Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use

Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.

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Effectiveness of Glucocorticoids on acute respiratory distress syndrome: An umbrella review

10.21203/rs.2.22025/v1 ◽

2020 ◽

Author(s):

Semagn Mekonnen ◽

Haile Mariam Mulugeta Kassim ◽

Bivash Basu ◽

Solomon Nega

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Systemic Review ◽

Cochrane Library ◽

Umbrella Review ◽

Quality Of Evidence ◽

Secondary Outcomes

Abstract Background Management of Acute Respiratory Distress Syndrome is a very challenging critical illness in ICU with high morbidity and mortality worldwide.The review was intended to provide evidence on the effectiveness of Glucocorticoid treatment for acute respiratory distress syndrome Method A comprehensive search strategy was conducted on PubMed/Medline, Cochrane Library, Science direct, LILACS, and African Online Journal. Data extraction was carried out with two independent authors with customized checklist. The quality of each systemic review was assessed by two independent authors using AMSTAR tool and the overall quality of evidence was generated with online GRADEpro GDT software for primary and secondary outcomes. Result The umbrella review included nine systemic reviews and meta-analysis and one narrative review with eight thousand four hundred ninety one participants. The methodological quality of the included studies was moderate to high quality. The overall quality of evidence and recommendation varied form high to very low. Conclusion There is high to moderate quality evidence on the initiation of early low dose prolonged glucocorticoid for reduction of mortality for ARDS. However, randomized controlled trials with large sample sizes to address ventilator-free days, the incidence of infection and other glucocorticoid associated adverse events is required as the quality of evidence with these secondary outcomes were low to very low

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Quality of inter-hospital transportation in 431 transport survivor patients suffering from acute respiratory distress syndrome referred to specialist centers

Annals of Intensive Care ◽

10.1186/s13613-018-0357-y ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Sebastian Blecha ◽

◽

Frank Dodoo-Schittko ◽

Susanne Brandstetter ◽

Magdalena Brandl ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome

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Bauchlagerung bei Beatmung – Schritt für Schritt

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0665-6637 ◽

2019 ◽

Vol 144 (14) ◽

pp. 978-981 ◽

Cited By ~ 1

Author(s):

Tobias Bertram Vogt ◽

Barbara Sensen ◽

Stefan Kluge

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Standard Of Care ◽

Prone Positioning ◽

Severe Condition ◽

Improve Outcome ◽

Intensive Care Patients

AbstractThe Acute Respiratory Distress Syndrome is still a very severe condition in intensive care patients. Prone positioning is known to improve outcome in patients with moderate to severe ARDS. Therefore proning in these patients is nowadays to be regarded as a standard of care. The risks of proning are reasonably low – if proning is done correctly. Therefore a method of proning in a step-by-step-approach is shown in this article.

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Rituximab Twice Weekly for Refractory Thrombotic Thrombocytopenic Purpura in a Critically Ill Patient with Acute Respiratory Distress Syndrome

Case Reports in Oncology ◽

10.1159/000505236 ◽

2020 ◽

Vol 13 (1) ◽

pp. 153-157

Author(s):

Bahjat Azrieh ◽

Arwa Alsaud ◽

Khaldun Obeidat ◽

Amr Ashour ◽

Seham Elebbi ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Thrombotic Thrombocytopenic Purpura ◽

Distress Syndrome ◽

Standard Of Care ◽

Critically Ill Patient ◽

Microangiopathic Hemolytic Anemia ◽

Thrombocytopenic Purpura ◽

Life Threatening

Thrombotic thrombocytopenic purpura (TTP) is a rare, serious, life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and hypercoagulability. The etiology is a deficiency of ADAMTS13 which is usually caused by acquired antibodies. Plasma exchange and steroids is the standard of care in the treatment of TTP. However, there are refractory cases of TTP which require further management. Rituximab appears to be a safe and effective therapy for refractory and relapsing TTP. Here we report a challenging case of TTP that responded to treatment with rituximab twice weekly. According to our knowledge, rituximab twice weekly has never been used for TTP before.

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