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Current Affairs

Cytokine storm syndrome

Date: 04 April 2020 Tags: Miscellaneous

Issue

Evidence is emerging that a subset of the infected patients develop severe COVID-19 because of an overreaction of their immune systems, which triggers what is known as a “cytokine storm syndrome” (CSS).

 

Background

While various studies have shown that the disease has more severe consequences for those above the age of 60 years, and especially those with existing co-morbidities such as heart disease, diabetes, hypertension, chronic respiratory disease and cancer, some countries have also reported deaths of younger people, including teenagers, after catching the infection.

 

Details

  • An analysis of over 55,000 laboratory-confirmed cases revealed that 2.5 per cent of those under the age of 19 developed severe disease from the coronavirus, and 0.2 per cent were critically ill.

  • Critical COVID-19 patients are defined by manifestations that include respiratory failure requiring mechanical ventilation and shock or organ failure that requires intensive care, and which may lead to death.

  • The immune systems in our bodies protect us from bacteria, viruses, and parasites by removing them from our systems. The immune system gets activated by things that the body does not recognise as its own. These things are called antigens, and include bacteria, fungi and viruses.

  • An effective immune system response involves inflammation, an important and indispensable part of the process. Without such an immune response, injuries would not heal, and infections would become deadly.

  • Inflammation has an important protective function. The release of inflammatory mediators increases the blood flow to the area, which allows larger numbers of immune system cells to be carried to the injured tissue, thereby aiding the repairing process.

  • However, if this inflammatory response is not regulated, very dangerous consequences can follow. This is when a ‘cytokine storm’ can be triggered. The damage to the surrounding cells can be catastrophic, leading to sepsis and potentially, death.

  • Cytokines are signalling proteins that are released by cells at local high concentrations, a cytokine storm or CSS is characterised by the overproduction of immune cells and the cytokines themselves because of a dysregulation in the process.

  • A severe immune reaction, leading to the secretion of too many cytokines in the bloodstream, can be harmful since an excess of immune cells can attack healthy tissue as well.

  • Cytokine storm can occur due to an infection, auto-immune condition, or other diseases. Signs and symptoms include high fever, inflammation (redness and swelling), severe fatigue, and nausea.

  • Cytokine storms are not exclusive to coronavirus patients. It is an immune reaction that can occur during other infectious and non-infectious diseases as well.

  • In the case of any flu infection, a cytokine storm is associated with a surge of activated immune cells into the lungs, which, instead of fighting off the antigen, leads to lung inflammation and fluid build-up, and respiratory distress.

  • Increased pro-inflammatory cytokine responses against human coronaviruses such as SARS-CoV-1 (which caused SARS), SARS-CoV-2 (which is responsible for the current COVID-19 pandemic), and MERS can result in acute lung injury and acute respiratory distress syndrome (ARDS).