Immunity and COVID-19: On the path towards precision medicine?

Thomas Planté-Bordeneuve, Antoine Froidure, Charles Pilette Published in the journal : May 2020 Category : Pneumology

COVID-19, which is caused by the SARS-CoV-2 virus, induces in 5 to 15% of cases a severe phenotype with bilateral pneumonia, sometimes complicated by an acute respiratory distress syndrome and respiratory failure. Patients present with lymphopenia and possibly neutrophilia, which are of prognostic relevance. In addition, some patients develop immune overactivation, which is associated with a cytokine storm and a poor prognosis. Although the underlying mechanisms remain poorly understood, the virus’ ability to escape immune mechanisms could play an important role. An improved understanding of the disease immunopathology should help defining a precision medicine to treat COVID-19 patients based on predictive (or early) biomarkers of severity.

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The SARS-CoV-2 pandemic in Sub-Saharan Africa, Questions, fears, and hopes

Ella Larissa Ndoricyimpaye, Joseph Tuyishimire, Sophie Vanwambeke, Léon Mutesa, Elias Nyandwi, Nadine Rujeni, Jean-Paul Coutelier Published in the journal : May 2020 Category : Pays émergents

The frequency of confirmed cases, along with subsequent deaths due to SARS-CoV-2 pandemic, appears to be lower in developing countries, especially Sub-Saharan Africa. This is most probably due to the delayed epidemic outbreak in this part of the world, where several local elements may modify the epidemic’s course. Indeed, the less favorable socio-economic conditions associated with promiscuity, along with health services already stretched to the utmost by several other diseases, as well as the frequency of aggravating diseases in some countries may at times induce a difficult health situation where it is difficult to be properly prepared in order to correctly respond to the outbreak. On the other hand, the populations’ age pyramid, as well as their potential genetic traits and co-infections’ immuno-regulatory mechanisms could effectively decrease the infection’s severity. To lessen the direct and indirect impacts of the epidemic in these countries, it is crucial to strengthen their diagnostic and treatment capacities, using a thorough scientific analysis of local risk factors most likely to be improve our understanding of this pandemic.

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ENT complaints associated with COVID-19 infection

Caroline Huart, Karl Le Bras, Caroline de Toeuf, Naima Deggouj, Philippe Rombaux Published in the journal : May 2020 Category : Otorhinolaryngology

Although fever, respiratory symptoms, cough, and fatigue were initially considered as the leading symptoms of COVID-19 infection, it has now become evident that patients often report ear, nose, and throat (ENT) symptoms. Notably, we are currently facing an outbreak of olfactory dysfunction along with the COVID-19 pandemic. Although the World Health Organization states that this symptom is less common, several studies have demonstrated that this symptom is often observed, and that anosmia may even constitute the only complaint of SARS-CoV-2 carriers in some cases. Consequently, it is now admitted that patients with isolated sudden anosmia and no nasal obstruction should be considered as potential COVID-19 patients. Hence, this symptom should motivate the initiation of quarantine and use of appropriate personal protective equipment for attending medical teams.

As SARS-CoV-2 has a tropism for ENT mucosa and given that ENT procedures may generate aerosolization, ENT examination is a procedure with a particularly high risk of transmission for medical doctors. Therefore, adequate personal protective equipment should be employed when performing ENT examination. Moreover, it is advised to limit procedures leading to aerosolization as much as possible, as well as to adapt ENT surgical techniques during the pandemic.

This paper has reviewed the ENT symptoms possibly related to COVID-19 infection, with a particular focus on anosmia. We have also provided a reminder concerning good clinical practice recommendations in the ENT setting.

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ONCOVID, or how not to harm

Alice Kalantari, Jean-Pascal Machiels, Cédric Van Marcke Published in the journal : May 2020 Category : Oncologie médicale

The management of oncology patients during a pandemic is a challenge on several levels. We have never faced before a pandemic of this magnitude, especially in the era of advanced medicine that uses many immunosuppressive or immunomodulating drugs.

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Pregnancy and COVID-19

Corinne Hubinont, Frédéric Debieve, Pierre Bernard Published in the journal : May 2020 Category : Obstétrique

The COVID-19 pandemia may affect pregnant women. Though the vast majority of infected pregnant patients are asymptomatic, about 9% exhibit symptoms of pneumonia, which must be diagnosed and appropriately treated. The first published papers suggested a management similar to that of non-pregnant patients in terms of diagnostic tests and therapies. Given the increased risk of preterm labor, corticosteroids for fetal lung maturation should be administrated in case of imminent labor. The delivery route should be chosen based on obstetrical data even if elective caesarian section was reported in most published patients. Loco-regional anesthesia is permitted. Only a few cases of maternal-fetal transmission have been reported to date, with transmission mainly occurring during and after delivery. Perinatal morbidity and mortality have been shown to be very low. Only one maternal death was reported so far. Breastfeeding is possible using specific hygiene measures, such as hand washing and surgical mask wearing. In conclusion, this up-to-date literature review suggests that COVID-19-infected pregnant women and their newborn face a good outcome. However, more information from large multicenter studies must be collected, in an effort to confirm these encouraging data.

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Neurological implications of SARS-CoV-2 infection

Pietro Maggi, Antoine Guilmot, Sofia Maldonado Slootjes, Caroline Huart, Bernard Hanseeuw, Thierry Duprez, Julien De Greef, Leila Belkhir, Jean Cyr Yombi, Adrian Ivanoiu, Vincent van Pesch Published in the journal : May 2020 Category : Neurology

A steadily increasing number of cases with neurological manifestations that are potentially related to COVID-19 are being reported in the literature. These most often include sudden anosmia, headache, encephalopathy, and stroke. The pathophysiological mechanisms underlying "Neuro-COVID" remain largely unknown, while the viral genome is very rarely detected in the cerebrospinal fluid. A study currently ongoing at the Cliniques universitaires Saint-Luc is aimed at investigating COVID-19 associated cerebrospinal fluid changes as well as immunohistochemical evidences of olfactory neuroepithelial cells direct viral infection and evidencing a direct infection of olfactory neuroepithelial cells.

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COVID-19, kidney, and renal diseases

Johann Morelle, Arnaud Devresse, Nathalie Demoulin, Valentine Gillion, Eric Goffin, Nada Kanaan, Laura Labriola, Michel Jadoul Published in the journal : May 2020 Category : Nephrology

This short contribution first focuses on the growing evidence showing that the kidney is a target for the coronavirus, with signs of kidney disease being a marker of COVID-19 severity. It next discusses the reasons not to withdraw angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in high-risk groups, as well as the potential risk of virus transmission inside the hemodialysis unit or via peritoneal dialysis. Finally, the article summarizes the data available regarding COVID-19 in kidney transplant recipients and concludes with some considerations concerning the major challenges faced when it comes to ensuring high-quality medical care during this pandemic.

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COVID-19 in neonatology: a synthesis of the current situation

Julien Toulmonde, Olivier Danhaive, Nancy Laval, Fiammetta Piersigilli Published in the journal : May 2020 Category : Neonatology

The beginning of 2020 was marked by the spread of SARS-CoV-2 virus, a new virus from the beta-coronavirus family, from Hubei, China. This virus is responsible for a global pandemia of pneumonia with acute respiratory distress syndrome. Although the infection appears to be less acute in the pediatric population, neonates tend to be more frequently affected. Several cases of neonatal SARS-CoV-2 infections have been reported to date, including one in an extremely premature neonate. Nevertheless, the clinical picture seems to be less critical and neonatal mortality associated with COVID-19 has not been reported to date. The transmission mode from mother to infant has not been clearly demonstrated so far. Breastfeeding is allowed in most countries. The aim of this article is to summarize the epidemiological context and current knowledge on COVID-19 in infants and neonates.

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COVID-19: SARS-CoV-2 infection

J. De Greef, L. Pothen, H. Yildiz,W. Poncin, G. Reychler, S. Brilot, S. Demartin, E. Lagneaux, R. Lattenist, J. Lux,G. Pierman, G. Vandercam, S. Wallemacq, A. Scohy , A. Verroken, B. Mwenge, G. Liistro, A. Froidure, C. Pilette, L. Belkhir, J-C. Yombi Published in the journal : May 2020 Category : Médecine interne et maladies infectieuses

The world is facing a serious pandemic. The disease called COVID-19 is caused by a new coronavirus, SARS-CoV-2, which started to spread in China in December 2019. COVID-19 is a condition that may be particularly serious and even fatal in elderly people, as well as in patients with comorbidities such as high blood pressure, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer. The clinical presentation is mild in approximately 80% of cases, moderate to severe in 15% of cases, and critical in 5% of cases. The most common symptoms of COVID-19 are fever, fatigue, muscle aches, and dry cough. Some patients may exhibit nasal congestion, chills, sore throat, or diarrhea. Severely ill patients can develop an acute respiratory distress syndrome (ARDS), shock, thrombosis, and multiple organ failure, and they are at risk of death. COVID-19 patients with ARDS have a poor prognosis, with an estimated mortality rate of more than 10%. SARS-CoV-2 is primarily transmitted through respiratory droplets. Airway and hand hygiene is therefore essential. The diagnosis is made by reverse transcription-polymerase chain reaction on a nasopharyngeal or oropharyngeal swab and, in suggestive cases, by chest computed tomography, which has a high sensitivity. There is currently no effective specific treatment for COVID-19. Many molecules have been tried or are under investigation. The treatment currently remains supportive.

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COVID-19: A thrombotic disease?

Cédric Hermans, Catherine Lambert Published in the journal : May 2020 Category : Hémostase

COVID-19, especially in its severe form, is associated with a coagulopathy responsible for an increased incidence of venous and arterial thrombosis, pulmonary embolism, and pulmonary microthrombosis. Biologically, it results in increased D-dimer levels, which is of diagnostic and prognostic relevance. Depending on its severity, the COVID-19 infection requires a treatment with low-molecular-weight heparin (LMWH) at preventive or semi-therapeutic doses. In case of proven or strongly suspected thrombosis, anticoagulation with LMWH at therapeutic doses is recommended.

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