POS1229 ANTI-MDA5 AND ANTISYNTHETASE ANTIBODIES SCREENING IN SEVERE SARS-COV-2 PNEUMONIA. BE AWARE OF FALSE POSITIVE RESULTS

Background:Several reports have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may trigger a vigorous immune response that could lead to the appearance of various autoantibodies such as antinuclear antibodies, antiphospholipid antibodies or anti-neutrophil cytoplasmic antibodies, among others. Moreover, the pulmonary involvement in SARS-CoV-2 may resemble that of patients with anti-MDA5 positive syndrome or acute form of antisynthetase syndrome.Objectives:Our aim was to analyse the presence of anti-MDA5 and other myositis-specific autoantibodies such as the antisynthetase antibodies in patients diagnosed with severe acute respiratory syndrome caused by SARS-CoV-2.Methods:Retrospective observational study performed in a tertiary care center. We included 28 patients admitted to the intensive care unit with severe acute respiratory syndrome, 14 at the onset of the disease (group A) and 14 after 30 days of being treated in an intensive care unit (group B). Chest CT was performed at the admission. We analyzed the presence of anti-MDA5 and antisynthetase antibodies by immunoblot (Euroimmune®) and in those who were positive we performed a confirmatory test by immunoprecipitation.Results:All chest CT showed bilateral ground glass pattern. Three out of 14 patients of group A (12 males, 86%, mean ± SD age 67.1 ± 12.2) were positive for antisynthetase antibodies (2 anti-PL7, 1 anti-Jo1), and 6 out of 14 patients of the group B (6 males, 48%, mean ± SD age 68.7 ± 8.1) were positive to antisynthetase antibodies (2 anti-PL7, 2 anti-PL-12, 1 anti-EJ, 1 anti-OJ+PL7). Immunoblots also show positivity for other myositis-specific or associated antibodies, such as anti-TIF1g, anti-PM75, anti-SAE and anti-SRP. All of these results found by immunoblotting were negative by immunoprecipitation. None of the 28 patients were positive for anti-MDA5 antibodies.Conclusion:Severe SARS-CoV-2 pneumonia is characterized by ground glass pattern in chest CT, as it is found in anti-MDA5 or antisynthetase syndrome. The positivity of several myositis related autoantibodies showed in immunoblot appears to be more related to the vigorous immune response producing polyclonal immunoglobulins than triggering a real myositis-associated interstitial lung disease. Clinicians must be aware about these false positive results in patients with severe COVID-19 acute respiratory syndrome.References:[1]Xu Q. MDA5 should be detected in severe COVID-19 patients. Med Hypotheses. 2020; 143:109890.[2]Giannini M, Ohana M, Nespola B, Zanframundo G, Geny B, Meyer A. Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care? Eur Respir J. 2020; 56:2001618.[3]Vlachoyiannopoulos PG, Magira E, Alexopoulos H, Jahaj E, Theophilopoulou K, Kotanidou A, Tzioufas AG. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis. 2020 Dec;79(12):1661-1663Disclosure of Interests:None declared

Manifestations of COVID-19 infection in patients with Multiple sclerosis and Neuromyelitis optica

Introduction: The pandemic caused by the new SARS-Cov2 coronavirus, raised concerns about the impact of COVID19 on patients with autoimmune diseases such as Multiple Sclerosis (MS) and the Neuromyelitis Optic Spectrum (ENMO), undergoing treatment with immunosuppressive, immunomodulatory and monoclonal antibodies. Objective: To analyze the clinical evolution of COVID19 in patients diagnosed with MS and ENMO. Methods: retrospective study including patients diagnosed with MS and ENMO at the demyelinating disease outpatient clinic at Hospital Santa Marcelina, who were diagnosed with COVID 19 from April 2020 to April 2021. Results: 27 patients were included, with a mean age of ± 41.74 years (21 - 63 years), four with ENMO (14.81%) and twenty-three (85.19%) with Multiple Sclerosis (91.3 % with Sending MS - Recurrent (RR), and 8.7% with Secondary MS - Progressive (SP)). No patient had an outbreak, and only one (3.7%) had a pseudo-outbreak, 21 patients (77.8%) had nasal / oropharyngeal swab with positive RT-PCR for SARS-Cov2, 02 patients had negative RT-PCR and positive IgG (7 , 4%), and 04 patients (14.8%) with RT-PCR and serology not performed (presumed diagnosis of COVID19). Twenty patients (74%) had mild symptoms of COVID19, two (7.5%) with moderate symptoms, and another five (18.5%) with severe symptoms (admitted to the ICU), none of whom died. Four patients (14.8%) had an altered chest tomography (ground-glass pattern). Seven patients (34%) had some clinical or psychiatric comorbidity. Conclusion: The manifestations and complications of COVID-19 in this group of patients were similar to those presented by the general population.

A Review of Radiographic Findings in Sars-Cov-2 Patients

Introduction: At the end of 2019, more specifically in December, the outbreak of the new coronavirus - Sars-Cov-2, which caused pneumonia, emerged in Wuhan, and soon spread throughout China, where researchers began to suspect a possible pandemic. , being a disease that causes a deficiency of structures of the respiratory system, leading to alterations in breathing functions, with respiratory muscle deficiencies and exercise tolerance. During the pandemic peak still in Wuhan, the main radiographic findings in hospitalized patients revealed bilateral opacity on computed tomography (CT) examination, lobular and subsegmental consolidation areas, ground-glass opacities, consolidation with rounded morphology, and peripheral pulmonary distribution. Aims: Analyze through the available literature review the main radiological alterations caused by Sars-Cov-2. Methodology: This is an integrative literature review using PubMed, Scielo, Google Scholar, Microsoft Academic databases. Inclusion criteria were complete and original articles in English and Portuguese. Duplicates and other literature reviews were excluded. Results: Radiographic findings are different in the early and advanced phases of the disease, but characteristic signs such as the matte glass pattern were found in both phases. Conclusion: The radiographic findings of patients diagnosed with COVID-19 are not the main criteria for clinical diagnosis, but knowledge of characteristic symptoms is fundamental. Therefore, the multidisciplinary team must discuss the radiological findings most common to the virus, this will directly aid early diagnosis, in addition to reducing the high mortality rates globally.

Neumonía por COVID19: Valoración por imagen, lo básico [COVID19 pneumonia: Imaging evaluation, the basics]

Resumen<br />La pandemia de COVID-19 ha resultado en una emergencia de salud global. Los estudios de imagen utilizados en esta enfermedad son la radiografía de tórax (RX) y la tomografía computarizada (TC). Ambas modalidades tienen sus hallazgos descritos, pero no son específicos dado que muchas enfermedades pueden producir patrones similares, particularmente las neumonías virales. Los RX de tórax muestra hallazgos consistentes en opacidades alveolares las cuales son múltiples, periféricas, bilaterales y basales, mientras que la tomografía de tórax sus hallazgos más frecuentes son presencia de patrón en vidrio deslustrado, consolidaciones, engrosamiento septal, patrón en empedrado, dilatación bronquial y engrosamiento peri bronquial, broncograma, patrón de halo invertido y patrón de neumonía organizada. Los hallazgos por imagen dependen del tiempo de evolución de la enfermedad ya que en etapas tempranas puede ser normal tanto en la RX como la TC. El riesgo de trombo embolismo pulmonar es alto y más frecuente que en pacientes con COVID-19 negativo.<br /><br />Abstract<br />The COVID-19 pandemic has resulted in a global health emergency. The imaging studies used in this disease are chest radiography (CXR) and computed tomography (CT). Both imaging modalities findings have had their findings. These findings described are not specific since many diseases can produce similar patterns. CXR shows somewhat consistent findings consisting of alveolar opacities which are multiple, peripheral, bilateral and basal, while CT the most frequent findings are the presence of grounded glass pattern, consolidations, septal thickening, crazy paving pattern, bronchial dilation and peribronchial thickening, air bronchograms, inverted halo sign and organized pneumonia. Imaging findings depends on the evolution time of the disease since in the early stages both chest radiography and tomography may be normal. The risk for pulmonary embolism is high and more frequent than in patients with negative COVID-19.<br /><br />

Development and Validation of a New Risk Score for Infection From Coronavirus (SARS-COV-2) [Ri.S.I.Co], That We Learned on the Field Treating Coronavirus Disease (COVID-19) Patients

Background: The pandemic of Coronavirus Disease 2019 asked to change the organization of entire hospitals to try to prevent them to become epidemiological clusters. The actually adopted diagnostic tools are lacking of sensibility or specificity. The aim of the study is to create an easy-to-get risk score (Ri.S.I.Co., RIsk Score for Infection from new COronavirus), developed on the field, to stratify patients admitted to the hospital according to their risk of Covid-19 infection.Methods: This prospective study included all patients who were consecutively admitted in the “suspected COVID-19 department” of the Bufalini Hospital, Cesena (Italy). All clinical, radiological and laboratory predictors were included in a multivariable logistic regression model to create a risk model. A simplified model was internally ed externally validated. Two score thresholds for stratifying the probability of COVID-19 infection were introduced.Results: From 11th March to 5th April 2020, 200 patients were consecutively admitted. A Ri.S.I.Co lower than 2 had an higher sensibility than SARS-Cov-2 nucleic acid detection (96,2% vs 65,4%, p<0,001). The presence of ground glass pattern at lung-CT scan had a lower sensibility than a Ri.S.I.Co lower than 2 (88,5% vs 96,2%, p<0,001) and a lower specificity than a Ri.S.I.Co higher than 6 (75,0% vs 96,9%, p<0,001). Conclusions: We believe that the Ri.S.I.Co could allow to stratify admitted patients according to their risk, avoiding hospitals becoming themselves the main Covid-19 carriers. Furthermore, it could guide clinicians in starting therapies early in severe-onset cases with a high probability of COVID-19, before molecular SARS-CoV-2 infection is confirmed.Strengths and limitations of this study:Ri.S.I.Co., (RIsk Score for Infection from new COronavirus) is an easy-to-get risk-score developed on the field, to stratify patients admitted to the hospital according to their risk of Covid-19 infection.We believe that the Ri.S.I.Co could allow to stratify admitted patients according to their risk, before molecular SARS-CoV-2 infection is confirmed, avoiding hospitals becoming themselves the main Covid-19 carriers.Ri.S.I.Co had an higher sensibility than SARS-Cov-2 nucleic acid detection and an higher sensibility and specificity of the presence of ground glass pattern at lung-CT scan.Ri.S.I.Co was developed and validated on hospitalized patients, further studies would be necessary to understand if it is generalizable to non-hospitalized patients or on the population of other countries with different mean age, different prevalence of comorbidities and different health policies.