SARS-CoV-2 has become the focus of scientific attention. The presentation of COVID-19 can range from lack of symptoms to severe respiratory distress and multiorgan failure requiring ICU admission and mechanical ventilation and eventual death.
CVID (common variable immune deficiency) are characterized of having primary antibody deficiencies with defective antibody production (IgG). A study published in the Journal of Allergy and Clinical Immunology from Italy identified 5 patients with CVID and Covid-19. Patients with CVID and Covid-19 presented with a severe form of the disease requiring treatment with multiple drugs, including antiretroviral agents and IL-6 blocking drugs as well as mechanical ventilation. The treatment and course of the 5 patients are outlined here for the patients who had both CVID and Covid-19.
- 59 year old female with high fever and dyspnea, symptoms were 20 days. Treatment Hydroxycholoroquine, azithromycin, tocilzumab. Patient passed away.
- 32 year old female with high fever and dyspnea, symptoms were 16 days. Treatment was hydroxychloroquinine, darunavir/ritonavir and toclizumab. Patient recovered and had no ICU admission.
- 57 year old male with fever and dyspnea, symptoms were 25 days. Treatment with hydroxychloroquine, lopinavir/ritionavir, remdesivir and methylprednisolone. Patient recovered.
- 52 year old male had symptoms for 21 days. Treatment was hydroxychloroquine, azithromycin, lopinavir/ritonavir. No ICU admission and patient recovered.
- 41 year old male with 19 days of symptoms. Treatment was hydroxychloroquine, piperacillin/tazobactam, lopinavir/ritonavir, tocilizumab and remdesivir. Patient was admitted to ICU and recovered.
All patients with CVID are vulnerable to most bacterial infections because antibodies are important in blocking infectivity and preventing diseases. In addition, antibodies have a role in the immune response to viral infections. Children appear to better contain SARS-CoV-2 in the early phase of infection possibly because their B cells are able to generate natural antibodies in a timely manner on encounter with novel pathogens compared to adults. Inflammation can aggravate COVID-19 and treatment with drugs that inhibit IL-6 aim to reduce the cytokine storm and lung inflammation. IL-6 produced by B cells may increase the level of inflammation. This cytokine storm syndrome plays a significant role in the respiratory failure in COVID-19 infection.