Clinical features of COVID-19 in children with a chronic adenotonsillar disorder

Abstract

BACKGROUND: COVID-19, caused by SARS-CoV-2, is a highly contagious infectious disease associated with a risk of severe complications. In Russia, the COVID-19 incidence has exceeded 24 million, with new strains raising the incidence in children up to 18%. The prevalence of long COVID is rising. In children, the adaptive immune system, including the lymphoepithelial ring of the throat, plays a key role in determining the severity of COVID-19. The lymphoid tissue of the Waldeyer’s ring is one of the first immune barriers against coronaviruses and other respiratory infections. The high incidence of co-infection worsens the course of the disease. A chronic adenotonsillar disease has incidence of 32%–35% in children. However, impact of this disease on the severity of COVID-19 and the incidence of co-infection in children is poorly understood. AIM: The aim of the study was to evaluate impact of the chronic adenotonsillar disease on COVID-19 progression and the incidence of co-infections in children. MATERIALS AND METHODS: Conducted in St. Petersburg from January 2022 to March 2023, the study included 493 children (300 with COVID-19 and 144 with chronic adenotonsillar disease). Patients were divided into four groups to evaluate impact of chronic adenotonsillar disease on COVID-19 progression. Non-parametric statistical methods were used to analyze the clinical data. RESULTS: Children with both COVID-19 and chronic adenotonsillar disease demonstrated a more severe course of disease compared to those without chronic adenotonsillar disease. The first group showed an increased incidence of bronchitis, bacterial co-infections, longer hospitalization and disease duration, longer fever duration, and higher maximum temperature. Laboratory data showed higher white blood cell counts in patients with COVID-19 and chronic adenotonsillar disease compared to those without chronic adenotonsillar disease. CONCLUSIONS: Chronic adenotonsillar disease significantly complicates the course of COVID-19 in children. Further research is needed to elucidate the pathophysiological mechanisms and optimize treatment strategies for children with chronic adenotonsillar disease.