Lymphopenic acquired as signature of severe COVID-19 infection

In two recent articles in The Lancet, 85% of critically ill patients with COVID-19 showed lymphopenia.

The presence of lymphopenia as a signature of severe COVID-19 was confirmed by Wang D et al., who, in their study published in JAMA, reported that Intensive Care Units (ICUs) patients suffering this infection had a median lymphocyte count of 800 cells/mm, with non survivors exhibiting persistent lymphopenia.

Besides, ICU patients present also with high levels of plasma cytokines. The existence of hyper-cytokinemia in COVID-19 patients with lymphopenia could indicate a poor control of the pathogen, as showed in severe patients infected with the 2009 Pandemic Influenza virus. Interestingly, hypercytokinemia and lymphopenia were also evident in critical patients with Severe Acute Respiratory Syndrome due to the coronavirus emerged in 2003 (SARS-CoV).

These features (lymphopenia + hypercytokinemia) fit the characteristics of a particular immunological phenotype of Community Acquired Pneumonia (CAP), lymphopenic CAP (L-CAP), which, as authors recently demonstrated in an article published in the Journal of Infection, is associated with increased severity, mortality and a dysregulated immunological response.

In conclusion, there is growing evidence suggesting that severe infection caused by the COVID-19 induces L-CAP.

Link to the paper: https://doi.org/10.1016/j.jinf.2020.02.029

Editorial Disclaimer: information published during the 2020 COVID-19 pandemic may be updated frequently to reflect the dynamic nature of current understanding.

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