Therapeutic approach for severe COVID-19 and immunocompromised patients. A case series

Abstract

Background COVID-19 is a potentially critical infectious disease. Inflammatory response and disease severity may vary according to immune system status. The aim of this case series is to investigate different presentation of COVID-19 in immunocompromised patients. Methods this is a single centre case series about 17 immunocompromised patients admitted to our respiratory department during the recent COVID-19 pandemic. White blood cell count, C reactive protein, interleukin 6, lymphocytic subpopulation count (CD4+, CD8+, CD20+) and immunoglobulin count (IgG, IgM, IgA) were measured at hospitalization. Results the most common causes of immunosuppression observed in our severe COVID-19 population are hematological malignancies, immunosuppressant drugs for transplant, primary immunodeficiency and inflammatory bowel disease. Onset symptoms were fever (88%), cough (53%), dyspnoea (24%), asthenia (35%), anosmia and/or ageusia (17%), expectoration (12%). Compared to benign conditions, patients with malignancies show a lower lymphocytic count (490 vs 1100 cells/uL) and higher interleukin 6 (33 vs 13 pg/mL). Conclusions immunocompromised patients are at risk of adverse outcome from COVID-19. Hematological malignancies and anti-CD20 therapies induce a high risk. Primary immunodeficiency and classical immunosuppressant such as calcineurin inhibitors and antimetabolites share an intermediate risk.

Comparison of Clinical Outcome between Immunocompetent and Immunocompromised Children Aged 1 to 12 Years Admitted with Acute COVID-19 Infection – A Retrospective Review

“…11 Simioli et al found that immunocompromised adult patients are at risk of adverse outcomes from COVID-19, with a higher risk in patients having hematological malignancies. 12 Like our study, Fung and Babik reported similar manifestations of COVID-19 in immunocompromised and immunocompetent patients. 13…”

COVID-19-related health outcomes in people with primary immunodeficiency: A systematic review

“…A total of 459 people with PI and COVID-19 are described from 54 of the 68 studies [ 12 , 13 , 16 , [18] , [19] , [20] , [21] , 24 , 26 , 27 , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] ] (Table 2). These cases came from case reports as well as cohort studies with information available for individual patients.…”

COVID-19 in patients with B cell immune deficiency

“…The most important difference between immunocompromised and non-immunocompromised hosts is the increased risk of disease progression ( Fung and Babik, 2021 ). Antigen testing and nucleic acid amplification detection remain the mainstay of testing in acute illness ( Simioli et al, 2021 ).…”