CD14+单核细胞通过单核细胞人类白细胞抗原受体(mHLA-DR)将抗原呈递给适应性免疫细胞,被描述为免疫突触。mHLA-DR水平降低可显示获得性免疫缺陷,这常见于败血症和继发感染和致命结局的易感性。通过干扰素-γ(IFNγ)治疗可靠地诱导单核细胞HLA-DR表达。
我们报告了一例在体外膜氧合(ECMO)支持下的多重耐药超感染COVID-19急性呼吸窘迫综合征(ARDS)。检测到的肺炎克雷伯菌的耐药谱,铜绿假单胞菌,在肺炎克雷伯菌的情况下,鲍曼不动杆菌和弗氏柠檬酸杆菌分离株对包括碳青霉烯类(4MRGN)和头孢地洛在内的所有四种抗生素类别均具有耐药性。没有因果治疗性抗生素策略。因此,我们测量了患者的免疫状态,旨在确定潜在的获得性免疫缺陷。通过FACS分析鉴定的单核细胞HLA-DR表达揭示了34%阳性单核细胞的表达水平并提示严重的免疫抑制。我们指出IFNγ治疗,导致mHLA-DR表达迅速增加(96%),快速解决侵入性血流感染,70天出院.
超感染是COVID-19肺炎的危险并发症,脓毒症诱导的免疫抑制是其危险因素。免疫抑制通过单核细胞向适应性免疫系统的细胞的受干扰的抗原呈递来表达。这里介绍的病例非常显著,因为在一名患有COVID-19ARDS的患者中,没有针对检测到的导致血流感染和严重肺炎的细菌病原体的有效抗生素方案。通过IFNγ可能恢复患者自身的免疫力是增强患者免疫系统的合理选择,消除已识别的4MRGN,并允许肺部恢复。这得出结论,免疫状态监测对复杂的COVID-19-ARDS有用,同时使用IFNγ治疗可能支持抗生素策略。
在通过抑制mHLA-DR水平检测到免疫系统受损后,IFNγ可以安全地重新激活免疫系统。
CD14+ monocytes present antigens to adaptive immune cells via monocytic human leukocyte antigen receptor (mHLA-DR), which is described as an immunological synapse. Reduced levels of mHLA-DR can display an acquired immune defect, which is often found in sepsis and predisposes for secondary infections and fatal outcomes. Monocytic HLA-DR expression is reliably induced by interferon- γ (IFNγ) therapy.
We report a
case of multidrug-resistant superinfected COVID-19 acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support. The resistance profiles of the detected Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Citrobacter freundii isolates were equipped with resistance to all four antibiotic classes including carbapenems (4MRGN) and Cefiderocol in the
case of K. pneumoniae. A causal therapeutic antibiotic strategy was not available. Therefore, we measured the immune status of the patient aiming to identify a potential acquired immune deficiency. Monocyte HLA-DR expression identified by FACS analysis revealed an expression level of 34% positive monocytes and suggested severe immunosuppression. We indicated IFNγ therapy, which resulted in a rapid increase in mHLA-DR expression (96%), rapid resolution of invasive bloodstream infection, and discharge from the hospital on day 70.
Superinfection is a dangerous complication of COVID-19 pneumonia, and sepsis-induced immunosuppression is a risk factor for it. Immunosuppression is expressed by a disturbed antigen presentation of monocytes to cells of the adaptive immune system. The
case presented here is remarkable as no validated antibiotic regimen existed against the detected bacterial pathogens causing bloodstream infection and severe pneumonia in a patient suffering from COVID-19 ARDS. Possible restoration of the patient\'s own immunity by IFNγ was a plausible option to boost the patient\'s immune system, eliminate the identified 4MRGNs, and allow for lung recovery. This led to the conclusion that immune status monitoring is useful in complicated COVID-19-ARDS and that concomitant IFNγ therapy may support antibiotic strategies.
After a compromised immune system has been detected by suppressed mHLA-DR levels, the immune system can be safely reactivated by IFNγ.