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Coronavirus disease 2019 in patients with inborn errors of immunity: An international study.

Isabelle Meyts, Giorgia Bucciol, Isabella Quinti, Bénédicte Neven, Alain Fischer, Elena Seoane, Eduardo Lopez-Granados, Carla Gianelli, Angel Robles-Marhuenda, Pierre-Yves Jeandel, Catherine Paillard, Vijay G Sankaran, Yesim Yilmaz Demirdag, Vassilios Lougaris, Alessandro Aiuti, Alessandro Plebani, Cinzia Milito, Virgil Ash Dalm, Kissy Guevara-Hoyer, Silvia Sánchez-Ramón, Liliana Bezrodnik, Federica Barzaghi, Luis Ignacio Gonzalez-Granado, Grant R Hayman, Gulbu Uzel, Leonardo Oliveira Mendonça, Carlo Agostini, Giuseppe Spadaro, Raffaele Badolato, Annarosa Soresina, François Vermeulen, Cedric Bosteels, Bart N Lambrecht, Michael Keller, Peter J Mustillo, Roshini S Abraham, Sudhir Gupta, Ahmet Ozen, Elif Karakoc-Aydiner, Safa Baris, Alexandra F Freeman, Marco Yamazaki-Nakashimada, Selma Scheffler-Mendoza, Sara Espinosa-Padilla, Andrew R Gennery, Stephen Jolles, Yazmin Espinosa, M Cecilia Poli, Claire Fieschi, Fabian Hauck, Charlotte Cunningham-Rundles, Nizar Mahlaoui, IKlaus Warnatz, Kathleen E Sullivan, Stuart G Tangye.

J Allergy Clin Immunol 2021 Feb;147(2):520-531.

DOI: 10.1016/j.jaci.2020.09.010


Background: There is uncertainty about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in individuals with rare inborn errors of immunity (IEI), a population at risk of developing severe coronavirus disease 2019. This is relevant not only for these patients but also for the general population, because studies of IEIs can unveil key requirements for host defense.

Objective: We sought to describe the presentation, manifestations, and outcome of SARS-CoV-2 infection in IEI to inform physicians and enhance understanding of host defense against SARS-CoV-2.

Methods: An invitation to participate in a retrospective study was distributed globally to scientific, medical, and patient societies involved in the care and advocacy for patients with IEI.

Results: We gathered information on 94 patients with IEI with SARS-CoV-2 infection. Their median age was 25 to 34 years. Fifty-three patients (56%) suffered from primary antibody deficiency, 9 (9.6%) had immune dysregulation syndrome, 6 (6.4%) a phagocyte defect, 7 (7.4%) an autoinflammatory disorder, 14 (15%) a combined immunodeficiency, 3 (3%) an innate immune defect, and 2 (2%) bone marrow failure. Ten were asymptomatic, 25 were treated as outpatients, 28 required admission without intensive care or ventilation, 13 required noninvasive ventilation or oxygen administration, 18 were admitted to intensive care units, 12 required invasive ventilation, and 3 required extracorporeal membrane oxygenation. Nine patients (7 adults and 2 children) died.

Conclusions: This study demonstrates that (1) more than 30% of patients with IEI had mild coronavirus disease 2019 (COVID-19) and (2) risk factors predisposing to severe disease/mortality in the general population also seemed to affect patients with IEI, including more younger patients. Further studies will identify pathways that are associated with increased risk of severe disease and are nonredundant or redundant for protection against SARS-CoV-2.

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