AUTHOR=Shokati Eshkiki Zahra , Shahriari Arman , Seyedtabib Maryam , Torabizadeh Mehdi , Assarehzadegan Mohammad Ali , Nashibi Roohangize , Khosravi Maryam , Neisi Niloofar , Mard Seyed Ali , Shayesteh Ali Akbar 

TITLE=Innate and Adaptive Immunity Imbalance With Severe COVID-19 Pneumonia in Children and Adults

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.736013

DOI=10.3389/fped.2021.736013

ISSN=2296-2360

ABSTRACT=<p><bold>Introduction:</bold> Little is known about the laboratory and radiological characteristics and clinical significance of peripheral immune alterations in patients with coronavirus disease 2019 (COVID-19). This study aims to clarify these aspects in children and adults with COVID-19.</p><p><bold>Methods:</bold> In this consecutive pilot study, COVID-19 patients with the confirmed pneumonia and real-time RT-PCR were recruited prospectively in June 2020. The clinical, chest CT, and laboratory features, such as lymphocyte subpopulations, were analyzed for each individual.</p><p><bold>Results:</bold> Forty confirmed COVID-19 patients, 11 severe children, 12 severe adults, and 17 critical adult patients, besides 20 healthy pediatrics and 14 healthy adults as controls, were enrolled prospectively. Adult patients, especially critical ones, had a much higher prevalence of laboratory and chest CT abnormalities. Data regarding immune cell subsets in children patients, compared with matched controls, had higher CD3+ CD8+ T cells (<italic>p</italic> = 0.004) and lower CD4+/CD8+ ratio (<italic>p</italic> = 0.042), while adult patients, compared with matched controls, had lower CD14+ monocytes (<italic>p</italic> = 0.032). Adult patients were also categorized as experiencing critical or severe illness on admission and, compared with severe patients, had lower total lymphocytes (<italic>p</italic> &lt; 0.047), CD3+ T-lymphocytes (<italic>p</italic> &lt; 0.002), and CD3+ CD8+ T cells (<italic>p</italic> = 0.001) and, on the other hand, had higher CD3+ CD4+ T cells (<italic>p</italic> = 0.012) and CD4+/CD8+ ratio (<italic>p</italic> = 0.003). Non survived adults, compared with survived patients, had significantly lower CD3+ T-lymphocyte (<italic>p</italic> = 0.005).</p><p><bold>Conclusion:</bold> Unlike adult patients, who compared with matched controls and had more comorbidities, higher frequency of severe clinical symptoms, laboratory abnormalities, and immune cells alteration, clinical manifestations of COVID-19 in children (compared with matched controls) were relatively mild, and fewer clinical complications were seen either, perhaps because of a milder inflammatory response following their peripheral innate and adaptive immune cell alteration pattern.</p>