COVID-19 与流感:儿童的临床和免疫学特征

L. N. Mazankova, O. Kalyuzhin, N. Dracheva, O. I. Klimova, E. Samitova
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摘要

在 COVID-19 病原体和其他急性呼吸道传染病共同流行的情况下,同时感染 SARS-CoV-2 和其他病原体(尤其是流感病毒)的风险会增加。以前发表的关于这种合并感染过程的相互影响的数据非常矛盾。确定儿童合并感染 COVID-19 和流感的临床和免疫学特征。在 3983 名 COVID-19 住院患儿中,通过 PCR 鉴定出 48 名患者(1.2%)同时感染了甲型和乙型流感病毒。对 31 名合并感染 COVID-19 和流感的儿童进行了深入检查。对比组包括 30 名单一感染 SARS-CoV-2 的儿童。除了标准的体格检查、仪器检查和实验室检查外,还使用 ELISA 方法测定了对比组患者血清中 SARS-CoV-2 S 蛋白的 IgM 和 IgG 含量。在同时感染流感和由 SARS-CoV-2 的 delta 和 omicron 变体引起的感染的儿童中,与只感染 SARS-CoV-2 的患者相比,急性支气管炎更常见,与年龄无关。在感染 omicron-SARS-CoV-2 的患者中,合并感染流感病毒不会改变肺炎的发病率,而在感染 delta-SARS-CoV-2 的患者中,合并感染流感病毒会降低肺炎的发病率。在合并感染的儿童中,中毒综合征的严重程度和血液中的 D-二聚体水平更高。此外,与单一感染 SARS-CoV-2 的患者相比,合并感染 COVID-19 和流感的患者的 S 蛋白 IgM 和 IgG 浓度较低。与流感病毒合并感染会改变 COVID-19 的临床过程,而变化的性质和载体取决于 SARS-CoV-2 基因变异体。合并感染的儿童对 SARS-CoV-2 的体液免疫反应的严重程度有所下降。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
COVID-19 and the flu: clinical and immunological features in children
In conditions of co-circulation of COVID-19 pathogens and other acute respiratory infections, the risk of simultaneous infection with SARS-CoV-2 and other pathogens, in particular influenza viruses, increases. Previously published data on the mutual influence of such combined infectious processes are very contradictory.Purpose. To determine the clinical and immunological features of the combined course of COVID-19 and influenza in children.Material and methods. Among 3,983 hospitalized children with COVID-19, 48 patients (1.2%) co-infected with influenza A and B viruses were identified by PCR. 31 children with a combination of COVID-19/Influenza were subjected to in-depth examination. The comparison group consisted of 30 children with SARS-CoV-2 monoinfection. In addition to standard physical, instrumental and laboratory studies, serum levels of IgM and IgG to SARS-CoV-2 S protein were determined in patients of the compared groups using ELISA.Results. In children with a combination of influenza and infection caused by both delta and omicron variants of SARS-CoV-2, acute bronchitis was more common, regardless of age, compared with patients with SARS-CoV-2 monoinfection. Co-infection with the influenza virus did not change the incidence of pneumonia in patients with omicron-SARS-CoV-2 infection, and in patients with delta-SARS-CoV-2 infection it decreased it. In co-infected children, the severity of intoxication syndrome and the level of D-dimer in the blood were higher. In addition, patients with a combination of COVID-19 and influenza showed lower concentrations of IgM and IgG to S-protein in comparison with patients with SARS-CoV-2 monoinfection.Conclusion. Co-infection with influenza viruses alters the clinical course of COVID-19, while the nature and vector of changes depend on the SARS-CoV-2 gene variant. A decrease in the severity of the humoral immune response to SARS-CoV-2 in co-infected children was found.
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