Search

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects humans through the angiotensin converting enzyme-2 (ACE-2) receptor expressed on many cells, including lymphocytes. In Covid-19 patients IL-6 is overexpressed, and hyperactivated plasmacytoid lymphocytes are detected in peripheral blood film. We hypothesize that, due to the unpredictable interaction between the new virus and the B cell lineage of infected patients, a cascade of out of control events can ensue, capable of determining unexpected pathologic disorders involving such lineage. Here we report two cases of autoimmune hemolytic anemia (AIHA) and two cases of B-cell hematological malignancies developed or reactivated during acute SARS-CoV-2 infection. The temporal relationship of the events may suggest a potential causal relationship between SARS-CoV-2 infection and the hematopoietic disorders. We suggest that special attention should be paid to COVID-19 patients with underlining B cell lineage disorders. [ABSTRACT FROM AUTHOR]

Background: We measured frequency and epidemiologic, clinical, and hematochemical variables associated with respiratory tract infections (RTIs) in foreign-born and national patients hospitalized with fever with a history of international travel, and compared the final diagnosis of RTI with the presence of a respiratory syndrome (RS) at presentation. Methods: A prospective, multicenter, observational study was conducted at tertiary care hospitals in Northern Italy from September 1998 to December 2000. Results: A final diagnosis of RTI was obtained in 40 cases (7.8%), 27 (675%) with lower RTI and 13 (32.5%) with upper RTI. The most common RTIs were pneumonia (35%) and pulmonary tuberculosis (15%). A white blood cell count ≥ 10,000 and an erythrocyte sedimentation rate ≥ 20 mm/h were independently associated with a final diagnosis of RTI; onset of symptoms at ≥ 16 days and ≥ 75% neutrophils were independently associated with lower RTI. An RS was identified in 51 (9.9%) of 515 travelers. Sensitivity, specificity, and positive and negative predictive values of a diagnosis of RS for a final diagnosis of RTI were 675%, 94.9%, 52.9%, and 972%, respectively. Conclusions: Pneumonia and pulmonary tuberculosis were frequent among foreign-born and national travelers with fever admitted to a tertiary care hospital. Half of the pneumonia cases did not present with an RS at first clinical examination. [ABSTRACT FROM AUTHOR]

We evaluated the changes in the progression to death and AIDS and in the mean level of CD4 lymphocytes by calendar period in HIV-positive individuals before and after the introduction of HAART. Through data collected in a prospective cohort study (Italian Seroconversion Study) of 1899 HIV-infected persons with well estimated date of seroconversion, considered as time-zero of analysis, we calculated Kaplan-Meier curves and Cox models, allowing for staggered entries, to estimate the cumulative probability of survival and hazard-ratios (HR) for death and for AIDS by calendar period (1980-1996: pre-HAART era, 1997-1998: first HAART era, and 1999-2001: second HAART era), age at seroconversion, gender, and exposure category. During 17251 person-years, 660 HIV-positive patients developed AIDS and 510 died. Before 1997, the cumulative probability of survival, at twelve years from seroconversion, was 51.0%. In the period 1997-1998 the probability was 77.3% and in the period 1999-2001 it further increased at 91.2%. In the period 1980-1996 only older age at seroconversion was associated with more rapid progression to death. In the period 1987-2001 individuals infected through injecting drug use had a reduced increase of survival compared to those infected through sexual contact. Similar results were obtained for progression to AIDS. Finally we estimated an improved level of immunesuppression in the period 1987-2001. In fact, while in the period 1980-1996 we estimated a decrease of the CD4 lymphocites of -54.8 cells/mm3 (95% CI: -52.0; -57.6) per year; after 1996, we estimated an increase of CD4 of +39.6 (95% CI +34.1; +45.1)per year. This study provides strong evidence that the efficacy of the HAART estimated in the controlled clinical trials has resulted in a real reduction at the population level of morbidity and mortality.