immunosuppression is mostly defined and monitored by the measurement of decreased expression of HLA‐DR molecules on circulating monocytes (mHLA‐DR). In this interim review, we summarize the first mHLA‐DR results in COVID‐19 patients. In critically ill patients, results homogenously indicate a decreased mHLA‐DR expression, which, along with profound lymphopenia and other functional alterations, is indicative of a status of immunosuppression. © 2020 International Society for Advancement of Cytometry

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“…For instance, it has been reported that quick Sequential Organ Failure Assessment (qSOFA) was not appropriate to identify COVID-19 patients who will experience poor outcomes typical of sepsis. mHLA-DR expression levels have also been reported to be higher and plasma IL-6 levels were lower in SARS-CoV-2 sepsis patients (8)(9)(10)(11). These differences allow us to question whether the changes in the immune system induced by SARS-CoV-2 sepsis differ from those caused by bacterial sepsis and whether it is appropriate to translate treatment recommendations from bacterial sepsis.…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned Comparing Immune System Alterations of Bacterial Sepsis and SARS-CoV-2 Sepsis

et al. 2020

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BackgroundBacterial sepsis has been used as a prototype to understand the pathogenesis of severe coronavirus disease 2019 (COVID-19). In addition, some management programs for critically ill COVID-19 patients are also based on experience with bacterial sepsis. However, some differences may exist between these two types of sepsis.MethodsThis retrospective study investigated whether there are differences in the immune system status of these two types of sepsis. A total of 64 bacterial sepsis patients and 43 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sepsis were included in this study. Demographic data were obtained from medical records. Laboratory results within 24 h after the diagnosis of sepsis were provided by the clinical laboratory.ResultsThe results of blood routine (neutrophil, lymphocyte, and monocyte counts), infection biomarkers (C-reactive protein, ferritin, and procalcitonin levels), lymphocyte subset counts (total T lymphocyte, CD4+ T cell, CD8+ T cell, B cell, and NK cell counts), and lymphocyte subset functions (the proportions of PMA/ionomycin-stimulated IFN-γ positive cells in CD4+, CD8+ T cells, and NK cells) were similar in bacterial sepsis patients and SARS-CoV-2 sepsis patients. Cytokine storm was milder, and immunoglobulin and complement protein levels were higher in SARS-CoV-2 sepsis patients.ConclusionsThere are both similarities and differences in the immune system status of bacterial sepsis and SARS-CoV-2 sepsis. Our findings do not support blocking the cytokine storm or supplementing immunoglobulins in SARS-CoV-2 sepsis, at least in the early stages of the disease. Treatments for overactivation of the complement system and lymphocyte depletion may be worth exploring further.

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COVID-19 patients exhibit less pronounced immune suppression compared with bacterial septic shock patients

Cited by 30 publications

References 5 publications

Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report

Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report

Monocyte HLA‐DR Measurement by Flow Cytometry in COVID‐19 Patients: An Interim Review

Lessons Learned Comparing Immune System Alterations of Bacterial Sepsis and SARS-CoV-2 Sepsis

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