Does cystic fibrosis constitute an advantage in COVID-19 infection?
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LETTER TO THE EDITOR
Open Access
Does cystic fibrosis constitute an advantage in COVID-19 infection? Valentino Bezzerri, Francesca Lucca, Sonia Volpi and Marco Cipolli*
Abstract The Veneto region is one of the most affected Italian regions by COVID-19. Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), may constitute a risk factor in COVID-19. Moreover, respiratory viruses were generally associated with severe pulmonary impairment in cystic fibrosis (CF). We would have therefore expected numerous cases of severe COVID-19 among the CF population. Surprisingly, we found that CF patients were significantly protected against infection by SARS-CoV-2. We discussed this aspect formulating some reasonable theories. Keywords: Cystic fibrosis, SARS-CoV-2, Covid-19, Azythromycin, DNase
Introduction The comorbidities of obesity, hypertension, diabetes, heart failure, and chronic lung disease have been associated with poor outcome in coronavirus disease 2019 (COVID-19) [1]. Once Severe Acute Respiratory Syndrome (SARS)– Coronavirus (CoV)-2 has infected host cells, excessive inflammatory and thrombotic processes take place. A cytokine storm release with markedly elevated IL-6 levels are associated with increased lethality [2]. Increased neutrophilia is part of that inflammatory response and has been associated with a poorer outcome. Increased neutrophil extracellular traps (NET) have been hypothesized to be predictive of poor outcome in COVID-19 patients [3]. Cystic fibrosis (CF) lung disease, characterized by the release of a many proinflammatory cytokines and chemokines, is the major cause of morbidity and mortality in CF. Excessive NET accumulation has been observed in the CF airway [4]. Moreover, influenza and other respiratory viral infections are known to cause severe pulmonary impairment in CF. [5] Because of the risk factors of chronic lung disease and host hyper-immune * Correspondence: [email protected] Cystic Fibrosis Center of Verona, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
status, one would surmise that CF patients would be at an increased risk of developing severe COVID-19 illness.
Methods We conducted a retrospective study of 532 CF patients followed at the Cystic Fibrosis Center of Verona, Italy. SARS-CoV-2 positivity was tested by collecting combined nose-throat swabs and subsequent Real-Time PCR using the Nimbus MuDT tm (Seegene, Seoul, South Korea), and Simplexa COVID-19 Direct kits (DiaSorin, Stillwater, MN, USA), following the manufacturer guidelines. All patients tested in this study reported symptoms consistent with respiratory infection and were hospitalized at Cystic Fibrosis Center of Verona. Results The Veneto region is one of the Italian regions most strongly affected by COVID-19, with 19,729 cases and 2062 related fatalities (as of 23 July 2020). The Veneto region health system has carried out 1,149,084 multiple COVID-19 tests on 465,433 subjects so far (data from the Italian Ministry of Health). From 1 April to 23 July 2020, we cont
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