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Múñez-Rubio E, Calderón-Parra J, Fernández-Cruz A, Moreno-Torres V, Blanco-Alonso S, Ramos-Martínez A. Re: 'the unique COVID-19 presentation of patients with B cell depletion' by Belkin et al. Clin Microbiol Infect 2023; 29:272-273. [PMID: 36309327 PMCID: PMC9605786 DOI: 10.1016/j.cmi.2022.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Elena Múñez-Rubio
- Infectious Diseases Unit, Internal Medicine Department. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain.
| | - Jorge Calderón-Parra
- Infectious Diseases Unit, Internal Medicine Department. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Internal Medicine Department. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - Víctor Moreno-Torres
- Infectious Diseases Unit, Internal Medicine Department. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | | | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Internal Medicine Department. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain,Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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2
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Mendel A, Colmegna I, Bourque G, Rajda E, Lee TC, Gálvez JH, Vinet É, Cheng MP. More than a 'Hundred Days War': Persistent SARS-CoV-2 infection in a patient with ANCA-associated vasculitis. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:131-134. [PMID: 36337358 PMCID: PMC9608116 DOI: 10.3138/jammi-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few reports exist on the characteristics and outcomes of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised hosts. METHODS A 49-year-old patient with granulomatosis with polyangiitis (GPA) and a renal transplant experienced multiple hospitalizations for coronavirus disease 2019 (COVID-19) pneumonia and relapses between October 2020 and February 2021. Careful chart review of medical history, hospitalizations, and microbiological testing including SARS-CoV-2 cycle threshold values, therapies, and imaging was undertaken. SARS-CoV-2 genome sequencing was performed in five viral samples to distinguish persistent infection from re-infection with a different strain. RESULTS Sequencing confirmed that all samples tested were from the same viral lineage, indicating a long-term, persistent infection rather than re-infection with a new strain. The patient ultimately stabilized after two courses of remdesivir plus dexamethasone, replacement intravenous immunoglobulin, and bamlanivimab. Rituximab maintenance therapy for vasculitis remains on hold. CONCLUSIONS SARS-CoV-2 may persist for several months in immunocompromised hosts and may go unrecognized as an ongoing active infection. More studies are needed to determine how to optimize COVID-19 treatment in this vulnerable population.
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Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ines Colmegna
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Guillaume Bourque
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
| | - Ewa Rajda
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Todd C Lee
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - José Héctor Gálvez
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
| | - Évelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Matthew P Cheng
- Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada
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3
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Gros C, Mariaggi AA, Meritet JF, André E, Boisson M, Combier A, Descamps E, Frantz C, Wanono S, Morel J, Avouac J, Rozenberg F, Miceli-Richard C, Fogel O. Évaluation systématique de la réponse humorale contre le SARS-CoV-2 dans une cohorte française de 283 patients atteints d’un rhumatisme inflammatoire chronique ☆. REVUE DU RHUMATISME (ED. FRANCAISE : 1993) 2022; 89:405-411. [PMID: 35530370 PMCID: PMC9059432 DOI: 10.1016/j.rhum.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/14/2022]
Abstract
Objectifs Estimer la séroprévalence de l’infection par le SARS-CoV-2 chez les patients atteints de rhumatisme inflammatoire chronique et préciser la proportion de formes asymptomatiques et symptomatiques de COVID-19. Méthodes Nous avons réalisé un dépistage systématique de l’infection à COVID-19 parmi les patients atteints de spondyloarthrite (SpA, n = 143) et de polyarthrite rhumatoïde (PR, n = 140) suivis en hôpital de jour de rhumatologie à l’hôpital Cochin à Paris entre juin et août 2020. Pour chaque patient, un test sérologique détectant les IgG dirigées contre la protéine nucléocapside N (anti-N) et, pour certains patients, contre la protéine Spike (anti-S) du SARS-CoV 2, était réalisé. Nous avons effectué une analyse descriptive des données. Résultats Durant la période de juin à août 2020, la séroprévalence (IgG anti-N) du SARS-CoV-2 dans notre population était de 2,83 % (8/283 patients) sans distinction entre les patients atteints de PR et de SpA (2,14 % et 3,5 % respectivement). Sur les 283 patients, 11 ont eu un diagnostic d’infection à SARS-CoV-2 (3,8 %). Parmi ces 11 patients, 2 patients ont fait une forme asymptomatique de COVID-19 (18 %) dont le diagnostic a été confirmé sur la positivité de la sérologie anti-S. Sur les 283 patients, 85 % étaient sous biothérapie, principalement sous Rituximab (RTX) (n = 44) et Infliximab (IFX) (n = 136). Conclusion La séroprévalence du SARS-CoV-2 chez les patients atteints de rhumatismes inflammatoires chroniques, principalement sous biothérapie, était de 2,83 %. Parmi les patients infectés, 18 % étaient asymptomatiques. La stratégie associant interrogatoire des patients et sérologie anti-N est performante pour dépister les infections à SARS-CoV-2.
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Affiliation(s)
- Clothilde Gros
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Alice-Andrée Mariaggi
- Université Paris Descartes, service de virologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Jean-François Meritet
- Université Paris Descartes, service de virologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Emma André
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Margaux Boisson
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Alice Combier
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Elise Descamps
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Camelia Frantz
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Sarah Wanono
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Jacques Morel
- Service de rhumatologie, CHU et Université de Montpellier, France
| | - Jérôme Avouac
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Flore Rozenberg
- Université Paris Descartes, service de virologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Corinne Miceli-Richard
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France,Unité Mixte AP–HP/Institut Pasteur, Institut Pasteur, unité immunorégulation, Paris, France,Auteur correspondant
| | - Olivier Fogel
- Université Paris Descartes, service de rhumatologie, hôpital Cochin, AP–HP, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
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Progression of COVID-19 in a Patient on Anti-CD20 Antibody Treatment: Case Report and Literature Review. Case Rep Infect Dis 2022; 2022:8712424. [PMID: 35251723 PMCID: PMC8896938 DOI: 10.1155/2022/8712424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Accumulating evidence suggests that anti-CD20 treatments are associated with a more severe course of COVID-19. We present the case of a 72-year-old woman treated with the B-cell-depleting anti-CD20 antibody rituximab for seropositive rheumatoid arthritis with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing a clinical relapse more than 4 weeks after the first manifestation. Persistently positive reverse transcription polymerase chain reaction (RT-PCR) results along with a drop in cycling threshold (Ct) values, in addition to recovery of identical viral genotype by whole genome sequencing (WGS) during the disease course, argued against reinfection. No seroconversion was noted, as expected on anti-CD20 treatment. Several other case reports have highlighted potentially fatal courses of COVID-19 associated with B-cell-depleting treatments.
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Systematic assessment of the humoral response against SARS-CoV-2 in a French cohort of 283 patients with rheumatic diseases. Joint Bone Spine 2021; 89:105312. [PMID: 34883243 PMCID: PMC8647388 DOI: 10.1016/j.jbspin.2021.105312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Objectives To estimate the seroprevalence of SARS-CoV-2 infection in patients with rheumatic diseases and to specify the proportion of asymptomatic and symptomatic forms of COVID-19. Methods We screened for SARS-CoV-2 infection among spondyloarthritis (SpA, n = 143) or rheumatoid arthritis (RA, n = 140) patients in our outpatient clinic at Cochin Hospital in Paris between June and August 2020. We performed a qualitative SARS-CoV-2 serological test which detects IgG directed against the N nucleocapsid protein (anti-N) and, for some patients, against the Spike protein (anti-S). Descriptive analyses were managed. Results During June–August 2020, the SARS-CoV-2 seroprevalence rate in our population was 2.83% (8/283 patients) without significant difference between RA and SpA patients (2.14% and 3.5%, respectively). We report 11 out of 283 patients (3.8%) with a diagnosis of SARS-CoV-2 infection. Among these 11 patients, 1 patient was asymptomatic (9%) with a confirmed diagnosis of COVID-19 by anti-S serology. Of the 283 patients, 85% were under bDMARDs, mainly on rituximab (RTX) (n = 44) and infliximab (IFX) (n = 136). Conclusions The seroprevalence of SARS-CoV-2 in patients with rheumatic diseases, mainly under bDMARDs treatments, was 2.83%. Among infected patients, 9% were asymptomatic. Detecting SARS-CoV-2 infections could be based on the strategy using patients’ interview and anti-N serology.
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Chaudhry B, Didenko L, Chaudhry M, Malek A, Alekseyev K. Longest reported case of symptomatic COVID-19 reporting positive for over 230 days in an immunocompromised patient in the United States. SAGE Open Med Case Rep 2021; 9:2050313X211040028. [PMID: 34413976 PMCID: PMC8369853 DOI: 10.1177/2050313x211040028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
Coronavirus 2019 (COVID-19) pneumonia was first noted in Wuhan, China. Since the start of the pandemic, there have been millions of cases diagnosed. The average time from onset of symptoms to testing negative SARS-CoV-2 via reverse transcription polymerase chain reaction is roughly 25 days. In patients who continually test positive for COVID-19, it is essential to determine precisely which risk factors contribute to the increase in viral shedding duration. We present a case about a 62-year-old man who has persistently tested positive for COVID-19 for more than 230 days. We followed his treatment course, in which he had been hospitalized multiple times since the onset of symptoms back in April 2020. We have determined that patients with immunosuppression, especially those taking corticosteroids, are at increased risk of prolonged viral shedding. It is essential to continually monitor these immunocompromised patients as they required a greater time period in order to have an appropriate immune response in which antibodies are created.
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Affiliation(s)
| | - Lidiya Didenko
- Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA
| | | | - Andrew Malek
- Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA
| | - Kirill Alekseyev
- Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA
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Rodriguez-Pla A, Vikram HR, Khalid V, Wesselius LJ. COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review. Rheumatol Int 2021; 41:1509-1514. [PMID: 34091704 PMCID: PMC8180184 DOI: 10.1007/s00296-021-04905-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
A 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.
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Affiliation(s)
| | | | - Vanood Khalid
- Division of Hospital Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lewis J Wesselius
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
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Jones JM, Faruqi AJ, Sullivan JK, Calabrese C, Calabrese LH. COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: A Scoping Review. Pathog Immun 2021; 6:76-103. [PMID: 34056149 PMCID: PMC8150936 DOI: 10.20411/pai.v6i1.435] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. METHODS To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. RESULTS Among patients with iatrogenic B-cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous forms of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. CONCLUSIONS Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to control for clinical and biologic confounders of disease severity.
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Affiliation(s)
- Jessica M. Jones
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Aiman J. Faruqi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James K. Sullivan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Cassandra Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
| | - Leonard H. Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
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Kant S, Raman G, Damera P, Antiochos B, Seo P, Geetha D. Characteristics and Outcomes of COVID-19 in Patients With Antineutrophil Cytoplasmic Antibody -Associated Vasculitis. Kidney Int Rep 2021; 6:806-809. [PMID: 33521401 PMCID: PMC7837286 DOI: 10.1016/j.ekir.2020.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gaurav Raman
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pranav Damera
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brendan Antiochos
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philip Seo
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Immunosuppressants. REACTIONS WEEKLY 2021. [PMCID: PMC7791900 DOI: 10.1007/s40278-021-88939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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