Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases.

Angelica Corrias,Gian Mario Cortes,Maria Antonietta Marcialis,Vassilios Fanos,Alice Melis,Flaminia Bardanzellu

doi:10.3390/children8090753

Angelica Corrias, Gian Mario Cortes + Show 4 more

Open Access

https://doi.org/10.3390/children8090753

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Journal: Children	Publication Date: Aug 30, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: University of Cagliari

Abstract

Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

Highlights

In December 2019 the first case of infection by a new type of coronavirus was documented in Wuhan, China [1]
Our bibliographic research is updated to 28 May 2021; we have searched the available literature on Medline, ResearchGate, and Google Scholar, using “COVID-19 and inflammatory bowel diseases (IBD)” as key words
Since corticosteroids seem to increase infection risk, but the risk of undergoing severe forms of infection, which may lead to need for oxygen therapy, hospitalization, and even intensive care unit (ICU) admission, we looked for publications giving advice to follow during the pandemic

Summary

Introduction

In December 2019 the first case of infection by a new type of coronavirus was documented in Wuhan, China [1]. It is well known that the presence of comorbidities increases the risk of infection and worsens the outcome in SARS-CoV-2 infection [3,4]. This explains the growing interest regarding the relationship between IBD (inflammatory bowel diseases) and COVID-19. The hyperproduction of cytokines seems to increase the expression of angiotensin-converting enzyme 2 (ACE2) [6] In these patients, there is an increased expression of ACE2 in the gut mucosa [7] and an increase of ACE2 serum levels (as well as Ang and the ACE2: ACE ratio) [8]. This could play a protective role in the blood [9] by acting as a competitive receptor for the virus and leading to the reduction of the viral load that would infect the host

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