Cellular and humoral responses to SARS-CoV-2 (omicron variant) in children and adolescents with pulmonary tuberculosis

• Mikhail M. Averbakh
• Lyudmila V. Panova
• Elena S. Ovsyankina
• Atadzhan E. Ergeshov
• Tatiana G. Smirnova
• Ekaterina A. Kiseleva
• Yulia Yu. Khokhlova
• Svetlana S. Sterlikova

Abstract

Introduction. The consequences of COVID-19 infection in TB patients remain unclear. Coronavirus infection caused by primary variants of SARS-CoV-2 burdened the course of TB in elderly patients but did not exacerbate TB in children. The review of scientific literature did not reveal any studies describing T- and B-cell specific immune responses to SARS-CoV-2 in children and adolescents with TB.

Aim – to study expressiveness and duration of cellular and humoral immune responses to SARS-CoV-2 in children and adolescents with pulmonary TB after coronavirus disease or exposure to coronavirus infection caused by omicron strain.

Material and methods. We carried out a cohort prospective study including 34 patients aged 2–17 years with different forms of pulmonary TB, received treatment in the Children and Adolescents’ Department of the Central TB Research Institute. The children had a history of either coronavirus disease or exposure to coronavirus infection (omicron strain). Laboratory diagnosis of coronavirus infection in patients with clinical signs of acute respiratory viral infection (ARVI) was based on detection of SARS-CoV-2 RNA in nasopharyngeal swabs (omicron strain). Cellular immunity was assessed using T-SPOT.COVID (Oxford Immunotec, Great Britain) on panel A (COV-A) (Spike antigens) and panel B (COV-B) (Nucleocapsid antigens). IgM and IgG antibodies against nucleocapsid protein were determined (ARCHITECT, Abbott, USA) with assessment of positivity ratio (PR). The results of qualitative signs were expressed in absolute numbers with indication of proportions (%), the calculation of statistical significance used Pearson’s χ² criterion. The comparison of T cell and humoral immunity parameters after one and three months used Wilcoxon T-criterion.

Results. In all cases coronavirus infection had a mild course, the clinical picture of ARVI was observed in 67.6 % (23/34) of cases, and SARS-CoV-2 RNA was only determined in 74 % of cases. IgM antibodies were absent in all cases one month after the disease initiation/exposure. IgG antibodies were detected in 76.5 % of cases one month after the disease/exposure and 53 % of cases 3 months after the disease/exposure (р < 0.01). Positive results of specific T-cell immunity were observed in 97.1 % of cases after one month and 79.4 % after 3 months. At the same time specific T-cell immunity (panel A and panel B) significantly decreased by the 3^rd month of our study (р < 0.01). Trends in changes in T-cell immunity parameters (panels A and panels B) in groups of patients with and without clinical manifestations of the disease were different. If in the group with clinical manifestations, the number of spots did not change significantly when comparing the results after 1 and 3 months observation, in the group without clinical signs, a statistically significant decrease was noted by the 3^rd month in panel B, in the absence of significant dynamics in panel A.

Conclusion. In our study, coronavirus infection in children and adolescents with tuberculosis in all cases proceeded in a mild form and was characterized by the presence of a pronounced specific T cell response in 97.1 % and the production of specific IgG-antibodies in 76.5 % of patients after 1 month of the study with subsequent statistically significant decrease in indicators by the 3^rd month of observation – 79.4 and 53 %, respectively.

Keywords:SARS-CoV-2; coronavirus infection; antibodies; Т-cells; tuberculosis; children and adolescents

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