Post-COVID syndrome in children: whether a change in lymphocyte count is a risk factor for its development?

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.6.258928

Keywords:

COVID-19, Post-Acute COVID-19 syndrome, children, lymphocytes, adaptive reactions

Abstract

The aim of the study: to find risk factors for post-COVID syndrome formation based on the analysis of the dynamic leukocyte count, the relative and absolute blood lymphocyte contents.

Materials and methods. A retrospective analysis of medical records of children, aged 10–17 years, who were hospitalized during the second wave of the pandemic (January – July 2021) to the CNE “Lviv Regional Children’s Clinical Hospital “Ohmatdyt” with a diagnosis of moderate COVID-19. A total of 46 children were selected, among them 26 children (post-COVID(-) group), who had no symptoms after COVID-19 and 20 children (post-COVID(+) group) who described various complaints related to disfunction of different organ systems, which affected a normal child’s life.

Results. All children from the post-COVID(+) group complained of fatigue, about a third of children – headache (30 %), which were not observed before the disease, quarter of children (25 %) had problems with concentrating, one fifth (20 %) – periodically felt unmotivated anxiety. Analysis of the leukocytosis dynamics, absolute and relative lymphocytosis in the control after one week ±2 days revealed no significant changes in these indicators in the post-COVID(-) group of children. While in the post-COVID(+) group, a slight increase in leukocytosis (from 3.9 × 109/L to 4.05 × 109/L, P = 0.13) was accompanied by a significant decrease in the number of lymphocytes, both relative (from 27 % to 16 %, P = 0.002) and absolute (from 1.51 × 109/L to 0.51 × 109/L, P = 0.001).

Conclusions. Patients with persistent lymphopenia or hyperlymphocytosis (one week ±2 days) during acute period of COVID-19 represent a “vulnerable cohort” concerning long-term persistence of symptoms, including severe asthenia. The tendency towards normalization of lymphocyte number can be considered as a protective factor for the formation of post-COVID syndrome, while the negative dynamics or its absence – as a risk factor for prolonged persistence of symptoms.

Author Biographies

O. L. Lychkovska, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Propaedeutic Pediatrics and Medical Genetics

D. I. Kvit, Communal Non-commercial Establishment of the Lviv Regional Council “Lviv Regional Children’s Clinical Hospital “Ohmatdyt”, Ukraine

MD, Director

I. Yu. Kulachkovska, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Propaedeutic Pediatrics and Medical Genetics

О. M. Sadova, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Propaedeutic Pediatrics and Medical Genetics

L. Ya. Zhyvko, Danylo Halytsky Lviv National Medical University, Ukraine

MD, Assistant of the Department of Propaedeutic Pediatrics and Medical Genetics

М. I. Dats-Opoka, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Propaedeutic Pediatrics and Medical Genetics

N. S. Kosmynina, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Assistant of the Department of Propaedeutic Pediatrics and Medical Genetics

References

Chen, C., Cao, M., Peng, L., Guo, X., Yang, F., Wu, W., Chen, L., Yang, Y., Liu, Y., & Wang, F. (2020). Coronavirus Disease-19 Among Children Outside Wuhan, China. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3546071

Maltezou, H. C., Magaziotou, I., Dedoukou, X., Eleftheriou, E., Raftopoulos, V., Michos, A., Lourida, A., Panopoulou, M., Stamoulis, K., Papaevangelou, V., Petinaki, E., Mentis, A., Papa, A., Tsakris, A., Roilides, E., Syrogiannopoulos, G. A., Tsolia, M., & for Greek Study Group on SARS-CoV-2 Infections in Children (2020). Children and Adolescents With SARS-CoV-2 Infection: Epidemiology, Clinical Course and Viral Loads. The Pediatric infectious disease journal, 39(12), e388-e392. https://doi.org/10.1097/INF.0000000000002899

Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., Hui, D., Du, B., Li, L., Zeng, G., Yuen, K., Chen, R., Tang, C., Wang, T., Chen, P., Xiang, J,. Li, S., & Zhong, N. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18), 1708-1720. https://doi.org/10.1056/nejmoa2002032

Pousa, P. A., Mendonça, T., Oliveira, E. A., & Simões-E-Silva, A. C. (2021). Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations. Jornal de pediatria, 97(2), 116-139. https://doi.org/10.1016/j.jped.2020.08.007

Moratto, D., Giacomelli, M., Chiarini, M., Savarè, L., Saccani, B., Motta, M., Timpano, S., Poli, P., Paghera, S., Imberti, L., Cannizzo, S., Quiros-Roldan, E., Marchetti, G., & Badolato, R. (2020). Immune response in children with COVID-19 is characterized by lower levels of T-cell activation than infected adults. European journal of immunology, 50(9), 1412-1414. https://doi.org/10.1002/eji.202048724

Cervia, C., Nilsson, J., Zurbuchen, Y., Valaperti, A., Schreiner, J., Wolfensberger, A., Raeber, M. E., Adamo, S., Weigang, S., Emmenegger, M., Hasler, S., Bosshard, P. P., De Cecco, E., Bächli, E., Rudiger, A., Stüssi-Helbling, M., Huber, L. C., Zinkernagel, A. S., Schaer, D. J., Aguzzi, A., … Boyman, O. (2021). Systemic and mucosal antibody responses specific to SARS-CoV-2 during mild versus severe COVID-19. The Journal of allergy and clinical immunology, 147(2), 545-557.e9. https://doi.org/10.1016/j.jaci.2020.10.040

Tschernig, T., & Pabst, R. (2000). Bronchus-associated lymphoid tissue (BALT) is not present in the normal adult lung but in different diseases. Pathobiology, 68(1), 1-8. https://doi.org/10.1159/000028109

Havervall, S., Rosell, A., Phillipson, M., Mangsbo, S. M., Nilsson, P., Hober, S., & Thålin, C. (2021). Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. JAMA, 325(19), 2015-2016. https://doi.org/10.1001/jama.2021.5612

Greenhalgh, T., Knight, M., A'Court, C., Buxton, M., & Husain, L. (2020). Management of post-acute COVID-19 in primary care. BMJ, 370, m3026. https://doi.org/10.1136/bmj.m3026

Carvalho-Schneider, C., Laurent, E., Lemaignen, A., Beaufils, E., Bourbao-Tournois, C., Laribi, S., Flament, T., Ferreira-Maldent, N., Bruyère, F., Stefic, K., Gaudy-Graffin, C., Grammatico-Guillon, L., & Bernard, L. (2021). Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clinical microbiology and infection, 27(2), 258-263. https://doi.org/10.1016/j.cmi.2020.09.052

Becker R. C. (2021). COVID-19 and its sequelae: a platform for optimal patient care, discovery and training. Journal of thrombosis and thrombolysis, 51(3), 587-594. https://doi.org/10.1007/s11239-021-02375-w

Molteni, E., Sudre, C. H., Canas, L. S., Bhopal, S. S., Hughes, R. C., Antonelli, M., Murray, B., Kläser, K., Kerfoot, E., Chen, L., Deng, J., Hu, C., Selvachandran, S., Read, K., Capdevila Pujol, J., Hammers, A., Spector, T. D., Ourselin, S., Steves, C. J., Modat, M., … Duncan, E. L. (2021). Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. The Lancet. Child & adolescent health, 5(10), 708-718. https://doi.org/10.1016/S2352-4642(21)00198-X

Buonsenso, D., Munblit, D., De Rose, C., Sinatti, D., Ricchiuto, A., Carfi, A., & Valentini, P. (2021). Preliminary evidence on long COVID in children. Acta paediatrica, 110(7), 2208-2211. https://doi.org/10.1111/apa.15870

Zimmermann, P., Pittet, L. F., & Curtis, N. (2021). How Common is Long COVID in Children and Adolescents?. The Pediatric infectious disease journal, 40(12), e482-e487. https://doi.org/10.1097/INF.0000000000003328

Tan, L., Wang, Q., Zhang, D., Ding, J., Huang, Q., Tang, Y. Q., Wang, Q., & Miao, H. (2020). Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal transduction and targeted therapy, 5(1), 33. https://doi.org/10.1038/s41392-020-0148-4

Liang, L., Yang, B., Jiang, N., Fu, W., He, X., Zhou, Y., Ma, W. L., & Wang, X. (2020). Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge. Journal of Korean medical science, 35(47), e418. https://doi.org/10.3346/jkms.2020.35.e418

Brackel, C., Lap, C. R., Buddingh, E. P., van Houten, M. A., van der Sande, L., Langereis, E. J., Bannier, M., Pijnenburg, M., Hashimoto, S., & Terheggen-Lagro, S. (2021). Pediatric long-COVID: An overlooked phenomenon?. Pediatric pulmonology, 56(8), 2495-2502. https://doi.org/10.1002/ppul.25521

Yong S. J. (2021). Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases, 53(10), 737-754. https://doi.org/10.1080/23744235.2021.1924397

Jimeno, S., Ventura, P. S., Castellano, J. M., García-Adasme, S. I., Miranda, M., Touza, P., Lllana, I., & López-Escobar, A. (2021). Prognostic implications of neutrophil-lymphocyte ratio in COVID-19. European journal of clinical investigation, 51(1), e13404. https://doi.org/10.1111/eci.13404

Zheng, G., Wang, B., Zhang, H., Xie, C., Zhang, Y., Wen, Z., Guo Q., Zhu H., Ye G., Liang J., Meng Q., Xie J., Jiang S., Liu G., Gao W., Wang Y., & Guo, Y. (2020). Clinical characteristics of acute respiratory syndrome with SARS-CoV-2 infection in children in South China. Pediatric Pulmonology, 55(9), 2419-2426. https://doi.org/10.1002/ppul.24921

Kosmeri, C., Koumpis, E., Tsabouri, S., Siomou, E., & Makis, A. (2020). Hematological manifestations of SARS-CoV-2 in children. Pediatric blood & cancer, 67(12), e28745. https://doi.org/10.1002/pbc.28745

Panda, P. K., Sharawat, I. K., Panda, P., Natarajan, V., Bhakat, R., & Dawman, L. (2021). Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis. Journal of tropical pediatrics, 67(3), fmaa070. https://doi.org/10.1093/tropej/fmaa070

Maltezou, H. C., Pavli, A., & Tsakris, A. (2021). Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines, 9(5), 497. https://doi.org/10.3390/vaccines9050497

Garcia-Oscos, F., Salgado, H., Hall, S., Thomas, F., Farmer, G. E., Bermeo, J., Galindo, L. C., Ramirez, R. D., D'Mello, S., Rose-John, S., & Atzori, M. (2012). The stress-induced cytokine interleukin-6 decreases the inhibition/excitation ratio in the rat temporal cortex via trans-signaling. Biological psychiatry, 71(7), 574-582. https://doi.org/10.1016/j.biopsych.2011.11.018

Selye, H. (1953). Induction of topical resistance to acute tissue injury; an experimental study with the granuloma pouch technique. The Surgical clinics of North America, 1417-1446. https://doi.org/10.1016/s0039-6109(16)34043-9

Garkavi, L. Kh. (1969). Adaptatsionnaya "reaktsiya aktivatsii" i ee rol v mekhanizme protivoopukholevogo vliyaniya razdrazhenii gipotalamusa [Adaptive "activation reaction" and its role in the mechanism of antitumor effect of stimulation of the hypothalamus (Doctoral dissertation)]. Donetsk. [in Russian].

Matta, J., Wiernik, E., Robineau, O., Carrat, F., Touvier, M., Severi, G., de Lamballerie, X., Blanché, H., Deleuze, J. F., Gouraud, C., Hoertel, N., Ranque, B., Goldberg, M., Zins, M., Lemogne, C., & Santé, Pratiques, Relations et Inégalités Sociales en Population Générale Pendant la Crise COVID-19–Sérologie (SAPRIS-SERO) Study Group (2022). Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic. JAMA internal medicine, 182(1), 19-25. https://doi.org/10.1001/jamainternmed.2021.6454

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Published

2022-12-20

How to Cite

1.
Lychkovska OL, Kvit DI, Kulachkovska IY, Sadova ОM, Zhyvko LY, Dats-Opoka МI, Kosmynina NS. Post-COVID syndrome in children: whether a change in lymphocyte count is a risk factor for its development?. Zaporozhye Medical Journal [Internet]. 2022Dec.20 [cited 2024Nov.25];24(6):695-700. Available from: http://zmj.zsmu.edu.ua/article/view/258928

Issue

Vol. 24 No. 6 (2022)

Section

Original research

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