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.