COVID-19-associated lymphopenia: Difference between revisions
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==Overview== | ==Overview== | ||
[[Coronavirus]] disease 2019 (COVID-19) has been considered as a global [[pandemic]] since its first emergence in Wuhan,China.On March 12, 2020, the [[World Health Organization]] declared the COVID-19 outbreak a pandemic.There is no established system for the classification regarding COVID-19 related [[lymphopenia]]. four hypothetical mechanism regarding lymphopenia are : Direct infection of Lymphocyt, | [[Coronavirus]] disease 2019 (COVID-19) has been considered as a global [[pandemic]] since its first emergence in Wuhan,China.On March 12, 2020, the [[World Health Organization]] declared the COVID-19 outbreak a pandemic.There is no established system for the classification regarding COVID-19 related [[lymphopenia]]. four hypothetical mechanism regarding lymphopenia are : Direct infection of Lymphocyt, direct destroying of lymphocytic organs, inflamatory cytokins such as TNFɑ, IL-6,Lymphocyte inhibition, | ||
==Historical Perspective== | ==Historical Perspective== | ||
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** Direct infection of [[Lymphocyte|Lymphocytes]] | ** Direct infection of [[Lymphocyte|Lymphocytes]] | ||
**Direct destroying [[Lymphatic system|lymphatic]] organs | **Direct destroying [[Lymphatic system|lymphatic]] organs | ||
**[[Inflammatory]] [[cytokines]] such as TNF | **[[Inflammatory]] [[cytokines]] such as TNF ɑ, IL-6 , etc inducing [[lymphopenia]] | ||
**Inhibition of [[lymphocytes]] by [[metabolic]] [[molecules]] such as hyperlactic [[acidemia]] | **Inhibition of [[lymphocytes]] by [[metabolic]] [[molecules]] such as hyperlactic [[acidemia]] | ||
==Differentiating COVID-19 related Lymphocytopenia from other Diseases== | ==Differentiating COVID-19 related Lymphocytopenia from other Diseases== | ||
Revision as of 14:44, 29 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Oluwabusola Fausat Adogba, MD
Synonyms and keywords:
Overview
Coronavirus disease 2019 (COVID-19) has been considered as a global pandemic since its first emergence in Wuhan,China.On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.There is no established system for the classification regarding COVID-19 related lymphopenia. four hypothetical mechanism regarding lymphopenia are : Direct infection of Lymphocyt, direct destroying of lymphocytic organs, inflamatory cytokins such as TNFɑ, IL-6,Lymphocyte inhibition,
Historical Perspective
- Coronavirus disease 2019 (COVID-19) has been considered as a global pandemic since its first emergence in Wuhan,China.[1]
- On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.
- Since the first descriptive study lymphocyte count has been a marker of interest.[2]
Classification
There is no established system for the classification regarding COVID-19 related lymphopenia.
Causes
- There are four hypothetical mechanisms regarding lymphopenia[3][4]
- Direct infection of Lymphocytes
- Direct destroying lymphatic organs
- Inflammatory cytokines such as TNF ɑ, IL-6 , etc inducing lymphopenia
- Inhibition of lymphocytes by metabolic molecules such as hyperlactic acidemia
COVID-19 related Lymphocytopenia starts acutely in the course of the disease, with other manifestations of the disease.
Lymphocytopenia, is associated with corticosteroid use, infections with HIV and other viral, bacterial, and fungal agents, Hodgkin's disease, leukemia, malnutrition, systemic lupus erythematosus,[5] high stress levels, whole body radiation, rheumatoid arthritis, and iatrogenic conditions.
In alphabetical order. [6] [7]
- After influenza
- After snakebite
- Anesthesia
- Antibody deficiency syndrome
- Aplastic Anemia
- Banti's Syndrome
- Burns
- Congenital immune deficiency
- Cushing's Disease
- Dermatomyositis
- Drugs, toxins
- Exudative enteropathy
- Felty's Syndrome
- Heavy exercise
- HIV
- Hodgkin's Lymphoma
- Inflammatory Bowel Disease
- Lymphocyte tuberculosis
- Measles
- Paroxysmal nocturnal hemoglobinuria
- Polycythemia
- Postoperative
- Pregnancy
- Sarcoidosis
- Scarlet Fever
- Secondary hypersplenism
- Single non-Hodgkin's lymphomas
- Surgery
- Systemic Lupus Erythematosus
- Trauma
- Tuberculosis
- Uremia
- Whipple's Disease
- Zinc deficiency
Epidemiology and Demographics
The incidence of the Coronavirus Disease 2019 (COVID-19) as of June 28, 2020 is approximately 9,843,073 cases worldwide with 495,760 deaths.[8] Patients of all age groups may develop COVID-19. However, the elderly population and immunocompromised individuals are more likely to develop severe cases of COVID-19.
Risk Factors
People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19. These medical conditions include:[9]
- Chronic kidney disease
- Chronic obstructive pulmonary disease
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index [BMI] of 30 or higher)
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes mellitus
Screening
- The Centers for Disease Control CDC has developed a laboratory test to help estimate how many people in the United States have been infected with SARS-CoV-2. [10]
- This is known as the serology test, and many commercial laboratories call it an antibody test.
- CDC is using this serologic (antibody) test to evaluate the performance of commercial antibody tests. CDC will develop guidance for the use of antibody tests in clinical and public health settings.
- An antibody test looks for the presence of antibodies, which are specific proteins made in response to infections. Antibodies are detected in the blood of people who are tested after infection; they show an immune response to the infection.
- Antibody test results are especially important for detecting previous infections in people who had few or no symptoms.
Natural History, Complications, and Prognosis
Common hematologic complications of coronavirus include lymphopenia, neutrophilia and thrombocytosis. Lymphopenia is a prominent part of severe COVID-19 and a lymphocyte count of less than 1.5 × 109/L may be useful in predicting the severity of clinical outcomes.[11]
Diagnosis
Diagnostic Study of Choice
The primary method for diagnosis of COVID-19 is:
- Nuclei acid testing
Other tests include:
- Protein testing
- CT scans
History and Symptoms
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Lymphopenia as an indicator for severe disease
Lymphopenia is lymphocyte count of less than 1.5 × 109/L. It is associated with a 3-fold increased risk of severe COVID-19 infection. Patients with lymphopenia on admission have been associated with poor prognostic outcomes[12]. Recent studies have shown that 85% of severely ill patients have lymphopenia. Futhermore, patients who have died from COVID-19 infection showed significantly lower lymphocyte level than survivors.[13]
References
- ↑ "WHO Western Pacific | World Health Organization".
- ↑ Ruan, Qiurong; Yang, Kun; Wang, Wenxia; Jiang, Lingyu; Song, Jianxin (2020). "Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China". Intensive Care Medicine. 46 (5): 846–848. doi:10.1007/s00134-020-05991-x. ISSN 0342-4642.
- ↑ Fischer, Karin; Hoffmann, Petra; Voelkl, Simon; Meidenbauer, Norbert; Ammer, Julia; Edinger, Matthias; Gottfried, Eva; Schwarz, Sabine; Rothe, Gregor; Hoves, Sabine; Renner, Kathrin; Timischl, Birgit; Mackensen, Andreas; Kunz-Schughart, Leoni; Andreesen, Reinhard; Krause, Stefan W.; Kreutz, Marina (2007). "Inhibitory effect of tumor cell–derived lactic acid on human T cells". Blood. 109 (9): 3812–3819. doi:10.1182/blood-2006-07-035972. ISSN 0006-4971.
- ↑ Liao, Yuan-Chun; Liang, Wei-Guang; Chen, Feng-Wei; Hsu, Ju-Hui; Yang, Jiann-Jou; Chang, Ming-Shi (2002). "IL-19 Induces Production of IL-6 and TNF-α and Results in Cell Apoptosis Through TNF-α". The Journal of Immunology. 169 (8): 4288–4297. doi:10.4049/jimmunol.169.8.4288. ISSN 0022-1767.
- ↑ W L Ng, C M Chu, A K L Wu, V C C Cheng, K Y Yuen. "Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus". Quarterly Journal of Medicine. 99 (1): 37–47. doi:10.1093/qjmed/hci155.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ "Overview of Testing for SARS-CoV-2 | CDC".
- ↑ Zhao, Qianwen; Meng, Meng; Kumar, Rahul; Wu, Yinlian; Huang, Jiaofeng; Deng, Yunlei; Weng, Zhiyuan; Yang, Li (2020). "Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis". International Journal of Infectious Diseases. 96: 131–135. doi:10.1016/j.ijid.2020.04.086. ISSN 1201-9712.
- ↑ Huang, Ian; Pranata, Raymond (2020). "Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis". Journal of Intensive Care. 8 (1). doi:10.1186/s40560-020-00453-4. ISSN 2052-0492.
- ↑ Fathi, Nazanin; Rezaei, Nima (2020). "Lymphopenia in COVID‐19: Therapeutic opportunities". Cell Biology International. doi:10.1002/cbin.11403. ISSN 1065-6995.