Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that spread around the world during the past 2 years, has infected more than 260 million people worldwide and has imposed an important burden on the healthcare system. Several risk factors associated with unfavorable outcome were identified, including elderly age, selected comorbidities, immune suppression as well as laboratory markers. The role of immune system in the pathophysiology of SARS-CoV-2 infection is indisputable: while an appropriate function of the immune system is important for a rapid clearance of the virus, progression to the severe and critical phases of the disease is related to an exaggerated immune response associated with a cytokine storm. We analyzed differences and longitudinal changes in selected immune parameters in 823 adult COVID-19 patients hospitalized in the Martin University Hospital, Martin, Slovakia. Examined parameters included the differential blood cell counts, various parameters of cellular and humoral immunity (serum concentration of immunoglobulins, C4 and C3), lymphocyte subsets (CD3+, CD4+, CD8+, CD19+, NK cells, CD4+CD45RO+), expression of activation (HLA-DR, CD38) and inhibition markers (CD159/NKG2A). Besides already known changes in the differential blood cell counts and basic lymphocyte subsets, we found significantly higher proportion of CD8+CD38+ cells and significantly lower proportion of CD8+NKG2A+ and NK NKG2A+ cells on admission in non-survivors, compared to survivors; recovery in survivors was associated with a significant increase in the expression of HLA-DR and with a significant decrease of the proportion of CD8+CD38+cells. Furthermore, patients with fatal outcome had significantly lower concentrations of C3 and IgM on admission. However, none of the examined parameters had sufficient sensitivity or specificity to be considered a biomarker of fatal outcome. Understanding the dynamic changes in immune profile of COVID-19 patients may help us to better understand the pathophysiology of the disease, potentially improve management of hospitalized patients and enable proper timing and selection of immunomodulator drugs.
Očkovanie proti COVID-19 patrí v súčasnosti k najdôležitejším témam na diskusiu. Aj vzhľadom k viacerým medializovaným informáciám o závažných alergických reakciách po očkovaní mRNA vakcínami v zahraničí sa na špecialistov v odbore klinická imunológia aalergológia obracajú pacienti s otázkou zhodnotenia miery rizika očkovania. Klinický imunológ a alergológ má zároveň kľúčové postavenie v diferenciálnej diagnostike anáslednom manažmente postvakcinačných reakcií. V nasledujúcom článku uvádzame aktuálne poznatky oočkovaní proti COVID-19 z pohľadu imunológa a alergiológa s odvolaním sa na bežné postupy vo vakcinológii a odporúčania odborných spoločností.
Vaccination against COVID-19 is currently one of the most important topics for discussion. Due to published information about severe allergic reactions after vaccination with mRNA vaccines abroad, specialists in the field of clinical immunology and allergology are frequently asked to assess the risk of vaccination. At the same time, clinical immunologist and allergist has akey role in the differential diagnosis and subsequent management of post-vaccination reactions. In the following article, we present current knowledge about vaccination against COVID-19 from the perspective of aclinical immunologist and allergist with reference to standard vaccination recommendations and guidelines of medical societies.
The velocity of the COVID-19 pandemic spread and the variable severity of the disease course has forced scientists to search for potential predictors of the disease outcome. We examined various immune parameters including the markers of immune cells exhaustion and activation in 21 patients with COVID-19 disease hospitalised in our hospital during the first wave of the COVID-19 pandemic in Slovakia. The results showed significant progressive lymphopenia and depletion of lymphocyte subsets (CD3+, CD4+, CD8+ and CD19+) in correlation to the disease severity. Clinical recovery was associated with significant increase in CD3+ and CD3+CD4+ T-cells. Most of our patients had eosinopenia on admission, although no significant differences were seen among groups with different disease severity. Non-survivors, when compared to survivors, had significantly increased expression of PD-1 on CD4+ and CD8+ cells, but no significant difference in Tim-3 expression was observed, what suggests possible reversibility of immune paralysis in the most severe group of patients. During recovery, the expression of Tim-3 on both CD3+CD4+ and CD3+CD8+ cells significantly decreased. Moreover, patients with fatal outcome had significantly higher proportion of CD38+CD8+ cells and lower proportion of CD38+HLA-DR+CD8+ cells on admission. Clinical recovery was associated with significant decrease of proportion of CD38+CD8+ cells. The highest AUC values within univariate and multivariate logistic regression were achieved for expression of CD38 on CD8+ cells and expression of PD1 on CD4+ cells alone or combined, what suggests, that these parameters could be used as potential biomarkers of poor outcome. The assessment of immune markers could help in predicting outcome and disease severity in COVID-19 patients. Our observations suggest, that apart from the degree of depletion of total lymphocytes and lymphocytes subsets, increased expression of CD38 on CD3+CD8+ cells alone or combined with increased expression of PD-1 on CD3+CD4+ cells, should be regarded as a risk factor of an unfavourable outcome in COVID-19 patients. Increased expression of PD-1 in the absence of an increased expression of Tim-3 on CD3+CD4+ and CD3+CD8+ cells suggests potential reversibility of ongoing immune paralysis in patients with the most severe course of COVID-19.
- MeSH
- CD4-pozitivní T-lymfocyty MeSH
- CD8-pozitivní T-lymfocyty MeSH
- COVID-19 * MeSH
- lidé MeSH
- pandemie MeSH
- SARS-CoV-2 MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Goodov syndróm je charakterizovaný asociáciou tymómu a v dospelosti vzniknutej prevažne protilátkovej imunodeficiencie.Opisujeme prípad pacienta s tymómom, recidivujúcimi bronchopneumóniami a hnačkami. Pri laboratórnom vyšetrení zameranom na imunitný systém bola diagnostikovaná trojizotypová hypogamaglobulinémia s depléciou B-lymfocytov. Stav bol hodnotený ako Goodov syndróm a pacient bol nastavený na substitúciu imunoglobulínov. Autori poukazujú na potrebu myslieť na možnosť asociovanej poruchy imunity u pacientov s tymómom a recidivujúcimi infekciami.
Good's syndrome is characterized by association of thymoma and adult-onset predominantly antibody immunodeficiency. We describe a case of patient with thymoma and recurrent bronchopneumonias and diarrhoea. Laboratory examination revealed three-isotype hypogammaglobulinemia with depletion of B-lymphocytes. Good's syndrome was diagnosed and immunoglobulin substitution therapy was started. The authors would like to raise the awareness of possible association of antibody deficiency in patients with thymoma and recurrent infections.
- Klíčová slova
- Goodův syndrom,
- MeSH
- agamaglobulinemie MeSH
- bronchopneumonie MeSH
- diferenciální diagnóza MeSH
- imunoglobuliny aplikace a dávkování krev terapeutické užití MeSH
- imunologické techniky MeSH
- lidé MeSH
- opožděná diagnóza MeSH
- počítačová rentgenová tomografie MeSH
- průjem MeSH
- senioři MeSH
- syndromy imunologické nedostatečnosti * diagnóza terapie MeSH
- thymom chirurgie diagnóza MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
Autori popisujú problémy diagnostiky oligosymptomatického nodulárneho pľúcneho procesu s regionálnou lymfadenomegáliou, pôvodne považovaného za respiračnú tuberkulózu. Prostredníctvom kazuistiky mladej pacientky dokumentujú úskalia etiologickej diferenciálnej diagnostiky takýchto chorôb. Poukazujú na nutnosť opakovaných odberov biologického materiálu so snahou o mikrobiologické potvrdenie etiologického agens.
The authors describe diagnostic problems of oligosymptomatic nodular lung disease associated with regional lymphadenomegaly, originally considered as respiratory tuberculosis. The difficulties of etiologic differential diagnosis of such diseases are documented through the case report of a young patient. They point out the need of repeated sample taking with effort of microbiologic confirmation of etiologic agent.
- MeSH
- antituberkulotika terapeutické užití MeSH
- bronchoalveolární laváž MeSH
- bronchoalveolární lavážní tekutina mikrobiologie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- ethambutol terapeutické užití MeSH
- fluorochinolony terapeutické užití MeSH
- intracelulární infekce bakterií Mycobacterium avium * diagnostické zobrazování diagnóza farmakoterapie MeSH
- klarithromycin terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- Mycobacterium avium komplex izolace a purifikace MeSH
- neúspěšná terapie MeSH
- plicní sarkoidóza diagnóza MeSH
- plicní tuberkulóza diagnóza farmakoterapie MeSH
- počítačová rentgenová tomografie MeSH
- progrese nemoci MeSH
- rentgendiagnostika hrudníku MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
