Easy approach to detect cell immunity to COVID vaccines in common variable immunodeficiency patients

Background Patients with primary antibody deficiencies, such as Common Variable Immunodeficiency (CVID), have some problems to assess immune response after coronavirus disease (COVID) vaccination. Cutaneous delayed-type hypersensitivity (DTH) has the potential to be used as a useful, simple, and cheaper tool to assess T-cell (T lymphocyte) function.Methods Seventeen patients with CVID, a rare disease, received two doses of the mRNA-based Pfizer-BioNTech COVID-19 vaccine. Humoral Immune Response (HIR) was determined by measuring specific immunoglobulin G (IgG) antibodies, and Cellular Immune Response (CIR) was evaluated using an ex vivo interferon-gamma release assay (IGRA) and in vivo by DTH skin test.Results Two weeks after the second dose of the vaccine, 12 out of 17 CVID patients have high optical density (OD) ratios of specific anti-spike protein (S) IgG whereas five patients were negative or low. Ex vivo CIR was considered positive in 14 out of 17 S1-stimulated patients. Unspecific stimulation was positive in all 17 patients showing no T-cell defect. A positive DTH skin test was observed in 16 CVID patients. The only patient with negative DTH also had negative ex vivo CIR.Conclusions The use of DTH to evaluate CIR was validated with an optimal correlation with the ex vivo CIR. The CIR after vaccination in patients with antibody deficiencies seems to have high precision and more sensitivity to antibodies-based methods in CVID.Clinical Implications There is a remarkable correlation between cutaneous DTH and ex vivo IGRA after COVID vaccination. A COVID-specific skin DTH test could be implemented in large populations.Capsule Summary Cutaneous delayed-type hypersensitivity has the potential to be used as a useful, simple, and cheaper tool to assess T-cell functioning (AU)

Barotrauma en COVID-19: Asociación de neumotórax y uso de cánula nasal de alto flujo / Barotrauma in COVID-19: Association between pneumothorax and high flow nasal cannula use

La cánula nasal de alto flujo (CNAF) es una alternativa en la oxigenoterapia de pacientes en insuficiencia respiratoria aguda hipoxémica, especialmente en contexto de pandemia por SARS-CoV-2. Existen muchos beneficios, con distintos niveles de evidencia y muy pocos efectos adversos reportados a su uso descritos en adultos. Se presenta el caso de un paciente con enfermedad pulmonar obstructiva crónica, que cursando con una neumonía grave por SARS-CoV-2, mientras recibía terapia con CNAF, desarrolló un neumotórax. Esta complicación asociada a la terapia con CNAF es poco reportada en la literatura, lo que motiva este reporte.

High Flow Nasal Cannula (HFNC) is an alternative to deliver oxygen in patients with hypoxemic acute respiratory failure, especially in the context of SARS-CoV-2 outbreak. There are plenty of benefits described, with different evidence levels and very few adverse effects published in adults until now. We report the case of a patient with chronic obstructive pulmonary disease, presenting with SARS-CoV-2 severe pneumonia that while receiving oxygen with HFNC developed pneumothorax. This complication associated with HFNC has not been commonly described, which motivates this report.