Review Article
Year: 2020 | Month: May | Volume: 10 | Issue: 5 | Pages: 140-148
Cytokine Storm Syndrome in COVID-19: Diagnosis and Management Strategies
Sachin Maggo1, Pawan Dhull2, Amba Prasad Dubey3, Dick Brashier4, Awanish Karan5, Nilabh Kumar Singh6, Kapil Joshi7
1MD (Medicine), Department of Medicine, Army Hospital, Joshimath, Uttarakhand, India
2DNB (Neurology), Professor, Department of Medicine, Command Hospital, Lucknow, Uttar Pradesh, India
3DNB (Oncology & Hematology), Department of Medicine, Santhosh Medical College, Ghaziabad, Uttar Pradesh, India
4MD (Pharmacology), Department of Pharmacology, Army Hospital, Joshimath, Uttarakhand, India
5MS (ENT), Department of ENT, Army Hospital, Joshimath, Uttarakhand, India
6MD (Medicine), Department of Medicine, Army Hospital, Tejpur, Assam, India
7MBBS, Department of Medicine, Army Hospital, Joshimath, Uttarakhand, India
Corresponding Author: Sachin Maggo
ABSTRACT
Coronavirus disease 2019 (COVID-19), is a viral illness caused by novel coronavirus called as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was declared as a pandemic by the World Health Organisation (WHO) on March 11, 2020. Initial studies have shown molecular resemblances in the receptor binding domains of SARS-CoV and SARS-CoV-2 which bind angiotensin converting enzyme 2 (ACE 2) receptors, thereby entering the host cells to cause infection. COVID 19 can present as a broad spectrum of illness, from mild common cold to life threatening acute respiratory distress syndrome (ARDS), multiorgan dysfunction and shock. The key step transforming mild disease to severe is immune dysfunction and cytokine dysregulation resulting in what is called as “cytokine storm syndrome”. It is prudent to diagnose cytokine storm early in the course of disease to mitigate the subsequent consequences. The use of H score as in secondary haemophagocytic lymphohistiocytosis (sHLH) can be helpful as the inflammatory cytokine profile in sHLH is very similar to that of COVID 19. The article also discusses the past experience and current evidence of use of immunological cytokine specific antibodies, new anti-rheumatic drugs and role of convalescent plasma that may prove instrumental in the fight against COVID 19 as they can precisely target the key steps of the immune response. An approach in this regard is also proposed to screen patients of severe COVID 19 disease for exuberant inflammation by measuring cytokines in an attempt to identify patients who will benefit from this selective immunosuppression.
Key words: COVID 19; SARS-CoV-2; Cytokine storm syndrome; H score; Hydroxychloroquine; Tocilizumab; Convalescent plasma