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Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod.

芬戈莫德治疗多发性硬化症患者的严重新型冠状病毒肺炎感染。

  • 影响因子:2.55
  • DOI:10.1016/j.msard.2020.102180
  • 作者列表:"Foerch C","Friedauer L","Bauer B","Wolf T","Adam EH
  • 发表时间:2020-07-01
Abstract

BACKGROUND:Fingolimod is used for immune therapy in patients with multiple sclerosis. Long-term treatment is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. Patients with coronavirus disease 2019 (COVID-19) under Fingolimod treatment have not been described. METHODS AND RESULTS:We report a 57-year old female patient with a relapsing remitting multiple sclerosis under fingolimod treatment who experienced a severe COVID-19 infection in March 2020 (Extended Disability Status Scale: 2.0). Having peripheral lymphopenia typical for fingolimod treatment (total lymphocytes 0.39/nL [reference range 1.22-3.56]), the patient developed bilateral interstitial pneumonia with multiple ground-glass opacities on chest CT. Fingolimod medication was stopped. On the intensive care unit, non-invasive ventilation was used to provide oxygen and ventilation support regularly. Over the following two days, oxygenation improved, and the patient was transferred to a normal ward five days after admission. CONCLUSION:The implications fingolimod has on COVID-19 are complex. As an S1P analogue, fingolimod might enhance lung endothelial cell integrity. In addition, in case of a so-called cytokine storm, immunomodulation might be beneficial to reduce mortality. Future studies are needed to explore the risks and therapeutic effects of fingolimod in COVID-19 patients.

摘要

背景: 芬戈莫德用于多发性硬化症患者的免疫治疗。长期治疗与疱疹病毒再激活和呼吸道感染风险的小幅增加有关。未描述接受芬戈莫德治疗的冠状病毒病 2019 (新型冠状病毒肺炎) 患者。 方法和结果: 我们报告了 1 例在芬戈莫德治疗下复发缓解型多发性硬化的 57 岁女性患者,她在 2020 年 3 月经历了严重的新型冠状病毒肺炎感染 (扩展残疾状况量表: 2.0)。具有芬戈莫德治疗典型的外周淋巴细胞减少 (总淋巴细胞 0.39/nL [参考范围 1.22-3.56]),患者出现双侧间质肺炎,胸部CT上有多个磨玻璃影。停用芬戈莫德药物。在重症监护病房,采用无创通气,定期提供氧气和通气支持。在接下来的两天里,氧合改善,患者在入院五天后被转移到正常病房。 结论: 芬戈莫德对新型冠状病毒肺炎的影响是复杂的。作为S1P类似物,芬戈莫德可能增强肺内皮细胞完整性。此外,在所谓的细胞因子风暴的情况下,免疫调节可能有利于降低死亡率。需要进一步的研究来探讨芬戈莫德在新型冠状病毒肺炎患者中的风险和治疗效果。

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翻译标题与摘要 下载文献
影响因子:2.48
发表时间:2020-04-01
来源期刊:Infection
DOI:10.1007/s15010-020-01401-y
作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.

呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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