COVID-19 in Immunosuppressed Children

Frontiers in Pediatrics

Giovanna Zuin¹  Adriana Balduzzi¹  Andrea Biondi¹  Laura Rachele Bettini¹  Emanuele Nicastro²  Lorenzo D'Antiga³  Giovanni Montini⁴  Lucio Verdoni⁵ 

[1] MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy;Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy;Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy;Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy;Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy;Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy;

关键词: SARS–CoV−2;    kidney transplant;    rheumatologic diseases;    liver transplant;    cancer;    immunosuppression;    autoimmune disease;    innate immunity;   

DOI  :  10.3389/fped.2021.629240

来源: Frontiers

【 摘 要 】

Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression—if not associated with other elements of fragility—do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.

【 授权许可】

CC BY