RESUMO
Teenagers generally present mild to no symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the present report, we present the case of a 14-year-old boy with Angelman syndrome (AS) who presented with severe COVID-19 symptoms. He spent 20 days in the ICU with elevated inflammatory biomarkers (C-reactive protein and D-dimer) and increased peaks of neutrophil-to-lymphocyte ratio, which is uncommon for teenagers diagnosed with COVID-19. Although he showed physiological instability, he was able to produce neutralizing antibodies, suggesting a functional immune response. The literature concerning the immune response to infections in patients with AS is still poor, and to our knowledge, this was the first report of a patient with AS diagnosed with COVID-19. As such, the present study may alert other patients with AS or other rare diseases that they lack a competent immune response and could suffer severe consequences of SARS-CoV-2 infection.
RESUMO
Objetivo: Identificar e caracterizar os efeitos tóxicos do uso do cloreto de benzalcônio sobre a mucosa respiratória nasal, células do sistema imunológico e função mucociliar in vivo e in vitro. Métodos: O presente estudo foi realizado pela pesquisa de artigos disponíveis no banco de dados PUBMED, MEDLINE, SCIELO e LILACS nos últimos 20 anos. Foram selecionados ar¬tigos publicados nas línguas inglesa e portuguesa. Resultados: O cloreto de benzalcônio em diferentes concentrações concorreu para alteração tóxica em células da mu¬cosa nasal e aparelho ciliar. Adicionalmente, foram identifica¬das reduções da função mucociliar em modelos murinos e humanos. As alterações mucociliares identificadas a partir dos estudos analisados sugerem claramente a inibição dose e tempo dependentes do mecanismo de clareamento mucociliar. Em alguns estudos, observaram-se sintomas clínicos relevantes relacionados ao uso deste agente. Conclusões: O uso de CBZ associou-se a alterações histo¬morfológicas, distúrbios do transporte mucociliar e disfunção de granulócitos, in vitro e in vivo. (Au)Objective: To identify and to characterize the toxic effect of benzalkonium chloride on nasal respiratory mucosa, cells of the immune system and cilia function, in vitro and in vivo. Methods: The present study was carried by searching avai¬lable articles from PUBMED, MEDLINE, SCIELO and LILACS da¬tabase in the last 20 years. We selected published articles in Portuguese and English language. Results: Different concentrations of benzalkonium chloride concurred for toxic alteration in cells of the nasal mucosa and cilia device. Additionally, reduction of the cilia function in murines and human models had been identified. The cilia alterations from the analyzed studies suggest clearly the inhibition dose-dependant and time-dependant of the mechanism of mu¬cus clearance. In some studies, clinical symptoms associated to the use this pharmacologic agent was shown Conclusion: The CBZ was associated to hystomorphologic alterations; cilia transport disturbances and granulocyte dysfunction, in vitro and in vivo.