SARS-CoV-2 Evolution and Immune Escape in Immunocompromised Patients

Scherer, Erin M.; Babiker, Ahmed; Adelman, Max W.; Allman, Brent E.; Key, Autum; Kleinhenz, Jennifer M.; Langsjoen, Rose M.; Nguyen, Phuong-Vi; Onyechi, Ivy; Sherman, Jacob D.; Simon, Trevor W.; Soloff, Hannah; Tarabay, Jessica; Varkey, Jay B.; Webster, Andrew; Weiskopf, Daniela; Weissman, Daniel B.; Xu, Yongxian; Waggoner, Jesse J.; Koelle, Katia; Rouphael, Nadine; Pouch, Stephanie M.; Piantadosi, Anne

doi:10.1056/nejmc2202861

Cited by 75 publications

(58 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonetheless, in our cohort, the infection had a slightly but significantly longer course in children undergoing immunosuppressive therapy (13 vs. 10 days). This is consistent with previous reports in immunocompromised adults and children, and a matter of concern for the emergence of more virulent variants [ 19 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

Epidemiology, severity, and risk of SARS-CoV-2-related relapse in children and young adults affected by idiopathic nephrotic syndrome: a retrospective observational cohort study

et al. 2022

View full text Add to dashboard Cite

Background Children with underlying kidney diseases display a mild course of SARS-CoV-2 infection, but they only accounted for a minority of cases until the spread of the Omicron variant. Nonetheless, idiopathic nephrotic syndrome (INS) has been advocated as a predictor of worse outcome. Methods We investigated the spread, severity, and risk of relapse related to SARS-CoV-2 infection among children with INS. The incidence and characteristics of SARS-CoV-2 infections, immunosuppression, and vaccination status were retrospectively collected from the beginning of the pandemic to May 31, 2022. Results We enrolled 176 patients (73 females, median age 10.22 years); 28 had a steroid-resistant disease, and 108 (61.4%) were on immunosuppressive therapy. Sixty-one (34.7%) patients reported a SARS-CoV-2 infection, with incidence peaking between December 2021 and January 2022. No hospitalization or deaths were reported, and symptoms were absent or mild. The rate of SARS-CoV-2 infection was similar in children with and without immunosuppression (33.8% vs 35.2%; p = 0.85). None of the 38 immunosuppressed patients discontinued the therapy, but they had a longer time to negativization (13.31 vs. 10.04 days; p = 0.03). Proteinuria was detected in 7 patients, but only one had a relapse requiring steroid therapy, with prompt remission and a mild course. Conclusions After the spread of the Omicron variant, the rate of SARS-CoV-2 infection in children with INS was much higher than previously reported. In this large cohort, symptoms were mild, even in immunosuppressed patients and those with proteinuria. During the infection, transient proteinuria was common with a low rate of relapses. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information Supplementary Information The online version contains supplementary material available at 10.1007/s00467-022-05736-6.

show abstract

Section: Discussionsupporting

confidence: 93%

Epidemiology, severity, and risk of SARS-CoV-2-related relapse in children and young adults affected by idiopathic nephrotic syndrome: a retrospective observational cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Although recommendations are not yet supported by data 15 , it has been hypothesized that most at-risk patients should receive combination therapy including both moAbs and antivirals 29 . Indeed, despite treatment with moAbs or antivirals alone, immune-suppressed patients may show more prolonged infections, leading to unfavorable clinical outcomes 30 .…”

Section: Discussionmentioning

confidence: 99%

Interleukin-62/lymphocyte as a proposed predictive index for COVID-19 patients treated with monoclonal antibodies

Rotundo

Borelli

Scaglione

et al. 2022

Preprint

View full text Add to dashboard Cite

In a convenience sample of 93 patients treated with monoclonal antibodies (moAbs) against SARS-CoV-2, the interleukin-62/lymphocyte count ratio (IL-62/LC) was able to predict clinical worsening both in early stages of COVID-19 and in oxygen-requiring patients. Moreover, we analysed the 18 most at-risk patients treated with both moAbs and antiviral treatment and found that only 2 had clinical progression, while in another case, progression was not observed despite IL-62/LC being above the risk cut-off. By contrast, patients with a similar risk were reported to have an unfavorable outcome in most cases from recent data. In conclusion, IL-62/LC may be a valuable method to identify patients requiring more aggressive treatments both in earlier and later stages of the disease; however, most at-risk patients could be protected from clinical worsening by combining moAbs and antivirals, even if levels of the IL-62/LC biomarker are lower than the risk cut-off.

show abstract

“…Not only are prolonged disease courses associated with poor patient outcomes, but it has also been observed that these patients may have mutations in the virus sequences during the course of the disease, 9 , 10 , 11 , 12 which could eventually facilitate the emergence of new SARS-CoV-2 variants with the consequent public health problems derived from them. 13 In addition, observations have recently emerged about the possibility of promoting escape variants with convalescent plasma treatment and other treatments.…”

Section: Discussionmentioning

confidence: 99%

Persistently positive PCR SARS-CoV-2 at low cycle threshold in an immunosuppressed patient

Martin-Díaz¹,

Cabrejas-Ugartondo²,

Iglesias-López³

et al. 2022

The Brazilian Journal of Infectious Diseases

View full text Add to dashboard Cite

SARS-CoV-2 Evolution and Immune Escape in Immunocompromised Patients

Cited by 75 publications

References 5 publications

Epidemiology, severity, and risk of SARS-CoV-2-related relapse in children and young adults affected by idiopathic nephrotic syndrome: a retrospective observational cohort study

Epidemiology, severity, and risk of SARS-CoV-2-related relapse in children and young adults affected by idiopathic nephrotic syndrome: a retrospective observational cohort study

Interleukin-62/lymphocyte as a proposed predictive index for COVID-19 patients treated with monoclonal antibodies

Persistently positive PCR SARS-CoV-2 at low cycle threshold in an immunosuppressed patient

Contact Info

Product

Resources

About