Immunity and inflammatory biomarkers in COVID-19: A systematic review.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Patients can be asymptomatic or present respiratory and gastrointestinal symptoms, and even multiple-organ failure which can lead to death. The balance between an effective antiviral response and dysregulated immune response is the key factor determining the severity of COVID-19 progression. A systematic review was performed using the NCBI-PubMed database to find the articles related to COVID-19 immunity and inflammatory response published from 1 December 2019 to 15 April 2020. Haematological, immunological and biochemical parameters were extracted and correlated with disease severity, age and presence of comorbidities. Twelve articles were analysed comprising a total of 1042 hospitalized patients infected with SARS-CoV-2 and 95 different parameters. Total lymphocyte count and levels of CD3+ and CD4+ T cells were decreased in severe and critical cases. Neutrophilia was found in patients who progressed to acute respiratory distress syndrome (ARDS). Interleukin-six (IL-6) was high in mild and severe patients regardless of comorbidities. Erythrocyte sedimentation rate (ESR) and count and C-reactive protein (CRP) levels were increased regardless of disease severity or presence of comorbidities. High levels of D-dimer and lactate dehydrogenase were present in diabetic patients and patients who developed ARDS. Procalcitonin levels were elevated to varying degrees in severe and critical patients. We conclude that the total lymphocyte count, CD3+ and CD4+ T cells are low, especially in severe and critical COVID-19 patients; ESR, CRP and IL-6 were elevated, independent of the severity of disease. Understanding the inflammatory response of COVID-19 patients is essential for the development of better therapeutic and management strategies.

Antibodies to Der p 1 and Der p 2 in allergic patients.

INTRODUCTION AND OBJECTIVES: Atopic individuals are characterized by increased IgE production and Th2 response if exposed to certain antigens. It is known that the mother transfers anti-mite antibodies to the fetus and newborn, IgG thru the placenta, and IgA thru breastfeeding, but it is not clear whether there is a protective mechanism mediated by them concerning the development of future allergies. This study aimed to compare the levels of IgA, IgG, and IgE antibodies specific to Der p 1 and Der p 2 between atopic and healthy individuals. METHODS: Serum samples of 98 patients and 44 healthy controls were subjected to quantification for specific IgE, IgG, and IgA antibodies against Der p 1 and Der p 2 by ImmunoCap® and ELISA, and subjected to statistical analysis as indicated. RESULTS: Atopic patients had higher serum levels of IgE, IgG, and IgA specific to Der p 1 and Der p 2. The correlation was more robust between IgE and IgG antibodies. CONCLUSIONS: Allergic patients produce higher levels of antibodies against Der p 1 and Der p 2 compared with healthy individuals. The mechanisms involved still require detailed studies.

Triagem neonatal para imunodeficiência combinada grave / Newborn screening for severe combined immunodeficiency

As imunodeficiências primárias (IDP) são uma área recente e aindapouco conhecida da medicina. Pacientes com IDP apresentam, na maior parte dos casos, infecções graves e recorrentes de início precoce, elevada morbidade e mortalidade, resultando frequentemente em sequelas,elevado custo social e sofrimento dos familiares. Embora na Américado Norte e Europa se estime que sua incidência seja semelhante à dafenilcetonúria e do hipotireoidismo congênito (afecções congênitas quecontam com triagem neonatal), ainda faltam dados quanto à sua real incidência na população brasileira.O projeto em desenvolvimento no Instituto de Ciências Biomédicasda USP e Escola Paulista de Medicina da UNIFESP, visa contribuir para o avanço na implementação de testes de triagem neonatal para asimunodeficiências primárias, mais especificamente, ImunodeficiênciasCombinadas Graves, que constituem um grupo de doenças com diferentesdefeitos genéticos, que evoluem para o óbito precoce se não foremdiagnosticadas e tratadas a tempo e a Síndrome de DiGeorge, que seestima ser a síndrome genética de deleção mais prevalente (1:3.000nascidos vivos).Seguindo esta linha de pensamento, nossa hipótese é que no Brasilexiste um número desconhecido de pacientes com IDP não diagnosticadosou subdiagnosticados que após a implementação de técnicas de detecção molecular por triagem neonatal para a SCID e síndrome de DiGeorge, passarão a ser contabilizados e tratados corretamente, diminuindo portanto,a morbidade e mortalidade.

Primary immunodeficiency disorders (PIDD) are a recently-recognizedand relatively unstudied area of medicine. Patients with PIDD frequentlypresent with the early onset of severe recurrent infections, high morbidityand mortality, frequently resulting in sequelae, high social cost, andfamily burden. While in North America and Europe it is estimated thatits incidence is similar to phenylketonuria and congenital hypothyroidism(congenital disorders that rely on neonatal screening), there is a lack ofdata on its actual incidence in Brazil.The project being developed at Institute of Biomedical Sciences,University of São Paulo and Federal University of São Paulo MedicalSchool, aims to contribute to the implementation of neonatal screeningtests for primary immunodeficiencies. More specifically, severe combinedimmunodeficiencies, a group of diseases with several genetic defects,may progress to early death if not diagnosed and treated early in life;and DiGeorge Syndrome, which is estimated to be the most prevalentgenetic deletion syndrome (1:3,000).Our hypothesis is that, in Brazil there is an unknown number ofpatients with undiagnosed or underdiagnosed disease, which, after theimplementation of detection techniques through newborn screening forSCID and DiGeorge Syndrome, will be accounted for and treated properly,reducing therefore, the morbidity and mortality.