COVID-19 Infection - the Possibility to Involve Oxygen as Immunogen in the ARDS Determinism (Acute Respiratory Distress Syndrome).

Since its onset, the new coronavirus SARS-CoV-2 has manifested multiple paradoxes related to both complications of the infection and treatment resistance. The experiences in therapy started from the use of neutralizing monoclonal antibodies and anti-cytokine therapy (anti IL-6, anti-TNF-alpha and CCR5) up to experiments of immunomodulation with glucocorticoids and proposal of very powerful immunomodulatory drugs like cyclophosphamide in optimized diagrams in order to induce the depression of the immune hyperergic reaction with the maintenance of TH and TC lymphocyte resistance to keep the anti-viral activity in the absence of an etiological treatment. In this context, also the second major immunologic mechanism could function: the molecular mimicry - cross-reactivity between viral epitopes and various antigenic determinants from the body, other than the tissue structures of the respiratory system. In a similar manner, in the past, genital staphylococcal infections among women wearing tampons, sometimes generated a toxic-septic shock with an unexpected evolution to death. It is also about an atypical cytokine storm, generated by the staphylococcal toxins (super-antigenic) but probably, the aggressiveness was also generated by the cross reactivity with chemical antigens from the cotton fibers, because this disorder generally appeared among women in the menstrual period, sometimes the local genital infection being minor. Moreover, with the lapse of time, the reaction of shock no longer appeared, probable through the increase of immunologic tolerance to cotton fibers. In a similar manner, in COVID-19 a reaction of hyper-sensitivity to a gaseous antigen could overlap, considering the decrease of tolerance at the invasive administration of oxygen (the contact with BALT - the lymphatic system associated to the bronchia, where the resident macrophage is the siderophage) and partial maintenance at the non-invasive administration through mask or extracorporeal, which induces the first contact with the lymphatic elements associated to the oropharyngeal cavity or blood, where the siderophage can no longer be observed. In this context, some adult patients with COVID-19 could manifest an immunologic genetic defect of TS at BALT level, as women with staphylococcal toxic-septic shock had a local defect at the VALT level (lymphatic tissue associated with the genital tract). In children, the syndrome is rare and more multisystem, which rather suggests the breaking of central tolerance through the lack of intra-thymus or intra-medullary deletion of the auto-reactive clones of (Th TC), while among adults the defect seems to be more peripheral, local, with the involvement of TS and resident macrophages (siderophages). This could explain not only the higher level of severity in elder patients and those with cardiac disorders but also the rarity of the pathology in patients aged under nine years.