COVID-19 and children with Down syndrome: is there any real reason to worry? Two case reports with severe course
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CASE REPORT
Open Access
COVID-19 and children with Down syndrome: is there any real reason to worry? Two case reports with severe course Ahmad Kantar1*, Angelo Mazza2, Ezio Bonanomi3, Marta Odoni1, Manuela Seminara1, Ilaria Dalla Verde1, Camillo Lovati1, Stefania Bolognini1 and Lorenzo D’Antiga2
Abstract Background: Down syndrome (DS) is characterized by a series of immune dysregulations, of which interferon hyperreactivity is important, as it is responsible for surging antiviral responses and the possible initiation of an amplified cytokine storm. This biological condition is attributed to immune regulators encoded in chromosome 21. Moreover, DS is also characterized by the coexistence of obesity and cardiovascular and respiratory anomalies, which are risk factors for coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case presentation: A total of 55 children were admitted to the pediatric ward in Bergamo, between February and May 2020 for COVID-19. Here, we describe the cases of two children with DS and a confirmed COVID-19 diagnosis who had a severe course. In addition, both cases involved one or more comorbidities, including cardiovascular anomalies, obesity, and/or obstructive sleep apnea. Conclusions: Our observations indicate that children with DS are at risk for severe COVID-19 disease course. Keywords: Down syndrome, Trisomy 21, Coronavirus disease, Children, Case report
Background Down syndrome (DS) is associated with several immune dysregulations [1]. Consequently, the risks of recurrent and severe infections, autoimmune diseases, and inflammatory conditions are commonly reported [2–5]. Immune disorders in DS account for a vast disease burden ranging from quality-of-life issues to more serious health issues and life-threatening issues. Cardiovascular and pulmonary diseases are the most common cause of disease conditions and mortality in DS [6]. The mechanisms by which trisomy 21 causes immune dysregulations in individuals with DS are under * Correspondence: [email protected] 1 Pediatric Unit, Istituti Ospedalieri Bergamaschi, Gruppo Ospedaliero San Donato, Bergamo, Italy Full list of author information is available at the end of the article
continuous investigation. In DS, chromosome 21 harbor multiple genes involved in orchestrating immune responses, and their overexpression induce an overactive immune system. Among the major immune regulators encoded on chromosome 21 are four interferon (IFN) receptors, which serve as receptor subunits for the cytokines interleukin (IL)-10, IL-22, and IL-26 [7]. Furthermore, immune and non-immune cells in patients with DS are hypersensitive to IFN stimulation [1]. Previous studies have shown that T cell lineages of adults with DS show clear signs of heightened activity even in the absence of any obvious infections, a feature that is thought to be caused by chronic IFN hyperactivity [4]. For that reason, the IFN response, which is crucial for escalating antiviral responses, besides driving and ampli
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