Lesichkova Spaska, Mihailova Snezhina, Naumova Elisaveta, Yankova Petya, Krasteva Yana, Marinova Ralitsa
Clinic of Clinical Immunology and Stem Cell Bank, University Hospital Alexandrovska, Sofia, Bulgaria.
Expert Center for Rare Diseases-PID, University Hospital Alexandrovska, Sofia, Bulgaria.
Cent Eur J Immunol. 2022;47(4):357-361. doi: 10.5114/ceji.2022.124079. Epub 2023 Jan 31.
The association of immunocompromised patients and severity of COVID-19 infection is not well established. According to the Centers for Disease Control and Prevention (CDC), primary immune deficiencies (PIDs) are among the conditions that can predispose to a more severe course of COVID-19. We report the clinical course and immunological evaluation of five patients with common variable immune deficiency (CVID) who have experienced SARS-CoV-2 virus. Here we assess the severity of the infection, the immunophenotypic profile of the major lymphocyte subgroups, the nonspecific T-cell functional capacity and the SARS-CoV-2 specific effector T-cell immune response. Our results showed that the course of COVID-19 infection in CVID patients was mild to moderate and none of them developed a critical form of the disease. All patients developed a specific SARS-CoV-2 T cell immune response. Lymphopenia as well as impaired T-cell response prior to COVID-19 appeared to be related to a more severe course of the infection. Data on a good specific T cell response against SARS-CoV-2 in CVID patients will help to make the right vaccination decision and establish its efficacy. Clinical outcome even in these individual cases was in agreement with the therapeutic recommendations underlining that regular maintenance with subcutaneous immunoglobulins can be beneficial against immune system overreaction and a severe disease course and convalescent plasma is a treatment option in patients with CVID and COVID-19.
免疫功能低下患者与新冠病毒感染严重程度之间的关联尚未明确确立。根据美国疾病控制与预防中心（CDC）的数据，原发性免疫缺陷（PIDs）是可能使新冠病毒感染病情更严重的因素之一。我们报告了5例患有常见可变免疫缺陷（CVID）且感染了SARS-CoV-2病毒的患者的临床病程及免疫学评估情况。在此，我们评估了感染的严重程度、主要淋巴细胞亚群的免疫表型特征、非特异性T细胞功能能力以及针对SARS-CoV-2的特异性效应T细胞免疫反应。我们的结果显示，CVID患者的新冠病毒感染病程为轻度至中度，且无一例发展为重症。所有患者均产生了针对SARS-CoV-2的特异性T细胞免疫反应。新冠病毒感染前的淋巴细胞减少以及T细胞反应受损似乎与更严重的感染病程有关。CVID患者针对SARS-CoV-2产生良好特异性T细胞反应的数据，将有助于做出正确的疫苗接种决策并确定其疗效。即使在这些个别病例中，临床结果也与治疗建议一致，强调皮下注射免疫球蛋白的定期维持治疗可能有助于对抗免疫系统过度反应和严重病程，而康复期血浆是CVID合并新冠病毒感染患者的一种治疗选择。
