Post-COVID syndrome in children: whether a change in lymphocyte count is a risk factor for its development?
DOI:
https://doi.org/10.14739/2310-1210.2022.6.258928Keywords:
COVID-19, Post-Acute COVID-19 syndrome, children, lymphocytes, adaptive reactionsAbstract
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.
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
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 



