Coronavirus disease 2019 (COVID-19) in pediatric patients with autoimmune disorders

Abstract

Coronavirus disease 2019 (COVID-19) infection in pediatric patients with autoimmune disorders is an area of particular concern since autoimmune diseases can increase the risk of complications from the virus. However, as the infection rates were significantly higher in adults compared to children, this at-risk group of children was relatively underrepresented in COVID-19 research. The underlying inflammatory basis of autoimmune diseases and medications that affect the immune system, such as corticosteroids, could increase the risk of severe infection in this group of patients. COVID-19 could reportedly lead to a variety of alterations in the immune system. These alterations are plausibly dependent on the underlying immune-mediated diseases or prior use of immunomodulatory drugs. Patients administrating immunomodulatory agents, especially those with severe immune system dysregulation, can experience severe symptoms of COVID-19. Nonetheless, receiving immunosuppressive medications can benefit patients by preventing cytokine storm syndromes and lung tissue damage, threatening outcomes of COVID-19.

Conclusion: In this review, we sought to evaluate the currently available literature on the impact of autoimmune disease and its related therapeutic approaches on the COVID-19 infection course of disease in children and reflect on the gaps in the evidence and the need for further research in this field.

What is known: • The majority of children infected with COVID-19 demonstrate mild to moderate clinical manifestations compared to adults, whereas those children with pre-existing autoimmune conditions are at a greater risk for severe symptoms. •There is currently limited understanding of the pathophysiology and clinical outcomes of COVID-19 in pediatric patients with autoimmune disorders due to scattered reports and inadequate evidence.

What is new: • Generally, children with autoimmune disorders have more unfavorable outcomes than healthy children; yet, the severity is not extreme, and is highly dependent on their autoimmune disease type and severity, as well as the medication they are taking.

Keywords: Autoimmune disease; COVID-19; Immunomodulatory agents; Immunosuppression; Pediatrics.

Fig. 1

SARS-COV 2 potential for neurological disease exacerbation. Two potential neural pathways for SARS-COV 2 entry into the brain are by infection of the olfactory bulb or interactions with the eyes and oral mucosa. SARS-CoV-2 may transmit infection along blood–brain barrier (BBB) endothelial cells, blood-cerebrospinal fluid barrier epithelial cells in the choroid plexus, or it may enter the body through the CNS by making use of inflammatory cells as a "Trojan horse" [113]. Expression of IL-6, TNF-α, and other proinflammatory cytokines in a cytokine storm increased due to Viral presence, also glial inflammatory response may lead to damaged oligodendrocytes and BBB disruption, providing a second way for CNS invasion and lymphocyte infiltration [114]

Fig. 2

Adverse effects of immunosuppression that may influence the course of COVID-19. Reducing the immune systems' capacity to fight infections is one of the most important side effects to be concerned about in immunocompromised patients. Immunosuppressive medications have anti-inflammatory and immunomodulatory effects by preventing the synthesis of pro-inflammatory cytokines, lowering leucocyte trafficking, and causing T-lymphocyte apoptosis. These drugs stop the immune system from battling the pathogen. Hence, in the early phases of COVID-19, they could be hazardous. There is currently disagreement over the overall impact of immunosuppressive medications in patients with COVID-19