tetano
Editor, Senior Moderator
Proc Natl Acad Sci U S A
. 2022 Mar 1;119(9):e2122090119.
doi: 10.1073/pnas.2122090119.
Lack of association between pandemic chilblains and SARS-CoV-2 infection
Jeff R Gehlhausen[SUP] 1 [/SUP], Alicia J Little[SUP] 1 [/SUP], Christine J Ko[SUP] 1 2 [/SUP], Marc Emmenegger[SUP] 3 [/SUP], Carolina Lucas[SUP] 4 [/SUP], Patrick Wong[SUP] 4 [/SUP], Jon Klein[SUP] 4 [/SUP], Peiwen Lu[SUP] 4 [/SUP], Tianyang Mao[SUP] 4 [/SUP], Jillian Jaycox[SUP] 4 [/SUP], Eric Wang[SUP] 4 [/SUP], Yale IMPACT Team; Nelson Ugwu[SUP] 1 [/SUP], Cate Muenker[SUP] 5 [/SUP], Dilgash Mekael[SUP] 1 [/SUP], Rhonda Q Klein[SUP] 1 6 [/SUP], Robert Patrignelli[SUP] 7 [/SUP], Richard Antaya[SUP] 1 [/SUP], Jennifer McNiff[SUP] 1 2 [/SUP], William Damsky[SUP] 1 2 [/SUP], Kathy Kamath[SUP] 8 [/SUP], John Shon[SUP] 8 [/SUP], Aaron M Ring[SUP] 4 [/SUP], Inci Yildirim[SUP] 5 9 10 [/SUP], Saad Omer[SUP] 5 9 11 [/SUP], Albert I Ko[SUP] 5 11 [/SUP], Adriano Aguzzi[SUP] 3 [/SUP], Akiko Iwasaki[SUP] 12 4 13 14 [/SUP]
Collaborators, Affiliations
Abstract
An increased incidence of chilblains has been observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and attributed to viral infection. Direct evidence of this relationship has been limited, however, as most cases do not have molecular evidence of prior SARS-CoV-2 infection with PCR or antibodies. We enrolled a cohort of 23 patients who were diagnosed and managed as having SARS-CoV-2-associated skin eruptions (including 21 pandemic chilblains [PC]) during the first wave of the pandemic in Connecticut. Antibody responses were determined through endpoint titration enzyme-linked immunosorbent assay and serum epitope repertoire analysis. T cell responses to SARS-CoV-2 were assessed by T cell receptor sequencing and in vitro SARS-CoV-2 antigen-specific peptide stimulation assays. Immunohistochemical and PCR studies of PC biopsies and tissue microarrays for evidence of SARS-CoV-2 were performed. Among patients diagnosed and managed as "covid toes" during the pandemic, we find a percentage of prior SARS-CoV-2 infection (9.5%) that approximates background seroprevalence (8.5%) at the time. Immunohistochemistry studies suggest that SARS-CoV-2 staining in PC biopsies may not be from SARS-CoV-2. Our results do not support SARS-CoV-2 as the causative agent of pandemic chilblains; however, our study does not exclude the possibility of SARS-CoV-2 seronegative abortive infections.
Keywords: SARS-CoV-2; chilblain; covid toe; interferon; pernio.
. 2022 Mar 1;119(9):e2122090119.
doi: 10.1073/pnas.2122090119.
Lack of association between pandemic chilblains and SARS-CoV-2 infection
Jeff R Gehlhausen[SUP] 1 [/SUP], Alicia J Little[SUP] 1 [/SUP], Christine J Ko[SUP] 1 2 [/SUP], Marc Emmenegger[SUP] 3 [/SUP], Carolina Lucas[SUP] 4 [/SUP], Patrick Wong[SUP] 4 [/SUP], Jon Klein[SUP] 4 [/SUP], Peiwen Lu[SUP] 4 [/SUP], Tianyang Mao[SUP] 4 [/SUP], Jillian Jaycox[SUP] 4 [/SUP], Eric Wang[SUP] 4 [/SUP], Yale IMPACT Team; Nelson Ugwu[SUP] 1 [/SUP], Cate Muenker[SUP] 5 [/SUP], Dilgash Mekael[SUP] 1 [/SUP], Rhonda Q Klein[SUP] 1 6 [/SUP], Robert Patrignelli[SUP] 7 [/SUP], Richard Antaya[SUP] 1 [/SUP], Jennifer McNiff[SUP] 1 2 [/SUP], William Damsky[SUP] 1 2 [/SUP], Kathy Kamath[SUP] 8 [/SUP], John Shon[SUP] 8 [/SUP], Aaron M Ring[SUP] 4 [/SUP], Inci Yildirim[SUP] 5 9 10 [/SUP], Saad Omer[SUP] 5 9 11 [/SUP], Albert I Ko[SUP] 5 11 [/SUP], Adriano Aguzzi[SUP] 3 [/SUP], Akiko Iwasaki[SUP] 12 4 13 14 [/SUP]
Collaborators, Affiliations
- PMID: 35217624
- DOI: 10.1073/pnas.2122090119
Abstract
An increased incidence of chilblains has been observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and attributed to viral infection. Direct evidence of this relationship has been limited, however, as most cases do not have molecular evidence of prior SARS-CoV-2 infection with PCR or antibodies. We enrolled a cohort of 23 patients who were diagnosed and managed as having SARS-CoV-2-associated skin eruptions (including 21 pandemic chilblains [PC]) during the first wave of the pandemic in Connecticut. Antibody responses were determined through endpoint titration enzyme-linked immunosorbent assay and serum epitope repertoire analysis. T cell responses to SARS-CoV-2 were assessed by T cell receptor sequencing and in vitro SARS-CoV-2 antigen-specific peptide stimulation assays. Immunohistochemical and PCR studies of PC biopsies and tissue microarrays for evidence of SARS-CoV-2 were performed. Among patients diagnosed and managed as "covid toes" during the pandemic, we find a percentage of prior SARS-CoV-2 infection (9.5%) that approximates background seroprevalence (8.5%) at the time. Immunohistochemistry studies suggest that SARS-CoV-2 staining in PC biopsies may not be from SARS-CoV-2. Our results do not support SARS-CoV-2 as the causative agent of pandemic chilblains; however, our study does not exclude the possibility of SARS-CoV-2 seronegative abortive infections.
Keywords: SARS-CoV-2; chilblain; covid toe; interferon; pernio.