患有持续性新冠病毒感染的免疫功能低下患者：“长期感染者”综述
Immunocompromised Patients with Protracted COVID-19: a Review of "Long Persisters".
作者信息
Dioverti Veronica, Salto-Alejandre Sonsoles, Haidar Ghady
机构信息
Division of Infectious Diseases, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287 USA.
Clinical Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/University of Seville/CSIC, Avda. Manuel Siurot s/n 41013, Seville, Spain.
出版信息
Curr Transplant Rep. 2022;9(4):209-218. doi: 10.1007/s40472-022-00385-y. Epub 2022 Nov 12.
Abstract
PURPOSE OF REVIEW
Certain immunocompromised individuals are at risk for protracted COVID-19, in which SARS-CoV-2 leads to a chronic viral infection. However, the pathogenesis, diagnosis, and management of this phenomenon remain ill-defined.
RECENT FINDINGS
Herein, we review key aspects of protracted SARS-CoV-2 infection in immunocompromised individuals, or the so-called long persisters, and describe the clinical presentation, risk factors, diagnosis, and treatment modalities of this condition, as well as intra-host viral evolution. Based on the available data, we also propose a framework of criteria with which to approach this syndrome.
SUMMARY
Protracted COVID-19 is an uncharacterized syndrome affecting patients with B-cell depletion; our proposed diagnostic approach and definitions will inform much needed future research.
摘要
综述目的
某些免疫功能低下的个体有患持续性新冠病毒病（COVID-19）的风险，即严重急性呼吸综合征冠状病毒2（SARS-CoV-2）导致慢性病毒感染。然而，这一现象的发病机制、诊断和管理仍不明确。
最新发现
在此，我们综述了免疫功能低下个体或所谓的长期感染者中持续性SARS-CoV-2感染的关键方面，并描述了该病症的临床表现、危险因素、诊断和治疗方式，以及病毒在宿主体内的进化情况。基于现有数据，我们还提出了一个用于处理该综合征的标准框架。
总结
持续性COVID-19是一种影响B细胞耗竭患者的未明确特征的综合征；我们提出的诊断方法和定义将为未来急需的研究提供参考。
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2
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