Febrile neutropenia due to COVID-19 in an immunocompetent patient

Devi, Yumkham Monica; Sehrawat, Amit; Panda, Prasan Kumar; Nath, Uttam Kumar

doi:10.1136/bcr-2021-242683

Cited by 10 publications

(15 citation statements)

References 7 publications

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“…This suggests that the course of IM might be associated with the percentage of immature neutrophils and that this percentage can be of prognostic significance. A similar trend was observed in COVID-19 patients, whereby, a dramatic increase in the number of immature neutrophils was observed in peripheral blood and immature neutrophil-to-VD2 T-cell ratio was an early marker for severe COVID-19 (61)(62)(63). What is even more interesting is that the percentage of rod nuclear neutrophils was positively correlated with copies of EBV DNA in blood.…”

Section: Discussionsupporting

confidence: 72%

Tree Shrew Is a Suitable Animal Model for the Study of Epstein Barr Virus

et al. 2022

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Epstein-Barr virus (EBV) is a human herpesvirus that latently infects approximately 95% of adults and is associated with a spectrum of human diseases including Infectious Mononucleosis and a variety of malignancies. However, understanding the pathogenesis, vaccines and antiviral drugs for EBV-associated disease has been hampered by the lack of suitable animal models. Tree shrew is a novel laboratory animal with a close phylogenetic relationship to primates, which is a critical advantage for many animal models for human disease, especially viral infections. Herein, we first identified the key residues in the CR2 receptor that bind the gp350 protein and facilitate viral entry. We found that tree shrew shares 100% sequence identity with humans in these residues, which is much higher than rabbits (50%) and rats (25%). In vitro analysis showed that B lymphocytes of tree shrews are susceptible to EBV infection and replication, as well as EBV-enhanced cell proliferation. Moreover, results of in vivo experiments show that EBV infection in tree shrews resembles EBV infection in humans. The infected animals exhibited transient fever and loss of weight accompanied by neutropenia and high viremia levels during the acute phase of the viral infection. Thereafter, tree shrews acted as asymptomatic carriers of the virus in most cases that EBV-related protein could be detected in blood and tissues. However, a resurgence of EBV infection occurred at 49 dpi. Nanopore transcriptomic sequencing of peripheral blood in EBV-infected animals revealed the dynamic changes in biological processes occurring during EBV primary infection. Importantly, we find that neutrophil function was impaired in tree shrew model as well as human Infectious Mononucleosis datasets (GSE85599 and GSE45918). In addition, retrospective case reviews suggested that neutropenia may play an important role in EBV escaping host innate immune response, leading to long-term latent infection. Our findings demonstrated that tree shrew is a suitable animal model to evaluate the mechanisms of EBV infection, and for developing vaccines and therapeutic drugs against EBV.

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Section: Discussionsupporting

confidence: 72%

Tree Shrew Is a Suitable Animal Model for the Study of Epstein Barr Virus

et al. 2022

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“…Both the moderate (<1,000 cells/μl) and especially the severe neutropenia, which is also called agranulocytosis (<500 cells/μl), are conditions with an extraordinary risk of infections. The conditions require patient monitoring and empirical antibiotic therapy along with the administration of granulocyte colony-stimulating factor in some cases ( Devi et al., 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates

Zahmi

Habuza

Awawdeh

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundDubai (United Arab Emirates; UAE) has a multi-national population which makes it exceptionally interesting study sample because of its unique demographic factors.ObjectiveTo stratify the risk factors for the multinational society of the UAE.MethodsA retrospective chart review of 560 patients sequentially admitted to inpatient care with laboratory confirmed COVID-19 was conducted. We studied patients’ demographics, clinical features, laboratory results, disease severity, and outcomes. The parameters were compared across different ethnic groups using tree-based estimators to rank the ethnicity-specific disease features. We trained ML classification algorithms to build a model of ethnic specificity of COVID-19 based on clinical presentation and laboratory findings on admission.ResultsOut of 560 patients, 43.6% were South Asians, 26.4% Middle Easterns, 16.8% East Asians, 10.7% Caucasians, and 2.5% are under others. UAE nationals represented half of the Middle Eastern patients, and 13% of the entire cohort. Hypertension was the most common comorbidity in COVID-19 patients. Subjective complaint of fever and cough were the chief presenting symptoms. Two-thirds of the patients had either a mild disease or were asymptomatic. Only 20% of the entire cohort needed oxygen therapy, and 12% needed ICU admission. Forty patients (~7%) needed invasive ventilation and fifteen patients died (2.7%). We observed differences in disease severity among different ethnic groups. Caucasian or East-Asian COVID-19 patients tended to have a more severe disease despite a lower risk profile. In contrast to this, Middle Eastern COVID-19 patients had a higher risk factor profile, but they did not differ markedly in disease severity from the other ethnic groups. There was no noticeable difference between the Middle Eastern subethnicities—Arabs and Africans—in disease severity (p = 0.81). However, there were disparities in the SOFA score, D-dimer (p = 0.015), fibrinogen (p = 0.007), and background diseases (hypertension, p = 0.003; diabetes and smoking, p = 0.045) between the subethnicities.ConclusionWe observed variations in disease severity among different ethnic groups. The high accuracy (average AUC = 0.9586) of the ethnicity classification model based on the laboratory and clinical findings suggests the presence of ethnic-specific disease features. Larger studies are needed to explore the role of ethnicity in COVID-19 disease features.

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“…12 13 On day 3, ANCs were>1200/µL, other routine laboratory investigations were also normal and the patient also improved clinically from COVID-19. Thus, it is learnt from this experience and available literature that an early or delayed severe neutropenia could be found during severe COVID-19 infection [2][3][4] and could be a result…”

Section: Discussionmentioning

confidence: 88%

“…The previous studies do not mention neutropenia as a manifestation of COVID-19 infection. There are only a few previous case reports on neutropenia in otherwise immunocompetent adult patients2–4 and an infant 5. The neutropenia in patients with COVID-19 with haematological malignancy6 7 or solid tumour8 has also been reported.…”

Section: Discussionmentioning

confidence: 99%

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Self-limiting severe neutropenia in a patient with COVID-19

et al. 2021

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Neutropenia is a rare haematological complication of COVID-19 infection in immunocompetent patients. There is sparse literature on neutropenia in patients with COVID-19, except a few case reports. We encountered a similar case in an intensive care unit that developed severe neutropenia on day 24 of illness. Neutropenia resolved spontaneously on 4th day of its appearance. The patient was isolated and kept under close observation, antibiotics were upgraded and strict asepsis was maintained. Thus, we observed in a patient with no comorbidities and uncomplicated neutropenia that strict measures to prevent infection may suffice and the undue risk of hematopoietic therapy can be avoided. An expert opinion should always be sought in such cases as the presence of complications may require an aggressive approach.

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Febrile neutropenia due to COVID-19 in an immunocompetent patient

Cited by 10 publications

References 7 publications

Tree Shrew Is a Suitable Animal Model for the Study of Epstein Barr Virus

Tree Shrew Is a Suitable Animal Model for the Study of Epstein Barr Virus

Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates

Self-limiting severe neutropenia in a patient with COVID-19

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