Sakoulas et al.
A pilot study of 33 hypoxic subjects with coronavirus disease 2019 pneumonia randomized to receipt of standard of care plus IV immunoglobulin versus standard of care alone. Results indicate that IV immunoglobulin significantly improved hypoxia and reduced hospital length of stay and progression to mechanical ventilation in patients with A-a gradient greater than 200 mm Hg.
This paper discusses the etiology and pathophysiology of COVID 19, criteria for admission to intensive care, and medication strategies including Remdesivir, antibody treatments, intravenous immunoglobulins, anti-COVID-19-hyperimmunoglobulin, as well as ventilation strategies and treatments in hypoxic respiratory failure.
Herth et al.
A retrospective analysis of the clinical courses of 12 COVID-19 patients who received IVIg at various stages of their illness, including within the first 72 hours of clinical presentation, after initiation of ventilation, and after prolonged ventilation and ICU stay, indicates that treatment with immunomodulators, such as intravenous immunoglobulin (IVIg) may attenuate inflammatory responses observed in the severe stages of acute respiratory distress syndrome (ARDS) caused by COVID-19.
Esen et al.
A retrospective analysis of single-clinic treatment outcomes evaluating the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIg) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients, suggests that Octagam significantly prolonged median survival time (68 versus 18 days, p = 0.014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = 0.049). Confirmation of findings in a randomized, controlled trial is recommended.
This report describes a post-COVID-19 patient who developed chronic fatigue, orthostatic dizziness, and brain fog consistent with orthostatic hypoperfusion syndrome (OCHOS), a form of orthostatic intolerance, and painful small fiber neuropathy (SFN). This case suggests that post COVID-19 syndrome may present as an autoimmune OCHOS/SFN and that early immunotherapy may be effective.
Cao et al.
Three COVID-19 patients in China were treated with high-dose IVIg at the onset of respiratory distress and showed satisfactory clinical and radiographic recovery, suggesting that IVIg may be an effective treatment option.
Zhou et al.
After short-term treatment with combination low-dose corticosteroid and immunoglobulin, ten COVID-19 patients in Changsa, Hunan province, China, showed that their lymphocyte count, oxygenation index, and pulmonary lesions were significantly improved. In this study, short-term moderate-dose corticosteroid plus immunoglobulin reduced the continued deterioration of COVID-19 patients who failed to respond to low-dose therapy.
Xie et al.
Initiation of IVIg as adjuvant treatment for COVID-19 pneumonia within 48 hours of admission to hospital was demonstrated to reduce use of mechanical ventilation, length of ICU and hospital stay, and 28-day mortality in 58 cases of severe COVID-19 in the Wuhan Third Hospital in China from January-February 2020.
Shao et al.
174 critically ill, adult COVID-19 patients from multiple treatment centers in China were treated with high-dose IVIg. The study found that early administration (≤ 7 days) of IVIg can improve the prognosis of critical patients with COVID-19. The study also provides important information on the clinical application of IVIg in treatment of COVID-19 infection, including patient selection, administration timing, and dosage.
Mohtadi et al.
Five severely ill COVID-19 patients in whom standard treatments failed were administrated with IVIG which prevented the deterioration of clinical symptoms. All the patients were treated with high-dose IVIG (0.3-0.5 g/kg) for 5 consecutive days so that no patient would receive lower than 25 g of the drug. All the patients showed a desirable therapeutic response and were discharged from the hospital with a stable clinical condition after being recovered.
Jones et al.
A 6-month old infant diagnosed with classic Kawasaki disease who tested positive for COVID-19 was successfully treated with IVIg and high-dose aspirin to resolve fever and minimal respiratory symptoms.
Feldstein et al.
186 juvenile (<21 years of age) patients with Multisystem inflammatory Syndrome (MIS-C) were studied to understand its epidemiology and clinical course in children and its temporal association with COVID-19. Treatment with immunomodulating therapies was common. As of May 20, 2020, a total of 130 patients (70%) had been discharged alive, 52 (28%) were still hospitalized, and 4 (2%) had died. The study concludes that MIS-C associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents
Dufort et al.
The emergence of Multisystem Inflammatory Syndrome in children (MIS-C) in New York State coincided with widespread SARS-CoV-2 transmission. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. Results found that this hyperinflammatory syndrome presented with dermatologic, mucocutaneous, and gastrointestinal manifestations and was associated with cardiac dysfunction.
Verdoni et al.
In Bergamo province, Italy, an outbreak of Kawasaki disease was diagnosed during the COVID-19 epidemic centered there. The incidence, features, and treatment of patients with such Kawasaki-like disease are detailed in this study.
Chiotos et al.
This study looks at 6 critically ill children with Multisystem Inflammatory Syndrome in Children (MIS-C). The patients received therapies that have been used successfully for the treatment of Kawasaki disease, including IVIg and methylprednisolone. In most patients, this was highly effective in reducing systemic inflammation, as evidenced by resolution of fever, with improving cardiac function over a period of days. Overall, five of the six patients described in this cohort have been discharged from the hospital.