Discussion:
This may be the first reported in Bangladesh with this combination of
Down syndrome and COVID-19 patients to the best of our knowledge. People
with intellectual disabilities the unique issues resulting from the
COVID-19 epidemic (15). Down syndrome patients, who have the most
typical kind of intellectual impairment(16). With a prevalence of about
1 in 1,000 live births, Down syndrome seems to be the most prevalent
chromosomal defect in people around the globe. Considering an estimated
prevalence of Down syndrome of around 0.125% in Bangladesh (17).
Individuals with Down syndrome have unique socio-demographic potential
risks for COVID-19. They are more likely to have complications such as
obesity, diabetes, congenital heart disease, and respiratory disorders
linked to a worse COVID-19 outcome in the overall population (18).
Furthermore, The production of cytokines that are more involved in the
triggering of a prothrombotic procoagulant reaction (19) and Down
syndrome may be an established risk factor for thromboembolic illness
and an increased risk of cardiovascular episodes (20, 21). There is a
higher incidence of respiratory infections, immunological dysfunction,
systemic inflammation, early ageing, and complications linked with
COVID-19 risk, all of which contribute to poor patient outcomes,
although it is uncertain they are more prone to SARS-CoV-2 infection
(3).
The TMPRSS2 gene is found on chromosome 21q22.3, suggesting that it may
be overexpressed in people with Down syndrome. The protein produced by
this gene is related to the increase in TMPRSS2 receptors at the
molecular level. As a result, it is reasonable to believe that this
contribution may account for some of these people’s more severe COVID-19
cases. Studies in Down syndrome patients can help researchers learn more
about the processes behind the infectious process in COVID-19, which
will help them better understand and prioritize treatments for severe
instances in the overall population (22).
This case demonstrates the need for more clinical and scientific
research into the genetic susceptibilities that influence the severity
of COVID-19 and SARS-CoV-2-related problems. While there is an apparent
dearth of systematic epidemiological data on COVID-19 in Down syndrome
patients, we want to draw attention to this hyperinflammatory and
life-threatening presentation of adults with Down syndrome to ensure the
early clinical diagnosis of comparable cases in the ongoing SARS-CoV-2
pandemic.
In one research, hospital individuals with Down syndrome and COVID-19
had a relative risk of mortality of 2.9 compared to controls (23). Since
the H1N1 outbreak in Mexico in 2009, the chances of intubation and
mortality were 8-fold and 335-fold higher for individuals with Down
syndrome than for others (24). The one research of 12 people with Down
syndrome and COVID-19 revealed that those admitted with COVID-19 had a
worse illness than their age-matched counterparts (25). In these two
investigations, people with Down syndrome are identified as a high-risk
population for severe COVID-19 with a poor prognosis. Difficulty
breathing, fever, coughing, and muscle fatigue were the most common
signs and symptoms of COVID-19 in patients with Down syndrome (4). This
case report supports this observation. On the other side, patients with
Down syndrome had a more severe condition than controls, with a higher
risk of sepsis and the need for mechanical breathing, according to a
prior study (25). It’s possible that in the first wave of the pandemic,
people with Down syndrome were hospitalized later due to diagnostic
delays, resulting in even worse clinical outcomes. This tendency,
however, has not been seen in the overall population who have been
treated for SARS-CoV-2 pneumonia(26, 27). This patient was diagnosed as
soon as her symptoms began, and she received rapid treatment for her
problem and additional investigations. So, this patient outcome, she was
discharged from hospital with a stable condition. In COVID-19
individuals with Down syndrome, the main complication for inpatient and
death was age, which is in line with evidence from the general
population as published in previous ISARIC4C survey data (23).
Significantly, we noticed an elevated death rate starting at 40, much
younger than the entire populace. Many indications of accelerated ageing
have been extensively observed in people with Down syndrome (28). In our
case, the patient’s age of 42 was a risk factor during admission into
the hospital as for COVID-19.
Limitation, we solely focused on hospital admissions; outcomes in the
specific community (including asymptomatic and mild COVID-19 cases)
might vary.
Effective strategy from both family members and local practitioners is
required for individuals with Down syndrome to adhere to the necessary
guidelines. To summarize, patients with Down syndrome have multiple risk
factors for respiratory infections and poor outcomes due to a high
number of comorbidities, anatomical changes in the upper respiratory
tract, and immunological dysregulation. Individuals with Down syndrome
are among the priority candidates for early immunosuppression, current
antiviral treatments, and, once accessible, the SARS-CoV-2 vaccine.