Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use

Abstract

Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

“…For these exploratory analyses, 13 uncontrolled large case series without individual patient data enrolling 358 participants were included in descriptive analysis . In this study, 125 case reports or case series enrolling 265 participants were included for patient-level exploratory analyses. One study was included in both the descriptive analysis and the individual patient data analysis because individual patient data were available only for a subgroup of patients.…”

Stress and Hypertension in War and Covid-19 Conditions

“…Фізіологічні зміни за умов стрес-реакції організму можуть бути і нечіткі, наприклад субмаксимальна частота серцевих скорочень і температура серця знижені (за «теплових» навантажень при 33°C щодо 13°C) [6]. Відзначені і численні випадки невиявленого адаптивного імунітету, поствакцинального чи пост-COVID-19-інфекції, у пацієнтів, які застосовували імунодепресанти [21]. При цьому лишається основне завдання для охорони здоров'я -мінімізація пізнього кардіометаболічного тягаря COVID-19, оптимізація стану серцево-судинної системи поза контекстом COVID-19 у майбутньому, розуміння соціальної ізоляції та її наслідків [3,22], обтяжених військовими діями.…”

Evaluation of anti-severe acute respiratory syndrome coronavirus 2 antibody levels in coronavirus disease breakthrough infection during immunosuppressive therapy in a patient with connective tissue disease-related interstitial lung disease

“…However, breakthrough infections, SARS-CoV-2 infection more than 2 weeks after a second vaccination of the mRNA vaccine or after a first vaccination of the viral vector vaccine, rarely occur when an individual who has been fully vaccinated against COVID-19 gets infected with SARS-CoV-2 [ 5–8 ]. A mechanism of breakthrough infection is decreased serum levels of anti-SARS-CoV-2-IgG antibody in response to vaccination originating from immunocompromised conditions induced by immunosuppressive therapy [ 9 ]. However, no reports have evaluated the levels of anti-SARS-CoV-2-IgG antibodies in breakthrough infections in cases undergoing immunosuppressive therapy with polypharmacy for connective tissue disease-related interstitial lung disease (CTD-ILD).…”