Severity of SARS-CoV-2 infection in children with inborn errors of immunity (primary immunodeficiencies): a systematic review

Allergy, Asthma & Clinical Immunology

Research

Koblan M. Al Mutared¹  Sawsan Sami Albattat²  Abdulrahman A. Alnaim³  Rabab Abbas Majzoub³  Khalid Al Noaim³  Mohammed A. Al Ghamdi⁴  Abdulaziz A. Alahmari⁴  Zainab Al Alawi⁵  Zainah Sabr⁶  Yousef Hassan Alalawi⁷  Nourah Al Dossary⁸  Hanan Al Shaikh⁹  Ali A. Rabaan^1,10  Duaa Ali Al-Hajji^1,11  Anwar Ahmed Alkadi^1,12  Ola Alkhars^1,13  Muneera Alabdulqader^1,14  Essam Mohammed Al Abdulmohsen^1,15  Fatimah Mohammed Alhassan^1,16  Mortadah Essa Alobaidan^1,16  Hadi Hassan Almusallam^1,16  Mohammed Abdulhadi Alamer^1,17  Jawad Ali Al-Hajji^1,18  Yasin S. Almubarak^1,19  Abbas Al Mutair^2,20  Fatemah M. ALShakhs^2,21  Saad Alhumaid^2,22 

[1] Administration of Pharmaceutical Care, Ministry of Health, 66255, Najran, Saudi Arabia;College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia;Department of Pediatrics, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia;Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia;Division of Allergy and Immunology, College of Medicine, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia;Division of Allergy and Immunology, Pediatric Department, College of Medicine, King Khalid University, 62529, Abha, Saudi Arabia;Ear, Nose and Throat Department, Al Jabr Hospital for Eye, Ear, Nose and Throat, Ministry of Health, 36422, Al Mubarraz, Al-Ahsa, Saudi Arabia;General Surgery Department, Alomran General Hospital, Ministry of Health, 36358, Hofuf, Al-Ahsa, Saudi Arabia;Infection Prevention and Control Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia;Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, 31311, Dhahran, Saudi Arabia;College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia;Department of Public Health/Nutrition, The University of Haripur, 22620, Haripur, Khyber Pakhtunkhwa, Pakistan;Nursing Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia;Nursing Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia;Pediatric Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia;Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, 31982, Hofuf, Al-Ahsa, Saudi Arabia;Pharmacy Department, Aljafr General Hospital, Ministry of Health, 7110, Hofuf, Al-Ahsa, Saudi Arabia;Pharmacy Department, King Faisal General Hospital, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia;Pharmacy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia;Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 24231, Hofuf, Al-Ahsa, Saudi Arabia;Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, 36361, Hofuf, Al-Ahsa, Saudi Arabia;Research Center, Almoosa Specialist Hospital, 36342, Al Mubarraz, Al-Ahsa, Saudi Arabia;College of Nursing, Princess Norah Bint Abdul Rahman University, 11564, Riyadh, Saudi Arabia;School of Nursing, University of Wollongong, 2522, Wollongong, NSW, Australia;Nursing Department, Prince Sultan Military College of Health Sciences, 33048, Dhahran, Saudi Arabia;Respiratory Therapy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, 36424, Al Mubarraz, Al-Ahsa, Saudi Arabia;School of Pharmacy, University of Tasmania, 7000, Hobart, Australia;

关键词: Children;    COVID-19;    Errors;    Immunodeficiency;    Immunity;    Inborn;    Pediatric;    Primary;    SARS-CoV-2;    Systematic review;   

DOI  :  10.1186/s13223-023-00831-1

 received in 2023-03-12, accepted in 2023-07-30,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken.ObjectivesTo estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness.MethodsFor this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction.ResultsOf the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case–control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases.ConclusionChildren with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections–though the number of patients is small–but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1).

【 授权许可】

CC BY   
© Canadian Society of Allergy & Clinical Immunology 2023

【 图 表 】

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