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Introduction: The lack of a clear definition of cytokine release syndrome (CRS) allowed this study to analyze the utility of interleukin-6 (IL-6), ferritin, and D-dimer (DD) with other variables and their clinical evolution. Methods: A prospective, observational, and analytical study was conducted from October 2020 to July 2021 in 125 patients in the intensive care unit (ICU) of Hospital Obrero Nro. 2 of the Caja Nacional de Salud in Cochabamba, Bolivia. The three markers and other exams were requested to determine correlations, survival, and relationship with CRS. Results: The mean ferritin was 1193.7±814.8 ng/ml, D-dimer 1427±1005 ng/ml, and IL-6 58.5±34.1 pg/mL. No statistical association was found between these markers, but a Spearman's Rho of 0.5 between ferritin and DD (p<0.05) was found in patients who died. In addition, there were associations between male gender and ferritin, DD and dyspnea, and IL-6 and tracheostomy. Survival was 9 days 95% CI (8.02-9.98) with similar values of DD and ferritin for both normal and elevated levels. The values of the area under the curve (AUC) did not show prediction of mortality, but a rate of 70%. Survival was better in those who did not suffer from acute respiratory distress syndrome (ARDS), with eight days (p=0.011). Conclusions: It is not possible to relate CRS to IL-6, DD, and ferritin, or to define it with fever, leukocytosis, renal failure, tracheostomy, due to the heterogeneous values of IL-6 in relation to COVID-19 and other inflammatory pathologies. The position of a hypoinflammatory disease rather than a hypercytokinemia remains in doubt. [ABSTRACT FROM AUTHOR]

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), causing of coronavirus disease 2019 (COVID-19), is resulting in a worldwide pandemic and has affected more than 200 countries, leading in more than 10 million cases with 508,000 confirmed deaths. The disease spectrum is wide from mild symptoms to severe pneumonia, and some critical conditions be able to produce life-threatening complications, particularly in patients with cytokine release syndrome. This is characterized by dyspnea, hypoxemia and bilateral lung infiltrates on chest radiographic imaging, in case of disease progression invasive mechanical ventilation is needed. The clinical presentation includes hypotension, fever, septic shock with vasopressor therapy, endothelial injury, disseminated intravascular coagulation and multi-organic failure. The most relevant paraclinical parameters associated to cytokine release syndrome are cytopenias, elevated levels of inflammatory cytokines, transaminasemia, coagulation abnormalities and increment in C-reactive protein values. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6r), it has been successful administrated in cytokine release syndrome. We propose the blockage with tocilizumab in patients who fulfilled the clinical criteria of cytokine release syndrome based on the literature review as a therapeutic target for COVID-19 infection. [ABSTRACT FROM AUTHOR]

BACKGROUND: The pulmonary changes in COVID-19 are associated with cytokine release syndrome that could be treated with JAK inhibitors through the blockade of type I interferon and IL-6, IL-1, TNF and GM-CSF. CLINICAL CASE: A 32-year-old female with previous iron-deficiency anemia. She presented cough, tachypnea, fever, diarrhea and low oxygen saturation to 86% by pulse oximeter. PCR for SARS-CoV-2 was reported positive and bilateral pneumonia was seen on CT-scan. Diagnosis of COVID-19 pneumonia was confirmed. At diagnosis with erythrocyte sedimentation rate (ESR) 33 mm/hour, CRP 8.4 mg/dL, LDH 317 U/L, DD 412 ng/mL, lymphocytes 0.8 x 10³/μL, hemoglobin 7.4 g/dL with rest of bloodcount being normal. Ruxolitinib at 5 mg BID for 14 days was given. The patient was discharged after 7 days of hospital-length without supplemental oxygen and improvement in CT-scan and proinflammatory values: ESR 18 mm/hour, CPR 0.7 mg/mL, LDH 187 U/L, DD 308 ng/dL, lymphocytes 1.8 x 103/μL, hemoglobin 11.4 g/dL. CONCLUSIONS: Ruxolitinib proved to be a safe and efficient treatment for SARS-CoV-2 pneumonia with limitation of the cytokine release syndrome demonstrated by clinical evolution and proinflammatory markers. [ABSTRACT FROM AUTHOR]

For the treatment of COVID-19, countless drugs have been used, glucocorticoids, among them dexamethasone, have been used as a therapeutic alternative. In order to describe the pharmacological and toxicological aspects of this drug, an exhaustive literature search was carried out. Preliminary results of the Recovery experiment provide new evidence on the benefit of the use of corticosteroids, specifically dexamethasone, in patients hospitalized for COVID-19. Given their anti-inflammatory power, they are widely used for the treatment of COVID-19 in its most serious stages. They also suppress the functioning of the immune system, so they cannot be used in the initial stages of the disease: they are only useful in the inflammatory stage. Thus, desamethaxone is used in these patients to stop part of the damage produced when the immune system is overactivated in this cytokine storm, while the body tries to fight against the coronavirus. The benefits obtained from glucocorticoids vary considerably and their use must be carefully weighed in each patient to avoid toxicities. When glucocorticoids are used for short periods (<2 weeks), it is rare to see serious adverse effects, even with moderately large doses. So it is important to carry out a risk-benefit assessment, which the therapist must bear in mind. [ABSTRACT FROM AUTHOR]

Background: Dengue fever is a mosquito-borne infectious disease endemic in over 100 countries around the world. Among the complications that dengue can cause the Hemophagocytic Lymphohistiocytosis is one of great concern for its severity and complex diagnosis. Case report: Hereby we document a case of this disease expressed on a previously healthy 6-year-old female patient whose dengue infection was so severe that needed intensive care management with vasoactive drugs and diuretics. After a short period of wellness began newly with fever, pancytopenia, hepatitis, and inflammatory response symptoms. Conclusion: A Dengue associated Hemophagocytic Lymphohistiocytosis syndrome was suspected and treated with intravenous corticosteroids on a 3-day scheme at no signs of malignancy with excellent response. The health care professionals must know about this not novel entity in order to reach an efficient diagnosis and treatment mostly, but not only, those in tropical and sub-tropical regions of the word were dengue virus is endemic. [ABSTRACT FROM AUTHOR]