RESUMO
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. METHODS: We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses. RESULTS: SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in SOT recipients, with some showing evidence of either humoral or cellular response, but not both. CONCLUSION: Humoral and cellular immune responses to the BNT162b2 vaccine are markedly reduced in SOT recipients as compared to HCs, suggesting that SOT recipients may benefit from more tailored regimens such as higher dose and/or additional vaccinations.
Assuntos
COVID-19 , Transplante de Órgãos , Anticorpos Antivirais , Vacina BNT162 , Vacinas contra COVID-19 , Humanos , Imunidade Celular , SARS-CoV-2 , Transplantados , Vacinas Sintéticas , Vacinas de mRNARESUMO
background: Coronary artery disease (CAD) can masquerade as other illnesses due to its varied presentations, the co-existence of other chest pain etiologies, and the limitations of diagnostic modalities. Case report: We present a case of ambiguous chest pain due to multiple possible etiologies, including acute coronary syndrome (ACS), where initial cardiological testing yielded negative results. This led to a delay of 112 days in establishing the diagnosis and initiating appropriate treatment. Conclusion: This case emphasizes the crucial role of clinical context and risk stratification in chest pain evaluation. It is imperative to interpret cardiovascular test results carefully, taking into account the sensitivities, specificities, scope, and limitations of the utilized modalities.