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Castano-Jaramillo LM, Yamazaki-Nakashimada MA, O'Farrill-Romanillos PM, Muzquiz Zermeño D, Scheffler Mendoza SC, Venegas Montoya E, García Campos JA, Sánchez-Sánchez LM, Gámez González LB, Ramírez López JM, Bustamante Ogando JC, Vásquez-Echeverri E, Medina Torres EA, Lopez-Herrera G, Blancas Galicia L, Berrón Ruiz L, Staines-Boone AT, Espinosa-Padilla SE, Segura Mendez NH, Lugo Reyes SO. COVID-19 in the Context of Inborn Errors of Immunity: a Case Series of 31 Patients from Mexico. J Clin Immunol 2021; 41:1463-1478. [PMID: 34114122 PMCID: PMC8191444 DOI: 10.1007/s10875-021-01077-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patients with inborn errors of immunity (IEI) have a compromised or inappropriate immune response. Although they might be considered a high-risk group for severe SARS-CoV-2 infection, the reported impact of COVID-19 in these patients has been reassuring, while the differential susceptibility of distinct types of IEI remains unclear. OBJECTIVE We aimed to describe the findings and outcomes of our known patients with IEI who were diagnosed with COVID-19. METHODS In a retrospective study from March 2020 to February 2021, four centers in Mexico collected clinical, laboratory, and genetic data from pediatric and adult patients with known diagnoses of IEI who presented with COVID-19, based on compatible symptoms and positive SARS-CoV-2 testing or known household exposure. RESULTS We report 31 patients with known IEI from Mexico who presented with SARS-CoV-2 infection. Seventy-four percent were male, 52% were pediatric, and 81% survived. Their ages ranged from 5 months to 56 years, with a median of 17 years. Sixty-five percent had predominant antibody deficiencies, 48% were hospitalized, and 26% required ICU. Pediatric patients had a higher hospital admission rate than adults. Inpatient mortality was 40%, and ICU mortality rate was 63%. Forty-eight percent developed pneumonia, while 36% had evidence of hyperinflammation (4 adults and 7 children). Predominant laboratory features were lymphopenia and thrombocytopenia, seen in 70 and 44% of patients, respectively. The serum D-dimer median value was 2.6 (0.5-20.6) μg/mL, and the median highest ferritin value was 1015 (32-10,303) ng/mL. Intravenous immunoglobulin was used in 80% of patients. Other treatments included macrolides (39%) and corticosteroids (29%). Six patients died from secondary infection or uncontrolled systemic inflammation. DISCUSSION Although impaired immunity due to IEI may be a predisposing factor for severe COVID-19, most of our patients with IEI who acquired the SARS-CoV-2 infection developed a well-tolerated infection and survived, as have more than 80% of worldwide reported patients to date. An impaired immune or inflammatory response may be a predisposing factor for some and a protective factor for others. A systematic review of the literature could help identify those patients at risk of severe disease and complications. Healthcare-associated infections should be aggressively prevented.
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Affiliation(s)
| | | | - Patricia M O'Farrill-Romanillos
- Allergy and Immunology Department, Hospital de Especialidades, National Medical Center, Siglo XXI" IMSS, Mexico City, Mexico
| | | | | | - Edna Venegas Montoya
- Immunology Service, Hospital de Especialidades UMAE 25 IMSS, Monterrey, NL, Mexico
| | | | | | - Luisa B Gámez González
- Clinical Immunology Service, Hospital Infantil Especialidades de Chihuahua, Chihuahua, Mexico
| | | | - Juan Carlos Bustamante Ogando
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Estefanía Vásquez-Echeverri
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Edgar Alejandro Medina Torres
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Gabriela Lopez-Herrera
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Lizbeth Blancas Galicia
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Laura Berrón Ruiz
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | | | - Sara Elva Espinosa-Padilla
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Nora Hilda Segura Mendez
- Allergy and Immunology Department, Hospital de Especialidades, National Medical Center, Siglo XXI" IMSS, Mexico City, Mexico
| | - Saul O Lugo Reyes
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico.
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Espinosa Rosales FJ, Bergés García A, Coronado Zarco IA, Dávila Gutiérrez G, Faugier Fuentes E, García Campos JA, Lugo Reyes SO, Martínez Murillo C, Mogica Martínez MD, Segura Méndez NH, Salmerón Mercado ME, Staines Boone AT, Vargas Cañas ES, Yamazaki Nakashimada MA. Consenso Mexicano para la prescripción de inmunoglobulina G como tratamiento de reemplazo e inmunomodulación. Acta Pediatr Mex 2018. [DOI: 10.18233/apm39no2pp134-1711574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G humana. Se revisaron las bases de datos MEDLINE, EMBASE, BVS-LILACS, NGS, NICE, CENETEC, Imbiomed, TripDatabase y Medigraphic. Para el análisis de la información se utilizaron algoritmos con términos Medical Subject Headings (MeSH) o Descriptores en Ciencias de la Salud (DeCS) específicos para cada enfermedad, con la intención de identificar guías de práctica clínica u otro tipo de guías, revisiones sistemáticas, metanálisis, ensayos clínicos aleatorizados, estudios clínicos, estudios descriptivos u observacionales y análisis de costobeneficio. Para el estudio de la evidencia se organizaron ocho grupos de trabajo, de acuerdo con el campo de conocimiento y la experiencia de los especialistas. Se formularon preguntas clínicas con el constructo PICO, por su acrónimo en inglés: Patients (pacientes o población), Intervention (intervención de interés), Comparison (comparación con otra intervención) y Outcome (desenlace de interés). Después de discutir las evidencias correspondientes y responder las preguntas, se redactó un documento con declaraciones específicas por indicación y calidad de evidencia con el esquema GRADE. Las declaraciones fueron sometidas a evaluación y consenso por todo el grupo de trabajo y se elaboró un documento con el formato actual para validación externa por los principales representantes de las academias y los colegios de las áreas del conocimiento incluidas, para finalmente publicarlo como tratamiento de referencia en la prescripción de la inmunoglobulina G humana en México. CONCLUSIONES: La integración del consenso representa un esfuerzo en aras de proporcionar a los clínicos de instituciones de segundo y tercer nivel de atención en salud de México. Además de proporciona un instrumento validado para la prescripción correcta de inmunoglobulina G humana como tratamiento de reemplazo e inmunomodulación. Este documento debe actualizarse de manera continua, debido al activo campo de investigación clínica en diferentes aplicaciones de la medicina.
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Staines-Boone AT, Deswarte C, Venegas Montoya E, Sánchez-Sánchez LM, García Campos JA, Muñiz-Ronquillo T, Bustamante J, Espinosa-Rosales FJ, Lugo Reyes SO. Multifocal Recurrent Osteomyelitis and Hemophagocytic Lymphohistiocytosis in a Boy with Partial Dominant IFN-γR1 Deficiency: Case Report and Review of the Literature. Front Pediatr 2017; 5:75. [PMID: 28516082 PMCID: PMC5413492 DOI: 10.3389/fped.2017.00075] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/28/2017] [Indexed: 12/28/2022] Open
Abstract
Mutations in the genes coding for cytokines, receptors, second messengers, and transcription factors of interferon gamma (IFN-γ) immunity cause Mendelian susceptibility to mycobacterial disease (MSMD). We report the case of a 7-year-old male patient with partial dominant (PD) IFN-γ receptor 1 deficiency who had suffered from multifocal osteomyelitis attributable to bacille Calmette-Guérin vaccination since the age of 18 months. He developed hemophagocytic lymphohistiocytosis (HLH), a hyper-inflammatory complication, and died with multiorgan dysfunction, despite having been diagnosed and treated relatively early. Patients with PD IFN-γR1 deficiency usually have good prognosis and might respond to human recombinant subcutaneous IFN-γ. Several monogenic congenital defects have been linked to HLH, a catastrophic "cytokine storm" that is usually ascribed to lymphocyte dysfunction and thought to be triggered by interferon gamma. This is the sixth patient with both MSMD and HLH of whom we are aware. The fact that patients with macrophages that cannot respond to IFN-γ still develop HLH, bring these assumptions into question.
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Affiliation(s)
| | - Caroline Deswarte
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut Imagine, Paris, France
| | - Edna Venegas Montoya
- Pediatrics Department, UMAE 25 IMSS, Monterrey, Mexico.,Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | | | | | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut Imagine, Paris, France
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