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Alhumaid S, Al Mutared KM, Al Alawi Z, Sabr Z, Alkhars O, Alabdulqader M, Al Dossary N, ALShakhs FM, Majzoub RA, Alalawi YH, Al Noaim K, Alnaim AA, Al Ghamdi MA, Alahmari AA, Albattat SS, Almubarak YS, Al Abdulmohsen EM, Al Shaikh H, Alobaidan ME, Almusallam HH, Alhassan FM, Alamer MA, Al-Hajji JA, Al-Hajji DA, Alkadi AA, Al Mutair A, Rabaan AA. Severity of SARS-CoV-2 infection in children with inborn errors of immunity (primary immunodeficiencies): a systematic review. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:69. [PMID: 37559153 PMCID: PMC10413516 DOI: 10.1186/s13223-023-00831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. OBJECTIVES To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. METHODS For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. RESULTS Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case-control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. CONCLUSION Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections-though the number of patients is small-but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1).
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Affiliation(s)
- Saad Alhumaid
- School of Pharmacy, University of Tasmania, Hobart, 7000, Australia.
| | - Koblan M Al Mutared
- Administration of Pharmaceutical Care, Ministry of Health, 66255, Najran, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Zainah Sabr
- Division of Allergy and Immunology, Pediatric Department, College of Medicine, King Khalid University, 62529, Abha, Saudi Arabia
| | - Ola Alkhars
- Pediatric Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Muneera Alabdulqader
- Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Ministry of Health, 36358, Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatemah M ALShakhs
- Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Rabab Abbas Majzoub
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Yousef Hassan Alalawi
- Ear, Nose and Throat Department, Al Jabr Hospital for Eye, Ear, Nose and Throat, Ministry of Health, 36422, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Khalid Al Noaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Abdulrahman A Alnaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Abdulaziz A Alahmari
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Sawsan Sami Albattat
- College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia
| | - Yasin S Almubarak
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | | | - Hanan Al Shaikh
- Infection Prevention and Control Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Mortadah Essa Alobaidan
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Hadi Hassan Almusallam
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatimah Mohammed Alhassan
- Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed Abdulhadi Alamer
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Jawad Ali Al-Hajji
- Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 24231, Hofuf, Al-Ahsa, Saudi Arabia
| | - Duaa Ali Al-Hajji
- Nursing Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia
| | - Anwar Ahmed Alkadi
- Nursing Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, 36342, Al Mubarraz, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdul Rahman University, 11564, Riyadh, Saudi Arabia
- School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, 33048, Dhahran, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, 31311, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia
- Department of Public Health/Nutrition, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
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Conti F, Pacillo L, Amodio D, Rivalta B, Moratti M, Campoli C, Zama D, Corsini I, Giancotta C, Bernardi S, Naviglio S, Cicalese MP, Rabusin M, Aiuti A, Cancrini C, Lanari M, Viale P, Palma P, Pession A, Finocchi A. SARS-CoV-2 infection and treatment in a cohort of patients with inborn errors of immunity. Pediatr Allergy Immunol 2022; 33:e13833. [PMID: 36003051 PMCID: PMC9538295 DOI: 10.1111/pai.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucia Pacillo
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,PhD Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Donato Amodio
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Beatrice Rivalta
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,PhD Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Mattia Moratti
- Specialty School of Paediatrics, University of Bologna, Bologna, Italy
| | - Caterina Campoli
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Daniele Zama
- Paediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ilaria Corsini
- Paediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carmela Giancotta
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics (DPUO), Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Samuele Naviglio
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Rabusin
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina Cancrini
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Systems Medicine, Chair of Pediatrics, University of Rome "Tor Vergata", Rome, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Systems Medicine, Chair of Pediatrics, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Finocchi
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Systems Medicine, Chair of Pediatrics, University of Rome "Tor Vergata", Rome, Italy
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Sanchez Clemente N, Penner J, Breuer J, Ip W, Booth C. Case Report: A Severe Paediatric Presentation of COVID-19 in APDS2 Immunodeficiency. Front Immunol 2022; 13:881259. [PMID: 35707532 PMCID: PMC9190774 DOI: 10.3389/fimmu.2022.881259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
Critical respiratory manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are rare in children, and little is known about how immunocompromised children respond to the infection. We report a case of a 4-year-old boy with activated PI3K delta syndrome type 2 (APDS2) with a protracted and severe COVID-19 course with both inflammatory and acute respiratory features. He was treated with remdesivir, nitazoxanide, high-dose corticosteroids, and tocilizumab and made a full recovery. We propose that remdesivir may be used in combination with nitazoxanide to improve viral clearance and reduce the chance of resistance in treating acute SARS-CoV-2 infection.
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Affiliation(s)
- Nuria Sanchez Clemente
- Immunology and Infectious Diseases Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Justin Penner
- Immunology and Infectious Diseases Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Judith Breuer
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Winnie Ip
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Paediatric Immunology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Claire Booth
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Paediatric Immunology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Giardino G, Romano R, Coppola E, Cillo F, Borzachiello C, De Luca M, Palamaro L, Toriell E, Prencipe R, Cirillo E, Pignata C. SARS-CoV-2 infection in the immunodeficient host: necessary and dispensable immune pathways. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3237-3248. [PMID: 34273582 PMCID: PMC8279920 DOI: 10.1016/j.jaip.2021.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Since its outbreak in late December 2019 in Wuhan, coronavirus disease 2019 pandemic has posed a therapeutic challenge for the world population, with a plenty of clinical pictures and a broad spectrum of severity of the manifestations. In spite of initial speculations on a direct role of primary or acquired immune deficiency in determining a worse disease outcome, recent studies have provided evidence that specific immune defects may either serve as an experimentum naturae entailing this risk or may not be relevant enough to impact the host defense against the virus. Taken together, these observations may help unveil pathogenetic mechanisms of the infection and suggest new therapeutic strategies. Thus, in this review, we summarize current knowledge regarding the mechanisms of immune response against severe acute respiratory syndrome coronavirus 2 infection and clinical manifestations with a special focus on children and patients presenting with congenital or acquired immune deficiency.
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Affiliation(s)
- Giuliana Giardino
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Roberta Romano
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Emma Coppola
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Francesca Cillo
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Carla Borzachiello
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Martina De Luca
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Loredana Palamaro
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Elisabetta Toriell
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Rosaria Prencipe
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Emilia Cirillo
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, Naples, Italy;.
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