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Ono R, Kitagawa I. SARS-CoV-2 infection-induced immune thrombocytopenia: a systematic review of current reports. Ann Hematol 2024:10.1007/s00277-024-05765-1. [PMID: 38652242 DOI: 10.1007/s00277-024-05765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count with increased risk of bleeding, and viral infection may trigger ITP. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-induced ITP has been increasingly reported. We systemically reviewed the previously reported cases of SARS-CoV-2 infection-induced ITP and identified a total of 105 patients from 68 studies. The median age was 61 years, and 14 patients (12%) were < 18 years old (pediatric cases). In adult cases, a total of 53% patients were classified as moderate to severe SARS-CoV-2 infection. The median platelet count at diagnosis and nadir were 6,000/µL and 4,000/µL, respectively. When comparing platelet levels between non-severe SARS-CoV-2 infection and moderate to severe SARS-CoV-2 infection, the median values of platelet levels at diagnosis were not significantly different between the groups (4,000/µL in non-severe SARS-CoV-2 infection and 9,000/µL in moderate to severe SARS-CoV-2 infection, p-value = 0.22). Median nadir platelet levels were also not significantly different between groups (4,000/µL in non-severe SARS-CoV-2 infection and 8,000/µL in moderate to severe SARS-CoV-2 infection, p-value = 0.27). More than half of the cases (53 patients) were treated with combination therapy including steroid, intravenous immunoglobulin, and eltrombopag. Major bleeding and intracranial hemorrhage occurred in ten (11%) and six (6.6%) cases, respectively. The overall mortality rate was 7%. In pediatric cases, none of the patients experienced major bleeding and lethal outcomes.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Japan, 1-5-1 Tsujido Kandai, Fujisawa, Kanagawa, 251-0041, Japan
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Mokhtar G, Abdelbaky A, Adly A, Ezzat D, Abdel Hakeem G, Hassab H, Youssry I, Ragab I, Sherief LM, Zakaria M, Hesham M, Salama N, Salah N, Afifi RAA, El-Ashry R, Makkeyah S, Adolf S, Amer YS, Omar TEI, Bussel J, Abd El Raouf E, Atfy M, Ellaboudy M, Florez I. Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology-A Limited-Resource Country Perspective. CHILDREN (BASEL, SWITZERLAND) 2024; 11:452. [PMID: 38671669 PMCID: PMC11048986 DOI: 10.3390/children11040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt's health care context. METHODS The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. DISCUSSION The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis-Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ashraf Abdelbaky
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Dina Ezzat
- Pediatric Hematology Unit, Pediatric Department, Beni-Suef University, Beni-Suef 62521, Egypt;
- Pediatric Department, October 6 University, Giza 12585, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Pediatric Department, Minia University, Minia 61519, Egypt;
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - Ilham Youssry
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Laila M. Sherief
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Niveen Salama
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Nouran Salah
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Rasha A. A. Afifi
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Pediatric Department, Mansoura University, Mansoura 35516, Egypt;
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Sonia Adolf
- Pediatric, Hematology Department, Institute of Medical Research and Clinical Studies, National Research Center, Giza 1770, Egypt;
| | - Yasser S. Amer
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), Ribeirao Preto 14040-900, SP, Brazil
| | - Tarek E. I. Omar
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - James Bussel
- Pediatrics Department, Well Cornell Medical College, New York, NY 10065, USA;
| | - Eman Abd El Raouf
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Mervat Atfy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mohamed Ellaboudy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin 050010, Colombia;
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Anzai T, Nakashima N, Betsui H, Kawahara Y, Hayashi Y, Kimura H, Shimada A. Infant case of severe immune thrombocytopenia caused by COVID-19 infection. EJHAEM 2023; 4:1148-1151. [PMID: 38024599 PMCID: PMC10660122 DOI: 10.1002/jha2.811] [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] [Received: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Abstract
Immune thrombocytopenia (ITP) is a common childhood acute autoimmune bleeding disorder caused by numerous viruses and characterized by isolated thrombocytopenia. Although cases of ITP caused by coronavirus disease 2019 (COVID-19) infection have been reported in adults, pediatric reports are limited. We present the case of a 1-year-old girl who developed COVID-19-infection-related ITP with a very low platelet count (0.0 × 104/μL). We searched for COVID-19-related pediatric ITP cases and found 10 other cases, with the majority having platelet counts of <1.0 × 104/μL. Although pediatric ITP cases caused by COVID-19 infection may be severe, further studies are needed.
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Affiliation(s)
- Tatsuya Anzai
- Department of PediatricsJichi Medical UniversityShimotsukeTochigiJapan
- Department of PediatricsKoga Red Cross HospitalKogaIbarakiJapan
| | - Naomi Nakashima
- Department of PediatricsKoga Red Cross HospitalKogaIbarakiJapan
| | - Hiroyuki Betsui
- Department of PediatricsJichi Medical UniversityShimotsukeTochigiJapan
| | - Yuta Kawahara
- Department of PediatricsJichi Medical UniversityShimotsukeTochigiJapan
| | - Yuriko Hayashi
- Department of Health ScienceGunma Paz University Graduate SchoolTakasakiGunmaJapan
| | - Hirokazu Kimura
- Department of Health ScienceGunma Paz University Graduate SchoolTakasakiGunmaJapan
| | - Akira Shimada
- Department of PediatricsJichi Medical UniversityShimotsukeTochigiJapan
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Caseiro Alves ME, Carmo F, Malato M, Cunha F. Immune thrombocytopenia in the setting of acute SARS-CoV-2 infection. BMJ Case Rep 2023; 16:e254352. [PMID: 37385718 DOI: 10.1136/bcr-2022-254352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an immune-mediated event, characterised by the destruction of platelets by autoantibodies resulting in isolated thrombocytopaenia (platelets <100 x109/L). In children, most cases are preceded by a viral infection. Cases of ITP in the setting of SARS-CoV-2 infection have been described. We describe a previously healthy boy, who presented with an extensive frontal and periorbital haematoma, petechial rash on the trunk and coryza. He had suffered a minor head trauma, 9 days before admission. Blood tests revealed a platelet count of 8000/µL. The remainder study was unremarkable, except for a positive SARS-CoV-2 PCR. Treatment comprised a single dose of intravenous immunoglobulin, with increase in platelet count and no recurrence. We made a working diagnosis of an ITP concurrent with a SARS-CoV-2 infection. Although few cases have been described, SARS-CoV-2 might be considered as a trigger for ITP.
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Affiliation(s)
- M Eduarda Caseiro Alves
- Pediatria Médica, Centro Hospitalar e Universitário de Lisboa Central E.P.E, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Filipa Carmo
- Pediatria, Centro Hospitalar e Universitário de Lisboa Norte, E P E, Lisboa, Portugal
| | - Madalena Malato
- Pediatria Geral, Hospital de Vila Franca de Xira, E P E, Vila Franca de Xira, Portugal
| | - Florbela Cunha
- Pediatria Geral, Hospital de Vila Franca de Xira, E P E, Vila Franca de Xira, Portugal
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Schultz CM, Burke LA, Kent DA. A Systematic Review and Meta-analysis of the Initial Literature Regarding COVID-19 Symptoms in Children in the United States. J Pediatr Health Care 2023:S0891-5245(23)00055-X. [PMID: 36948964 PMCID: PMC10020381 DOI: 10.1016/j.pedhc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION COVID-19 symptom presentation among adults is mostly understood. However, understanding COVID-19 symptom presentation in children lags. METHOD A literature search was conducted in three electronic databases. Twenty-three initial publications addressing COVID-19 symptom presentation among hospitalized children in the United States met the criteria for review and meta-analysis. RESULTS Fever, the most common symptom, was present in nearly all cases. Gastrointestinal, respiratory, oral symptoms, and rash occurred in over half of the cases. Disease severity assessment showed that comorbidities were present in one-third of patients; intensive care was needed for half of the patients, and supplemental oxygen and mechanical ventilation were needed by 13.3% and 7.1%, respectively. DISCUSSION The magnitude and significance of COVID-19 symptoms in children compared with those in adults and three common childhood viral illnesses: influenza, respiratory syncytial virus, and gastroenteritis, are discussed. Important clinical differences were found that may help clinicians distinguish COVID-19 from other illnesses.
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Dain AS, Whitworth H, Raffini L. Letter to the Editor in Response to "Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients" Published in December 2021. J Pediatr Hematol Oncol 2023; 45:44-45. [PMID: 35973085 PMCID: PMC9812853 DOI: 10.1097/mph.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Aleksandra S Dain
- Department of Pediatrics Children's Hospital of Philadelphia University of Pennsylvania Philadelphia, PA
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7
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Shinno K, Banno Y, Kamimaki I. Severe immune thrombocytopenia that developed immediately after COVID-19 in a school-aged patient: A case report. Front Pediatr 2023; 11:1120093. [PMID: 37033169 PMCID: PMC10073461 DOI: 10.3389/fped.2023.1120093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder that is sometimes triggered by a preceding viral infection and is characterized by a transient or persistent decrease in the platelet (Plt) count. Herein, we report the first pediatric case of severe ITP that developed immediately after the diagnosis of coronavirus disease 2019 (COVID-19) in a school-aged girl. A previously healthy six-year-old girl was diagnosed with COVID-19 a day before experiencing a high fever, sore throat, and headache. She also presented with gingival hemorrhage, petechiae around both eyes and on the chest, and ecchymosis on her right leg. Based on the mucosal hemorrhage and a very low Plt count of 3 × 103/µl, we diagnosed her with severe ITP and urgently treated her with intravenous immunoglobulin (IVIG) to prevent life-threatening hemorrhage. The Plt count increased to 266 × 103/µl one week after treatment with IVIG. Given the possibility of severe ITP secondary to COVID-19, patients with COVID-19 should be carefully examined for the signs of ITP, such as mucosal hemorrhage. Their Plt counts should also be monitored.
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8
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Auteri G, Paglia S, Mazzoni C, Biondo M, Venturi M, Romagnoli AD, Bartoletti D, Cavo M, Vianelli N, Palandri F. Immune Thrombocytopenia Onset and Relapse During the COVID-19 Pandemic. A Monocenter Study. Mediterr J Hematol Infect Dis 2023; 15:e2023029. [PMID: 37180204 PMCID: PMC10171210 DOI: 10.4084/mjhid.2023.029] [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: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
Background And Objectives Several infections and vaccinations can provoke immune thrombocytopenia (ITP) onset or relapse. Information on ITP epidemiology and management during the Covid-19 pandemic is scarce. In a large monocenter ITP cohort, we assessed the incidence and risk factors for: 1) ITP onset/relapse after Covid19 vaccination/infection; 2) Covid19 infection. Methods Information on the date/type of anti-Covid-19 vaccine, platelet count before and within 30 days from the vaccine, and date/grade of Covid-19 was collected via phone call or during hematological visits. ITP relapse was defined as a drop in PLT count within 30 days from vaccination, compared to PLT count before vaccination that required a rescue therapy OR a dose increase of an ongoing therapy OR a PLT count <30 ×109/L with ≥20% decrease from baseline. Results Between February 2020 and January 2022, 60 new ITP diagnoses were observed (30% related to Covid-19 infection or vaccination). Younger and older ages were associated with a higher probability of ITP related to Covid19 infection (p=0.02) and vaccination (p=0.04), respectively. Compared to Covid-19-unrelated ITP, Infection- and vaccine-related ITP had lower response rates (p=0.03) and required more prolonged therapy (p=0.04), respectively. Among the 382 patients with known ITP at the pandemic start, 18.1% relapsed; relapse was attributed to Covid-19 infection/vaccine in 52.2%. The risk of relapse was higher in patients with active disease (p<0.001) and previous vaccine-related relapse (p=0.006). Overall, 18.3% of ITP patients acquired Covid19 (severe in 9.9%); risk was higher in unvaccinated patients (p<0.001). Conclusions All ITP patients should receive ≥1 vaccine dose and laboratory follow-up after vaccination, with a case-by-case evaluation of completion of the vaccine program if vaccine-related ITP onset/relapse and with tempest initiation of antiviral therapy in unvaccinated patients.
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Affiliation(s)
- Giuseppe Auteri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Simona Paglia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Camilla Mazzoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Mattia Biondo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Marta Venturi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Andrea Davide Romagnoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Daniela Bartoletti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italy
| | - Nicola Vianelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
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Sarfraz M, Sarfraz A, Sarfraz Z, Nadeem Z, Khalid J, Butt SZ, Thevuthasan S, Felix M, Cherrez-Ojeda I. Contributing factors to pediatric COVID-19 and MIS-C during the initial waves: A systematic review of 92 case reports. Ann Med Surg (Lond) 2022; 81:104227. [PMID: 35937636 PMCID: PMC9339082 DOI: 10.1016/j.amsu.2022.104227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background As the coronavirus disease 2019 (COVID-19) pandemic continues to sweep the world with unprecedented speed and devastation, data has shown that cases in the pediatric population have been significantly lower than in the adult population. We conducted a systematic review of case reports to identify the contributing factors of confirmed pediatric COVID-19 patients. Methods Using the PubMed platform, and Cochrane Central, we searched for primary studies alone. All database searches were performed between December 2019 and December 2020. We incorporated keywords including “pediatrics,” “Case reports,” “Cases,” “Covid-19″ into all searches. Results A total of 92 records were included in this novel review. Of all patients, 58% were male and the mean age of the patients was 6.2 years (SD: 5.9). Contributing factors to MIS-C infections were G6PD deficiency (17.6%), Group A streptococcus co-infection (17.6%), infancy (11.8%), whereas those in COVID-19 pediatric patients included congenital (18.5%), and genetic defects (13.8%), in addition to vertical transmission or during infancy (16.9%). Data of baseline demographic characteristics and clinical sequelae of included COVID-19 pediatric and MIS-C patients is presented. Conclusion With schools reopening and closing, the pediatric age group is susceptible to high rates of COVID-19 community transmission. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts. COVID-19 continues to devastate communities worldwide. The pediatric population has faced the ups and downs of the many variants of disease. This systematic review includes a total of 92 studies and identifies key contributing factors from developmental, maternal and pediatric. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts.
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McDaniel CG, Commander SJ, DeLaura I, Cantrell S, Leraas HJ, Moore CB, Reed CR, Pahl KS, Tracy ET. Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients. J Pediatr Hematol Oncol 2022; 44:323-335. [PMID: 34862349 DOI: 10.1097/mph.0000000000002321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
Given the limited information on the coagulation abnormalities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients, we designed a systematic review to evaluate this topic. A comprehensive literature search was conducted for "SARS-CoV-2," "coagulopathy," and "pediatrics." Two authors independently screened the articles that the search returned for bleeding, thrombosis, anticoagulant and/or antiplatelet usage, and abnormal laboratory markers in pediatric patients with SARS-CoV-2, and the authors then extracted the relevant data. One hundred twenty-six publications were included. Thirty-four (27%) studies reported thrombotic complications in 504 patients. Thirty-one (25%) studies reported bleeding complications in 410 patients. Ninety-eight (78%) studies reported abnormal laboratory values in 6580 patients. Finally, 56 (44%) studies reported anticoagulant and/or antiplatelet usage in 3124 patients. The variety of laboratory abnormalities and coagulation complications associated with SARS-CoV-2 presented in this review highlights the complexity and variability of the disease presentation in infants and children.
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Affiliation(s)
| | | | | | - Sarah Cantrell
- Duke University School of Medicine
- Duke University Medical Center Library and Archives, Durham, NC
| | | | | | | | - Kristy S Pahl
- Division of Pediatric Hematology-Oncology
- Department of Pediatrics
| | - Elisabeth T Tracy
- Department of Surgery
- Division of Pediatric Surgery, Duke University Medical Center
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11
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Alahyari S, Moradi M, Rajaeinejad M, Jalaeikhoo H. Post-COVID-19 hematologic complications: a systematic review. Expert Rev Hematol 2022; 15:539-546. [PMID: 35584541 DOI: 10.1080/17474086.2022.2080051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 crisis continues around the world. Some patients developed complications after the disease, which have been reported in limited studies. The aim of this study is to comprehensively assess the post-COVID hematologic complications in patients. AREAS COVERED We searched PubMed, Scopus and Google Scholar between January 2020 and August 2021 using related keywords. Evaluation of the articles was performed by two independent researchers. The extracted data included number of patients, age, type of hematological complication, duration of follow-up, response to treatment and prognosis. EXPERT OPINION Sixty five articles reported post-COVID hematologic complications. The most frequent hematologic complication in COVID-19 patients is thromboembolic events, which often occur in two forms: deep vein thrombosis (DVT) and pulmonary emboli (PE). In a group of patients after the diagnosis of COVID-19, a significant decrease in platelets was observed, which was attributed to the ITP induced by COVID-19. Hemolytic anemia and aplastic anemia have also been reported rarely in patients. Finally, post-COVID hematologic complications appear to go beyond thromboembolic events. Although these complications have been reported rarely, searching for methods to identify susceptible patients and prevent these complications could be the subject of future research.
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Affiliation(s)
- Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajaeinejad
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
| | - Hasan Jalaeikhoo
- AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
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Lapietra G, Ferretti A, Baldacci E, Chistolini A, Santoro C. Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience. EJHAEM 2022; 3:453-456. [PMID: 35602248 PMCID: PMC9110988 DOI: 10.1002/jha2.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 01/03/2023]
Abstract
Over the last 2 years, different cases of immune thrombocytopenia (ITP) in patients affected by SARS‐CoV2 have been reported. The management of SARS‐CoV2 in subjects with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection. In this report, we describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID‐19, referred to the Haematology Institute of University Hospital Policlinico Umberto I in Rome. Steroids + immunoglobulins for ND or relapsed ITP and continuation of home therapy for chronic ITP are advised, although further knowledge is required.
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Affiliation(s)
- Gianfranco Lapietra
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Antonietta Ferretti
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Erminia Baldacci
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Antonio Chistolini
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Cristina Santoro
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
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13
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Mobasheri L, Nasirpour MH, Masoumi E, Azarnaminy AF, Jafari M, Esmaeili SA. SARS-CoV-2 triggering autoimmune diseases. Cytokine 2022; 154:155873. [PMID: 35461172 PMCID: PMC8979824 DOI: 10.1016/j.cyto.2022.155873] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
Abstract
Autoimmunity, hyperstimulation of the immune system, can be caused by a variety of reasons. Viruses are thought to be important environmental elements that contribute to the development of autoimmune antibodies. It seems that viruses cause autoimmunity with mechanisms such as molecular mimicry, bystander activation of T cells, transient immunosuppression, and inflammation, which has also been seen in post-Covid-19 autoimmunity. Infection of respiratory epithelium by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dysregulates the immune response, triggers both innate and acquired immunity that led to the immune system's hyperactivation, excessive cytokine secretion known as “cytokine storm,” and finally acute respiratory distress syndrome (ARDS) associated with high mortality. Any factor in the body that triggers chronic inflammation can contribute to autoimmune disease, which has been documented during the Covid-19 pandemic. It has been observed that some patients produce autoantibody and autoreactive CD4+ and CD8+ T cells, leading to the loss of self-tolerance. However, there is a scarcity of evidence defining the precise molecular interaction between the virus and the immune system to elicit autoreactivity. Here, we present a review of the relevant immunological findings in Covid-19 and the current reports of autoimmune disease associated with the disease.
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Affiliation(s)
- Leila Mobasheri
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Nasirpour
- Department of Medical Genetics, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Elham Masoumi
- Department of Immunology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran; Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Mozhdeh Jafari
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Immunology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed-Alireza Esmaeili
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Immunology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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14
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An H, Eun M, Yi J, Park J. CRESSP: a comprehensive pipeline for prediction of immunopathogenic SARS-CoV-2 epitopes using structural properties of proteins. Brief Bioinform 2022; 23:6539139. [PMID: 35226074 DOI: 10.1093/bib/bbac056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
The development of autoimmune diseases following SARS-CoV-2 infection, including multisystem inflammatory syndrome, has been reported, and several mechanisms have been suggested, including molecular mimicry. We developed a scalable, comparative immunoinformatics pipeline called cross-reactive-epitope-search-using-structural-properties-of-proteins (CRESSP) to identify cross-reactive epitopes between a collection of SARS-CoV-2 proteomes and the human proteome using the structural properties of the proteins. Overall, by searching 4 911 245 proteins from 196 352 SARS-CoV-2 genomes, we identified 133 and 648 human proteins harboring potential cross-reactive B-cell and CD8+ T-cell epitopes, respectively. To demonstrate the robustness of our pipeline, we predicted the cross-reactive epitopes of coronavirus spike proteins, which were recognized by known cross-neutralizing antibodies. Using single-cell expression data, we identified PARP14 as a potential target of intermolecular epitope spreading between the virus and human proteins. Finally, we developed a web application (https://ahs2202.github.io/3M/) to interactively visualize our results. We also made our pipeline available as an open-source CRESSP package (https://pypi.org/project/cressp/), which can analyze any two proteomes of interest to identify potentially cross-reactive epitopes between the proteomes. Overall, our immunoinformatic resources provide a foundation for the investigation of molecular mimicry in the pathogenesis of autoimmune and chronic inflammatory diseases following COVID-19.
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Affiliation(s)
- Hyunsu An
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Minho Eun
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Jawoon Yi
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea
| | - Jihwan Park
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Republic of Korea.,Anti-Virus Research Center, Gwangju Institute of Science and Technology (GIST), Republic of Korea.,Laboratory for cell mechanobiology, Gwangju Institute of Science and Technology (GIST), Republic of Korea
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15
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Zama D, Pancaldi L, Baccelli F, Guida F, Gottardi F, Dentale N, Esposito F, Masetti R, Viale P, Pession A. Autoimmune hemolytic anemia in children with COVID-19. Pediatr Blood Cancer 2022; 69:e29330. [PMID: 34490986 PMCID: PMC8661945 DOI: 10.1002/pbc.29330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Daniele Zama
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli,” Pediatric Unit, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Livia Pancaldi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Francesco Baccelli
- Specialty School of Pediatrics, Alma Mater StudiorumUniversity of Bologna, IRCCS, Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Fiorentina Guida
- Specialty School of Pediatrics, Alma Mater StudiorumUniversity of Bologna, IRCCS, Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Francesca Gottardi
- Specialty School of Pediatrics, Alma Mater StudiorumUniversity of Bologna, IRCCS, Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Nicola Dentale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Fabio Esposito
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli,” Pediatric Unit, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli,” Pediatric Unit, IRCCSAzienda Ospedaliero‐Universitaria di Bologna, Alma Mater Studiorum, University of BolognaBolognaItaly
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16
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Ceglie G, De Ioris MA, Mercadante S, Olivini N, Del Bufalo F, Marchesani S, Cocca F, Monteferrario E, Boccieri E, Pianese J, Palumbo G. Immune thrombocytopenia in a child with COVID-19: Is it the calm after the (cytokine) storm? Pediatr Blood Cancer 2022; 69:e29326. [PMID: 34490996 PMCID: PMC8661709 DOI: 10.1002/pbc.29326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Giulia Ceglie
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly,PhD Program in Immunology, Molecular Medicine and Applied BiotechnologyUniversity of Rome Tor VergataRomeItaly
| | - Maria Antonietta De Ioris
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Stefania Mercadante
- University Department of PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly,Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Nicole Olivini
- University Department of PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Francesca Del Bufalo
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Silvio Marchesani
- University Department of PediatricsBambino Gesù Children's Hospital, IRCCSRomeItaly,Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Francesca Cocca
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Emanuela Monteferrario
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Emilia Boccieri
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Jolanda Pianese
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly
| | - Giuseppe Palumbo
- Department of Pediatric Hematology/OncologyCell and Gene Therapy, IRCCS Bambino Gesù Children's HospitalRomeItaly,Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
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17
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Dondi A, Sperti G, Gori D, Guaraldi F, Montalti M, Parini L, Piraccini BM, Lanari M, Neri I. Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature. Eur J Pediatr 2022; 181:3577-3593. [PMID: 35948654 PMCID: PMC9365226 DOI: 10.1007/s00431-022-04585-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
UNLABELLED COVID-19 can present with a range of skin manifestations, some of which specific of the pediatric age. The aim of this systematic literature review was to determine the type, prevalence, time of onset, and evolution of cutaneous manifestations associated with COVID-19 in newborns, children, and adolescents, after excluding multisystem inflammatory syndrome in children (MIS-C). PubMed, Tripdatabase, ClinicalTrials, and Cochrane Library databases were searched using an ad hoc string for case reports/series and observational studies, published between December 2019 and February 2022. Study quality was assessed using the STROBE and CARE tools. Seventy-three (49 case reports/series and 24 studies) out of 26,545 identified articles were included in the analysis. Dermatological lesions were highly heterogeneous for clinical presentation, time of onset, and association with other COVID-19 manifestations. Overall, they mainly affected the acral portions, and typically presented a favorable outcome. Pseudo-chilblains were the most common. CONCLUSIONS Mucocutaneous manifestations could be the only/predominant and early manifestation of COVID-19 that could precede other more severe manifestations by days or weeks. Therefore, physicians of all disciplines should be familiar with them. WHAT IS KNOWN • A variety of cutaneous manifestations have been reported in association with COVID-19. • Urticaria, maculopapular, or vesicular rashes can occur at any age, while chilblains and erythema multiforme are more common in children and young patients. WHAT IS NEW • Skin lesions related to SARS-CoV-2 infection often show a peculiar acral distribution. • Mucocutaneous lesions of various type may be the only/predominant manifestation of COVID-19; they could present in paucisymptomatic and severely ill patients and occur at different stages of the disease.
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Affiliation(s)
- Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giacomo Sperti
- School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Federica Guaraldi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy.
| | - Marco Montalti
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
| | - Lorenza Parini
- School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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18
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Abstract
Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome-coronavirus-2 virus that led to a pandemic. Acute manifestations of COVID-19 include fever, cough, dyspnea, respiratory failure, pneumonitis, anosmia, thromboembolic events, cardiogenic shock, renal injury, ischemic strokes, encephalitis, and cutaneous eruptions, especially of hands or feet. Prolonged symptoms, unpredictable recoveries, and chronic sequelae (long COVID) sometimes emerge even for some people who survive the initial illness. Sequelae such as fatigue occasionally persist even for those with only mild to moderate cases. There is much to learn about postacute COVID-19 dyspnea, anosmia, psychosis, thyroiditis, cardiac arrhythmia, and/or multisystem inflammatory response syndrome in children. Determining prognoses is imprecise. Examining patient databases about those who have survived COVID-19 is warranted. Multidisciplinary teams are assessing such disease databases to better understand longer-term complications and guide treatment.
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19
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Ricke DO. Models for SARS-CoV-2 associated thrombocytopenia associated with hemophagocytic histiocytes. Med Hypotheses 2021; 157:110700. [PMID: 34673371 PMCID: PMC8511625 DOI: 10.1016/j.mehy.2021.110700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023]
Abstract
A subset of COVID-19 patients is experiencing secondary immune thrombocytopenia, also called immune thrombocytopenic purpura (ITP) or secondary hemophagocytic lymphohistiocytosis (HLH). The pathogenesis of SARS-CoV-2 associated thrombocytopenia is unknown. Very rare cases of vaccine induced prothrombotic immune thrombocytopenia (VIPIT) are occurring associated with COVID-19 vaccines. COVID-19 VIPIT is associated with autoantibodies targeting platelet factor 4 (PF4) for COVID-19 adenovirus vaccines. Herein, four models for hemophagocytic histocytes contributions to the etiology of thrombocytopenia associated with SARS-CoV-2 are proposed. One of the models proposes potential involvement of hemophagocytic histocytes targeting platelets bound by autoantibodies consistent with observed PF4 autoantibodies in COVID-19 VIPIT.
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Affiliation(s)
- Darrell O Ricke
- Massachusetts Institute of Technology, Lincoln Laboratory, Lexington, MA 02420, USA.
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20
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Kok EY, Srivaths L, Grimes AB, Vogel TP, Sexson Tejtel SK, Muscal E. Immune thrombocytopenia following multisystem inflammatory syndrome in children (MIS-C) - a case series. Pediatr Hematol Oncol 2021; 38:663-668. [PMID: 33949910 DOI: 10.1080/08880018.2021.1917737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with coronavirus disease 2019 (COVID-19) from novel coronavirus (SARS-CoV-2) infection may present with immune thrombocytopenia (ITP). Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 causing systemic organ dysfunction. This case series presents the first reported cases of patients who developed ITP following MIS-C, while completing corticosteroid tapers. These patients responded to standard of care therapies for ITP and had appropriate platelet count recovery. We emphasize the importance of careful monitoring of those recovering from COVID-19 or MIS-C, to proactively identify clinical and laboratory abnormalities, in addition to long-term cardiovascular sequelae.
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Affiliation(s)
- Eric Y Kok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lakshmi Srivaths
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda B Grimes
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Tiphanie P Vogel
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - S Kristen Sexson Tejtel
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Eyal Muscal
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Rheumatology, Baylor College of Medicine, Houston, Texas, USA
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21
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Caserta S, Zaccuri AM, Innao V, Musolino C, Allegra A. Immune thrombocytopenia: options and new perspectives. Blood Coagul Fibrinolysis 2021; 32:427-433. [PMID: 34224465 DOI: 10.1097/mbc.0000000000001058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immune thrombocytopenia is a haematological, autoimmune disorder characterized by elevated platelet demolition due to the presence of antiplatelet autoantibodies derived from B cells and to an irregular, deficient process of platelets production in bone marrow. In this review, after a brief presentation of 'old' strategies used nowadays yet, we focused on new drugs used in the treatment of immune thrombocytopenia and their mechanism of action and posology, basing on the last scientific literature. The observation that CoViD-19 can be associated with immune thrombocytopenia is also put in evidence. Particular attention will be dedicated on the concept that the ideal treatment should represent a solution not only for the failure of normal processes of production and survival of platelets, but also it should improve quality of life of patients, with minimum adverse events. Anyway, despite enormous advances of the last years, further investigations are necessary in order to define scrupulously long-term efficacy of new molecules proposed.
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MESH Headings
- Aminopyridines/therapeutic use
- Antibodies, Monoclonal, Humanized/therapeutic use
- COVID-19/complications
- COVID-19/immunology
- Histocompatibility Antigens Class I
- Humans
- Immunosuppressive Agents/therapeutic use
- Morpholines/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Pyrimidines/therapeutic use
- Receptors, Fc/antagonists & inhibitors
- Receptors, Thrombopoietin/agonists
- SARS-CoV-2/immunology
- Syk Kinase/antagonists & inhibitors
- Thiazoles/therapeutic use
- Thiophenes/therapeutic use
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Affiliation(s)
- Santino Caserta
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood 'Gaetano Barresi', University of Messina, Messina, Italy
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22
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Behlivani E, Tragiannidis A, Hatzipantelis E, Panagopoulou P. Immune thrombocytopenia secondary to COVID-19 infection: Report of two cases. Pediatr Blood Cancer 2021; 68:e29175. [PMID: 34061445 PMCID: PMC8209819 DOI: 10.1002/pbc.29175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Evangelia Behlivani
- 4th Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiPapageorgiou General HospitalThessalonikiGreece
| | - Athanasios Tragiannidis
- Children & Adolescent Hematology‐Oncology Unit, 2nd Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Emmanuel Hatzipantelis
- Children & Adolescent Hematology‐Oncology Unit, 2nd Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Paraskevi Panagopoulou
- 4th Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiPapageorgiou General HospitalThessalonikiGreece
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23
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Ringoringo HP, Hartoyo E. Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931517. [PMID: 34471086 PMCID: PMC8422568 DOI: 10.12659/ajcr.931517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Male, 9-month-old
Final Diagnosis: Newly diagnosed ITP
Symptoms: Petechiae on the forehead • cheeks • mouth • extremities. The patient is febrile, had rhinorrhea for three days previously. The patient is pale, weak, cannot drink
Medication: —
Clinical Procedure: The patient had immunizations of the Measles-Rubella vaccine 19 days before. Physical examination: Eye, ENT, and mouth, no abnormalities. Heart and Lungs within normal limits. Abdomen: there was no organomegaly – there neither lymphadenopathy nor a congenital anomaly
Specialty: Hematology • Infectious Diseases • Pediatrics and Neonatology
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Affiliation(s)
- Harapan Parlindungan Ringoringo
- Department of Pediatrics, Faculty of Medicine, Lambung Mangkurat University, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia
| | - Edi Hartoyo
- Department of Pediatrics, Faculty of Medicine, Lambung Mangkurat University, Ulin General Hospital, Banjarmasin, South Kalimantan, Indonesia
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24
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Immune Thrombocytopenic Purpura in a Child with COVID-19: A Case Report. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.110428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It may have many undescribed clinical manifestations. Case Presentation: In this study, we report a 7-year-old male COVID-19 patient with low platelet count who presented with gingival bleeding and ecchymosis and had a good response to corticosteroid therapy. Conclusions: This case highlights the need to be vigilant for atypical presentations or complications of COVID-19, one of which is SARS-CoV-2-induced immune thrombocytopenic purpura (ITP). It is necessary to pay attention to platelet count in addition to typical clinical features and radiographic findings. On the other hand, viral testing in thrombocytopenic patients should be considered for timely diagnosis of COVID-19 and taking necessary measurements for patient isolation in order to prevent the spread of disease and healthcare workers’ infection during this pandemic.
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25
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Olivieri B, Betterle C, Zanoni G. Vaccinations and Autoimmune Diseases. Vaccines (Basel) 2021; 9:vaccines9080815. [PMID: 34451940 PMCID: PMC8402446 DOI: 10.3390/vaccines9080815] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022] Open
Abstract
Vaccines represent one of the most effective measures of public health medicine, saving countless lives and preventing lifelong disabilities. Vaccines are extremely safe, however, no vaccine is completely free from risks and adverse events can occur following vaccination. An adverse event following immunization (AEFI) may be a true adverse reaction caused by the vaccine or an event that temporally occurred after immunization but is not caused by it. Among the adverse reactions to vaccines, one of the most feared is the triggering of autoimmune diseases, which are a heterogeneous group of disorders characterized by dysregulation of the immune system. Currently, no mechanisms have been demonstrated that could explain the correlation between vaccination and the development of autoimmune diseases. Furthermore, epidemiological studies do not support the hypothesis that vaccines cause systemic autoimmune diseases. The only confirmed associations, although very rare, are those between the flu vaccine and Guillain-Barré syndrome, especially with old vaccine preparations, and measles-mumps-rubella (MMR) vaccine and thrombocytopenia. Due to the SARS-CoV2 pandemic, new types of vaccines have been developed and are now available. Close vaccine safety-surveillance is currently underway for these new vaccines.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, 37134 Verona, Italy;
| | - Corrado Betterle
- Department of Medicine (DIMED), Clinical Immunology and Allergy, University of Padua, 35128 Padua, Italy;
| | - Giovanna Zanoni
- Immunology Unit, University Hospital, 37134 Verona, Italy
- Correspondence:
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a variety of clinical manifestations related to viral tissue damage, as well as a virally induced immune response. Hyperstimulation of the immune system can serve as a trigger for autoimmunity. Several immune-mediated manifestations have been described in the course of SARS-CoV-2 infection. Immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) are the most common hematologic autoimmune disorders seen in the course of SARS-CoV-2 infection. Vaccine-induced thrombocytopenia is a unique autoimmune hematologic cytopenia associated with SARS-CoV-2 vaccination. This paper will review the current literature on the association of SARS-CoV-2 infection and vaccination with autoimmune cytopenias and the clinical course of autoimmune cytopenias in patients with COVID-19.
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Kossiva L, Thirios A, Panagouli E, Panos A, Lampidi S, Bacopoulou F, Tsolia M, Tsitsika A. A Case of COVID-19-Related Thrombocytopenia and Leukopenia in an Adolescent with Mild Symptoms. CHILDREN-BASEL 2021; 8:children8060509. [PMID: 34208610 PMCID: PMC8233745 DOI: 10.3390/children8060509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, there have been numerous reports and reviews on the complications caused by the disease, analyzing the acute and chronic consequences. The main symptoms of SARS-CoV-2 are dry cough, fever, and fatigue. COVID-19 appears to affect all systems, including renal, cardiovascular, circulatory, and respiratory systems, causing chronic obstructive pulmonary disease. We report on a 14-year-old male adolescent, who presented with thrombocytopenia (platelet count 92 × 109 /L) and leukopenia (white blood count 4.2 × 103 /μL) that was observed two months ago. Ten days before the first blood test, a viral infection with nasal congestion and runny nose was reported, without other accompanying symptoms. Viral antibodies screening revealed positivity for all the three specific COVID-19 antibodies. Further haematological evaluation with bone marrow aspiration revealed non-specific dysplastic features of the red cell and megakaryocyte progenitors. Although haematological alterations due to COVID-19 infection are available from adult patients’ reports, the effect of COVID-19 infection in the pediatric population is underestimated and this is the first case with such haematological involvement. Noteworthy, in the current case, the impact of the COVID-19 infection was not related to the severity of the disease, as the symptoms were mild. In similar cases, bone marrow aspiration would not be performed as a part of routine work-up. Thus, it is important when evaluating pediatric patients with COVID-19 infection to search and report those alterations in order to better understand the impact and the spectrum of clinical manifestations of the specific viral infection in children and adolescents.
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Affiliation(s)
- Lydia Kossiva
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Athanasios Thirios
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Eleni Panagouli
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Alexandros Panos
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Stavroula Lampidi
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Maria Tsolia
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
| | - Artemis Tsitsika
- 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (L.K.); (A.T.); (E.P.); (A.P.); (S.L.); (M.T.)
- Correspondence: ; Tel./Fax: +30-2107710824
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Saad MA, Alfishawy M, Nassar M, Mohamed M, Esene IN, Elbendary A. COVID-19 and Autoimmune Diseases: A Systematic Review of Reported Cases. Curr Rheumatol Rev 2021; 17:193-204. [PMID: 33121413 DOI: 10.2174/1573397116666201029155856] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Over 4.9 million cases of Coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide pandemic began. Since the emergence of COVID-19, a number of confirmed cases reported autoimmune manifestations. Herein, we reviewed the reported COVID-19 cases with associated autoimmune manifestations. METHODS We searched PubMed database using all available keywords for COVID-19. All related studies between January 1st, 2020 to May 22nd, 2020 were reviewed. Only studies published in English language were considered. Articles were screened based on titles and abstracts. All reports of confirmed COVID-19 patients who have associated clinical evidence of autoimmune disease were selected. RESULTS Among the 10006 articles, searches yielded thirty-two relevant articles for full-text assessment. Twenty studies has met the eligibility criteria. The twenty eligible articles reported 33 cases of confirmed COVID-19 diagnosis who developed an autoimmune disease after the onset of covid-19 symptoms. Ages of patients varied from a 6 months old infant to 89 years old female (Mean=53.9 years of 28 cases); five cases had no information regarding their age. The time between symptoms of viral illness and onset of autoimmune symptoms ranged from 2 days to 33 days (Mean of the 33 cases=9.8 days). Autoimmune diseases were one case of subacute thyroiditis (3%), two cases of Kawasaki Disease (6.1%), three cases of coagulopathy and antiphospholipid syndrome (9.1%), three cases of immune thrombocytopenic purpura (9.1%), eight cases of autoimmune hemolytic anemia (24.2%), and sixteen cases of Guillain-Barré syndrome (48.5%). CONCLUSION COVID-19 has been implicated in the development of a range of autoimmune diseases, which may shed light on the association between autoimmune diseases and infections.
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Affiliation(s)
- Mariam Ahmed Saad
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt
| | - Mahmoud Nassar
- Internal Medicine Department, Beni Suef University, Beni Suef, Egypt
| | - Mahmoud Mohamed
- Nephrology division, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Amira Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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29
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Alonso-Beato R, Morales-Ortega A, Fernández FJDLH, Morón AIP, Ríos-Fernández R, Rubio JLC, Centeno NO. Immune thrombocytopenia and COVID-19: Case report and review of literature. Lupus 2021; 30:1515-1521. [PMID: 34053365 DOI: 10.1177/09612033211021161] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has been reported as an important complication related to COVID-19.We present a 49-year-old male patient with systemic lupus erythematosus with lupus nephritis, antiphospholipid syndrome and history of ITP who developed an ITP flare in the context of COVID-19. He had no bleeding manifestations and had a good response to prednisone treatment.We review the characteristics of the cases reported to date in the literature, with an analysis of 57 patients. Mean age was 56 years (±19.6 SD), and 50.9% were male. This was the first episode of ITP in most of the patients (86.05%), with SARS-CoV-2 acting as the initial trigger. We found that ITP flares may appear in both mild and severe COVID-19 cases. They also appeared at any time during the course of the disease, 48.2% of patients developed it during hospitalization, while it was diagnosed at admission in the rest of the cases. Platelet counts were significantly lower than other ITP series, with a median nadir platelet count of 8 × 109/L (IQR 2-17.75 × 109/L). These patients show a higher bleeding rate (61.4%) compared with other ITP series. They also show a better response to treatment, with good response to the first line therapies in 76.9% of them. The most common first-line treatment was intravenous immunoglobulin (IVIG), used alone or combined with corticosteroids in 40.4% and 32.7% of cases respectively, while 25% of patients received only corticosteroids.Our review suggests that COVID-19-related ITP can be seen even in previously healthy patients. Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course. Given that this kind of ITP seems to be associated with a higher bleeding risk, its diagnosis in a clinical scenario such as COVID-19, where anticoagulant therapy is frequently used, may be critical. Treatment with IVIG and/or corticoids is often effective.
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Affiliation(s)
- Rubén Alonso-Beato
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital, Universitario Clínico San Cecilio, Granada, Spain
| | - José Luis Callejas Rubio
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital, Universitario Clínico San Cecilio, Granada, Spain
| | - Norberto Ortego Centeno
- Faculty of Medicine, University of Granada, Granada, Spain
- Biomedical Research Institute Ibs, Granada, Granada
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30
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Furukawa Y, Ando M, Azusawa Y, Kinoshita S, Harada S, Ochiai T, Honda T, Sugimoto K, Tabe Y, Komatsu N, Ando J. Persistent immune thrombocytopaenic purpura associated with SARS-CoV-2 infection. ACTA ACUST UNITED AC 2021; 2:530-533. [PMID: 34226897 PMCID: PMC8242397 DOI: 10.1002/jha2.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Yoshiki Furukawa
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Yoko Azusawa
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University School of Medicine Tokyo Japan
| | - Shintaro Kinoshita
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Sakiko Harada
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Tomonori Ochiai
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Tadahiro Honda
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Kazuya Sugimoto
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Yoko Tabe
- Department of Next Generation Hematological Laboratory Medicine Juntendo University School of Medicine Tokyo Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine Tokyo Japan.,Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University School of Medicine Tokyo Japan
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31
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Epidemiology and Viral Etiology of Pediatric Immune Thrombocytopenia through Korean Public Health Data Analysis. J Clin Med 2021; 10:jcm10071356. [PMID: 33806145 PMCID: PMC8037772 DOI: 10.3390/jcm10071356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is prevalent in children aged 2-5 years but may occur in all pediatric age groups. In 50-60% of pediatric patients, ITP is preceded by an upper respiratory tract infection 1-4 weeks before its onset. In this study, the relationship between the development of ITP and viral infections in children was assessed. We analyzed data of 6487 patients aged < 18 years with incident ITP from the Health Insurance Review and Assessment Open Access Big Data Platform (2015 to 2018) and the Korea Disease Control and Prevention Agency. The monthly positive detection rate (PDR) of seven respiratory and four acute diarrhea viruses was calculated. The virus PDR seasonal trend data was analyzed through ARIMA modeling. The ITP diagnostic data and prevalence of viral infection 1 and 2 months prior were analyzed using the Granger test. The overall male to female (M/F) ratio was 1.2, whereas it was 1.4 in the youngest age group (< 1 year). The overall ITP incidence rate was 18.1 per 100,000 person-years. Respiratory syncytial virus, rhinovirus, rotavirus, and astrovirus infections influenced ITP occurrence in children. However, rotavirus infection is positively associated with the etiology of ITP after 1-2 months.
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32
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Gilpin S, Byers M, Byrd A, Cull J, Peterson D, Thomas B, Jacobson P. Rhabdomyolysis as the Initial Presentation of SARS-CoV-2 in an Adolescent. Pediatrics 2021; 147:peds.2020-019273. [PMID: 33037123 DOI: 10.1542/peds.2020-019273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
The novel coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has created a global pandemic, with many cases affecting the elderly. However, children have been affected as well, with ∼2.4% to 3.7% of cases reported. This case is the first published case of an adolescent presenting with rhabdomyolysis as the first sign of novel coronavirus disease 2019, with extremely elevated creatinine kinase levels, approaching almost 400 000 U/L. This case adds to the growing body of literature of a variety of life-threatening manifestations associated with severe acute respiratory syndrome coronavirus 2 infection and highlights the importance of how prompt recognition of these unique presentations of the disease is important to mitigate complications.
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Affiliation(s)
- Shawnese Gilpin
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois;
| | - Michael Byers
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Allison Byrd
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Jennifer Cull
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Danielle Peterson
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Bettina Thomas
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Phillip Jacobson
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.,Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
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33
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Taherifard E, Taherifard E, Movahed H, Mousavi MR. Hematologic autoimmune disorders in the course of COVID-19: a systematic review of reported cases. ACTA ACUST UNITED AC 2021; 26:225-239. [PMID: 33594951 DOI: 10.1080/16078454.2021.1881225] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients. METHOD Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients' history, presentations, paraclinical data, treatment course and outcome were extracted from the records. RESULTS A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia. CONCLUSION The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1-2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.
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Affiliation(s)
- Erfan Taherifard
- Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Ehsan Taherifard
- Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Hamed Movahed
- Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
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34
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Barcellini W, Giannotta JA, Fattizzo B. Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature. Front Immunol 2021; 11:609198. [PMID: 33574816 PMCID: PMC7870679 DOI: 10.3389/fimmu.2020.609198] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.
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Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Oncohematology, University of Milan, Milan, Italy
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35
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Thakur V, Ratho RK, Kumar P, Bhatia SK, Bora I, Mohi GK, Saxena SK, Devi M, Yadav D, Mehariya S. Multi-Organ Involvement in COVID-19: Beyond Pulmonary Manifestations. J Clin Med 2021; 10:446. [PMID: 33498861 PMCID: PMC7866189 DOI: 10.3390/jcm10030446] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease 19 (COVID-19), due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become an on-going global health emergency affecting over 94 million cases with more than 2 million deaths globally. Primarily identified as atypical pneumonia, it has developed into severe acute respiratory distress syndrome (ARDS), a multi-organ dysfunction with associated fatality. Ever since its emergence, COVID-19 with its plethora of clinical presentations has signalled its dynamic nature and versatility of the disease process. Being a disease with droplet transmission has now assumed the proportion of a suspected airborne nature which, once proved, poses a Herculean task to control. Because of the wide distribution of the human angiotensin-converting enzyme-2 (hACE2) receptors, known for its transmission, we envisage its multiorgan spread and extensive disease distribution. Thus, an extensive review of the extrapulmonary organotropism of SARS-CoV-2 with organ-specific pathophysiology and associated manifestations like dermatological complications, myocardial dysfunction, gastrointestinal symptoms, neurologic illnesses, hepatic and renal injury is needed urgently. The plausible mechanism of site-specific viral invasion is also discussed to give a comprehensive understanding of disease complexity, to help us to focus on research priorities and therapeutic strategies to counter the disease progression. A note on the latest advancements in vaccine research will enlighten the scientific world and equip it for better preparedness.
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Affiliation(s)
- Vikram Thakur
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India; (V.T.); (I.B.); (G.K.M.)
| | - Radha Kanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India; (V.T.); (I.B.); (G.K.M.)
| | - Pradeep Kumar
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan 173229, India;
| | - Shashi Kant Bhatia
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Korea;
| | - Ishani Bora
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India; (V.T.); (I.B.); (G.K.M.)
| | - Gursimran Kaur Mohi
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India; (V.T.); (I.B.); (G.K.M.)
| | - Shailendra K Saxena
- Centre for Advanced Research, Faculty of Medicine, King George’s Medical University, Lucknow 226003, India;
| | - Manju Devi
- Department of Oral Pathology and Microbiology, RUHS College of Dental Sciences (Government Dental College), RUHS University of Rajasthan, Jaipur, Rajasthan 302016, India;
| | - Dhananjay Yadav
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 712-749, Korea
| | - Sanjeet Mehariya
- Department of Engineering, University of Campania ‘Luigi Vanitelli’, Real Casa dell’ Annunziata, Via Roma 29, 81031 Aversa, Italy
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36
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Toor SM, Saleh R, Sasidharan Nair V, Taha RZ, Elkord E. T-cell responses and therapies against SARS-CoV-2 infection. Immunology 2021; 162:30-43. [PMID: 32935333 PMCID: PMC7730020 DOI: 10.1111/imm.13262] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel coronavirus strain. Some studies suggest that COVID-19 could be an immune-related disease, and failure of effective immune responses in initial stages of viral infection could contribute to systemic inflammation and tissue damage, leading to worse disease outcomes. T cells can act as a double-edge sword with both pro- and anti-roles in the progression of COVID-19. Thus, better understanding of their roles in immune responses to SARS-CoV-2 infection is crucial. T cells primarily react to the spike protein on the coronavirus to initiate antiviral immunity; however, T-cell responses can be suboptimal, impaired or excessive in severe COVID-19 patients. This review focuses on the multifaceted roles of T cells in COVID-19 pathogenesis and rationalizes their significance in eliciting appropriate antiviral immune responses in COVID-19 patients and unexposed individuals. In addition, we summarize the potential therapeutic approaches related to T cells to treat COVID-19 patients. These include adoptive T-cell therapies, vaccines activating T-cell responses, recombinant cytokines, Th1 activators and Th17 blockers, and potential utilization of immune checkpoint inhibitors alone or in combination with anti-inflammatory drugs to improve antiviral T-cell responses against SARS-CoV-2.
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Affiliation(s)
- Salman M. Toor
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Reem Saleh
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Varun Sasidharan Nair
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Rowaida Z. Taha
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Eyad Elkord
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
- Biomedical Research CenterSchool of Science, Engineering and EnvironmentUniversity of SalfordManchesterUK
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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38
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Halpert G, Shoenfeld Y. SARS-CoV-2, the autoimmune virus. Autoimmun Rev 2020; 19:102695. [PMID: 33130000 PMCID: PMC7598743 DOI: 10.1016/j.autrev.2020.102695] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel; Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel; Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg 199034, Russian Federation.
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39
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Soares ACCV, Loggetto SR, Manga FCM, Faustino LR, Braga JAP. Outcome of SARS-CoV-2 and immune thrombocytopenia in a pediatric patient. Hematol Transfus Cell Ther 2020; 43:101-103. [PMID: 32989428 PMCID: PMC7510526 DOI: 10.1016/j.htct.2020.09.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
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40
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Bhattacharjee S, Banerjee M. Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review. ACTA ACUST UNITED AC 2020; 2:2048-2058. [PMID: 32984764 PMCID: PMC7501509 DOI: 10.1007/s42399-020-00521-8] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19-associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.
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Affiliation(s)
- Sukrita Bhattacharjee
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
| | - Mainak Banerjee
- Institute of Post Graduate Medical Education and Research, Kolkata, India
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41
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Venn AMR, Schmidt JM, Mullan PC. Pediatric croup with COVID-19. Am J Emerg Med 2020; 43:287.e1-287.e3. [PMID: 32980228 PMCID: PMC7490245 DOI: 10.1016/j.ajem.2020.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with "COVID-19 croup," SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.
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Affiliation(s)
- April M R Venn
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, 630 W. 168th St, New York, NY 10032, USA.
| | - James M Schmidt
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA.
| | - Paul C Mullan
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA.
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Ehrenfeld M, Tincani A, Andreoli L, Cattalini M, Greenbaum A, Kanduc D, Alijotas-Reig J, Zinserling V, Semenova N, Amital H, Shoenfeld Y. Covid-19 and autoimmunity. Autoimmun Rev 2020; 19:102597. [PMID: 32535093 PMCID: PMC7289100 DOI: 10.1016/j.autrev.2020.102597] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Michael Ehrenfeld
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel.
| | - Angela Tincani
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Sechenov University, Russia; U.O. Reumatologia e Immunologia Clinica, ASST-Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Laura Andreoli
- U.O. Reumatologia e Immunologia Clinica, ASST-Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Assaf Greenbaum
- The Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Darja Kanduc
- Department of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Italy
| | - Jaume Alijotas-Reig
- Hospital Universitari Vall d'Hebron & Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vsevolod Zinserling
- V.A. Almazov Research Center and S.P. Botkin infectious Hospital, Saint-Petersburg, Russia
| | - Natalia Semenova
- V.A. Almazov Research Center and S.P. Botkin infectious Hospital, Saint-Petersburg, Russia
| | - Howard Amital
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Sechenov University, Russia
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43
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Deruelle E, Ben Hadj Salem O, Sep Hieng S, Pichereau C, Outin H, Jamme M. Immune thrombocytopenia in a patient with COVID-19. Int J Hematol 2020; 112:883-888. [PMID: 32677007 PMCID: PMC7365304 DOI: 10.1007/s12185-020-02943-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
This case report describes immune thrombocytopenic purpura in a 41-year-old man hospitalized in the intensive-care unit for COVID-19, 13 days after the onset of COVID-19 symptoms with respiratory failure at admission. Acute respiratory distress syndrome was treated with, among other drugs, low-molecular-weight heparin. On day 8, his platelet count began descending rapidly. On day 10, heparin treatment was replaced by danaparoid sodium, but by day 13, the continued low platelet count made a diagnosis of heparin-induced thrombocytopenia unlikely. Normocytic nonregenerative anemia gradually developed. On day 13, a bone marrow aspiration showed numerous megakaryocytes and a few signs of hemophagocytosis. Corticosteroids were introduced on day 14, and platelets began rising after 3 days and then fell again on day 19. Intravenous immunoglobulin (IV Ig) was then administered. Two days later, the platelet count returned to normal. The immune cause was confirmed by ruling out the differential diagnoses and the excellent and rapid response to intravenous immunoglobulins. Finally, the patient's respiratory state improved. He was discharged to a respiratory rehabilitation unit on day 38. Our case suggests that an immunological cause should be considered in patients with thrombocytopenia during COVID-19.
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Affiliation(s)
- Emilie Deruelle
- Intensive Care Unit, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France
| | - Omar Ben Hadj Salem
- Intensive Care Unit, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France
| | - Sonnthida Sep Hieng
- Laboratory of Hematology, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France
| | - Claire Pichereau
- Intensive Care Unit, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France
| | - Hervé Outin
- Intensive Care Unit, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France
| | - Matthieu Jamme
- Intensive Care Unit, Poissy Saint Germain Hospital, 9-10 rue du champ Gaillard, 78300, Poissy, France. .,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France.
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Lassandro G, Palladino V, Amoruso A, Palmieri VV, Russo G, Giordano P. Children in Coronaviruses' Wonderland: What Clinicians Need to Know. Mediterr J Hematol Infect Dis 2020; 12:e2020042. [PMID: 32670520 PMCID: PMC7340228 DOI: 10.4084/mjhid.2020.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023] Open
Abstract
Human coronaviruses (HCoVs) commonly cause mild upper-respiratory tract illnesses but can lead to more severe and diffusive diseases. A variety of signs and symptoms may be present, and infections can range in severity from the common cold and sore throat to more serious laryngeal or tracheal infections, bronchitis, and pneumonia. Among the seven coronaviruses that affect humans (SARS)-CoV, the Middle East respiratory syndrome (MERS)-CoV, and the most recent coronavirus disease 2019 (COVID-19) represent potential life-threatening diseases worldwide. In adults, they may cause severe pneumonia that evolves in respiratory distress syndrome and multiorgan failure with a high mortality rate. Children appear to be less susceptible to develop severe clinical disease and present usually with mild and aspecific symptoms similar to other respiratory infections typical of childhood. However, some children, such as infants, adolescents, or those with underlying diseases may be more at-risk categories and require greater caution from clinicians. Available data on pediatric coronavirus infections are rare and scattered in the literature. The purpose of this review is to provide to clinicians a complete and updated panel useful to recognize and characterize the broad spectrum of clinical manifestations of coronavirus infections in the pediatric age.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Anna Amoruso
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Viviana Valeria Palmieri
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
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