Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study.

PURPOSE: There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. METHODS: We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. RESULTS: 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. CONCLUSION: The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).

[Angioedema related to the use of streptokinase]. / Angioedema relacionado ao uso de estreptoquinase.

Angioedema is a rare reaction to streptokinase, acute and potentially fatal, which should be quickly diagnosed and treated to guarantee the best prognosis for the patient. We describe here the case of a 65-year-old man, who displayed an anaphylactic reaction after the beginning of thrombolysis with streptokinase, which was quickly treated, and remained hospitalized for one week in the Intensive Care Unit.

Severe hypoleptinaemia associated with insulin resistance in patients with common variable immunodeficiency.

OBJECTIVE: Common variable immunodeficiency (CVI) is a primary immunodeficiency syndrome characterized by impaired production of antibodies and recurrent infections. Delay in diagnosis leads to metabolic wastage and low body weight. Leptin, a hormone produced by white adipose tissue, modulates insulin action by signal transduction cross-talk and by direct action on pancreatic beta-cells. We hypothesized that patients with CVI might present a defective regulation of leptin production and insulin resistance. PATIENTS: Thirteen CVI patients (39 +/- 11 years) under gammaglobulin replacement were evaluated in parallel with 13 gender-, age-, body weight- and body mass index (BMI)-matched healthy voluntaries, and with data from two large population series, the Bruneck and the Hoorn Studies. MEASUREMENTS: Serum leptin and insulin levels, homeostasis model assessment - insulin resistance (HOMA-IR), body composition, haematological, biochemical and immunoglobulin measurements were obtained. Data were analysed by a one-way analysis of variance (anova) and by Pearson's rank analysis. The institutional ethics committee approved the study, and informed consent was obtained from patients and controls. RESULTS: No differences were found between CVI and the control group when comparing gender distribution, age, body weight, BMI, waist/hip ratio, relative body fat and fasting glucose levels. Leptin levels were lower (P < 0.05) in CVI patients than in controls and lower than fasting leptin levels detected in a large population study. CVI patients' serum leptin levels did not correlate with BMI (r = 0.074, P = 0.8) and their high HOMA-IR indicated insulin resistance. CONCLUSIONS: CVI patients are relatively hypoleptinaemic and insulin resistant, and their serum leptin levels are not correlated to their BMI.

Níveis séricos e polimorfismos gênicos da lectina ligadora de manose (MBL) e da serino protease associada à MBP (MASP)-2 em uma amostra da população brasileira / Mannose-binding lectin (MBL) and MBL associated serine protease (MASP)-2 serum levels and genetic polymorphisms in a Brazilian population sample

A Lectina Ligadora de Manose (MBL) é uma proteína que reconhece carboidratos na superfície microbiana levando à ativação do sistema complemento. Este processo é mediado por Serino Proteases tal como a MASP-2. O complexo MBL/MASP-2 é responsável pela formação da C3 convertase C4bC2b. Os níveis séricos de MBL e a MASP-2 (genes MBL2 e MASP-2, respectivamente) são geneticamente determinados, e podem ser influenciados pela presença de polimorfismos em um único nucleotídeo SNPs em genes codificadores destas proteínas. OBJETIVO: Determinar os níveis séricos e polimorfismos gênicos da MBL e MASP-2 em uma amostra da população brasileira. MÉTODOS: 294 amostras de doadores de sangue [mediana = 36,51 ± 10,56; 18-63 anos; 91/294 (30,95%) sexo feminino, 203/294 (69,05%) sexo masculino] foram genotipadas para os SNPs do éxon 1 (MBL2): SNPs localizados nos códons 52 (ArgCys), 54 (GlyAsp) e 57 (GlyGlu) e SNP Asp371Tyr (D371Y, A>C ) do gene da MASP-2 (éxon 9). Foi utilizado o ensaio de temperatura de dissociação para éxon 1 (MBL2) e sequenciamento direto dos promoters (H/L, X/Y e P/Q, nas posições -550, -221 e +4, respectivamente). A combinação das variantes do éxon 1 MBL2 foram agrupadas e denominadas alelo O e o genótipo selvagem foi denominado A. O éxon 9 da MASP-2 foi genotipado através da plataforma TaqMan. RESULTADOS: MBL2: 58,5% A/A, 36,39% A/O e 5,1% O/O; promoters: 13% H/H, 39% H/L, 48% L/L; 2% X/X, 26% X/Y, 72% Y/Y; 52% P/P, 37% P/Q, 11% Q/Q; haplótipos encontrados: 15% LXPA, 28% HYPA, 8% LYQO, 12% LYPO, 11% LYPA, 22% LYQA e 4% HYPO. Quanto à produção, 56,12% produziram altos níveis de MBL, 30,61% níveis médios e 13,27% níveis baixos ou insuficientes de MBL. Para MASP-2: 38,78% A/A, 44,56% A/C e 16,67% C/C. CONCLUSÃO: A prevalência (5,1%) SNP O/O do éxon 1 (MBL2) está de acordo com a literatura brasileira, é semelhante à européia (4%) e japonesa (5%), menor que a africana (10-14%). Níveis séricos de MBL corresponderam aos genótipos determinados. Esta é a...

BACKGROUND: Mannose-binding lectin (MBL) is a protein that recognizes carbohydrates on microbial surface leading to complement activation. This process is mediated by MBL-associated serine proteases, such as MASP-2. MBL/MASP-2 complex is responsible for generating the C3 convertase C4bC2b. Both MBL and MASP-2 levels are genetically determined, and can be influenced by the presence of single nucleotide polymorphisms (SNPs) in the genes encoding for these proteins (namely MBL2 and MASP-2). OBJTECTIVE: to determine MBL and MASP-2 serum levels and the frequencies of MBL2 and MASP-2 gene polymorphisms in a Brazilian population sample. METHODS: 294 blood donor samples [median age = 36.51 ± 10.56 years, range 18-63, 91/294 (31%) females and 203/294 (69%) males] were genotyped for MBL2 exon 1 SNPs: single point mutation in codon 52 (ArgCys), 54 (GlyAsp) and 57 (GlyGlu), and MASP-2 polymorphism Asp371Tyr (D371Y, A>C) (exon 9). A melting temperature assay was used to perform the genotyping of MBL2 SNPs. The combination of variants of MBL2 were grouped together as allele O, wild types were indicated as A. Exon 1 promoters were evaluated by direct genotype sequencing- alleles H/L, X/Y and P/Q (positions -550, -221 and +4, respectively). MASP-2 exon 9 genotyping was performed by using TaqMan pre-developed assay. RESULTS: MBL2: 58.5% A/A, 36.39% A/O, 5.1% O/O; promoters: 13% H/H, 39% H/L, 48% L/L; 2% X/X, 26% X/Y, 72% Y/Y; 52% P/P, 37% P/Q, 11% Q/Q; haplotypes: 15% LXPA, 28% HYPA, 8% LYQO, 12% LYPO, 11% LYPA, 22% LYQA and 4% HYPO. MASP-2: 38.78% A/A, 44.56% A/C and 16.67% C/C. CONCLUSION: The prevalence (5.1%) of O/O genotype of MBL2 exon 1 SNPs in our population is in accordance with Brazilian reports, similar to European (4%) and Japanese (5%); lower than Africans (10-14%). There is a correlation between MBL serum levels and genotyping. Moreover, this is the first report of D371Y MASP-2 polymorphism frequency in a Brazilian population. Our data may contribute to...

Angioedema relacionado ao uso de estreptoquinase / Angioedema related to the use of streptokinase

O angioedema é uma reacão rara, aguda e potencialmente fatal, à estreptoquinase, devendo ser diagnosticada prontamente e tratada para garantir melhor prognóstico ao paciente. Descrevemos aqui o caso de um homem de 65 anos, que apresentou reacão anafilática após o início de trombólise com estreptoquinase, sendo rapidamente tratado, permaneceu uma semana internado em Unidade de Terapia Intensiva.