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J Pediatr Infect Dis 2022; 17(01): 033-039
DOI: 10.1055/s-0041-1739392
Original Article

Relationship between Pneumonia and the Thymus Gland in Children with COVID-19: A Volumetric Computed Tomography Study

Furkan E. Urfali 
1   Department of Interventional Radiology, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
,
Damla Geçkalan Soysal
2   Department of Pediatrics, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
,
Sahinde Atlanoglu 
3   Department of Radiology, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
,
Mehmet Korkmaz
1   Department of Interventional Radiology, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
,
Özlem Genc
4   Department of Microbiology, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
,
Rahmi Özdemir
5   Department of Pediatric Cardiology, Kütahya Evliya Celebi University School of Medicine, Kutahya, Turkey
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Abstract

Objective Many studies showed that less-severe disease symptoms and fewer mortality rates have been reported in pediatric novel coronavirus disease 2019 (COVID-19) patients. In this study, we aimed to reveal the relationship between the volume of thymus gland, which provides T lymphocyte maturation in children, with the severity of lung involvement and blood laboratory values in pediatric patients with COVID-19 infection.

Methods Thymus density and thymus and cardiac volumes were measured in pediatric COVID-19 patients and a control group that underwent thoracic tomography for reasons other than infection. Thymus/heart ratios were calculated to index the thymus volumes of the patients to their body dimensions. The severity of pneumonia was demonstrated by proportioning the involved lung parenchymal volume to the total lung volume in patients with typical involvement in thoracic tomography. The relationship between volumetric and blood laboratory values was statistically evaluated.

Results Thymus density (p = 0.015) and thymus/heart ratio (p = 0.04) significantly differed between patients with COVID-19 infection and the control group. A correlation was observed between the pneumonia involvement rate and C-reactive protein (CRP) (k: 0.451, p = 0.08) and white blood cell (WBC; k: 0.419, p = 0.015) values in the thoracic tomography of the COVID-19 group.

Conclusion The thymus gland is enlarged as an indicator of activation in COVID-19 infection. We hope that our study will guide new studies on the prognostic value of thymus size in lymphopenic patients with severe disease.

Keywords

COVID-19 - pneumonia - thymus - computed tomography - volumetric measurement


Publikationsverlauf

Eingereicht: 27. März 2021

Angenommen: 21. September 2021

Artikel online veröffentlicht:
06. Dezember 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 WHO Director-General's opening remarks at the media briefing on COVID19 -March 2020. Accessed October 4, 2021 at: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—1/211-march-2020
    Google Scholar
  • 2 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol 2020; 55 (05) 1169-1174
    CrossrefPubMedGoogle Scholar
  • 3 Rehman S, Majeed T, Azam Ansari M, Ali U, Sabit H, Al-Suhaimi EA. Current scenario of COVID-19 in pediatric age group and physiology of immune and thymus response. Saudi J Biol Sci 2020; 27: 2567-2573
    CrossrefPubMedGoogle Scholar
  • 4 Bialek S, Boundy E, Bowen V. et al; CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. Morb Mortal Wkly Rep 2020; 69 (12) 343-346
    CrossrefPubMedGoogle Scholar
  • 5 Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention.. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020 [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41 (02) 145-151
    PubMedGoogle Scholar
  • 6 Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020; 323 (14) 1335
    CrossrefPubMedGoogle Scholar
  • 7 Dong Y, Mo XI, Hu Y. et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; 16: 16
    PubMedGoogle Scholar
  • 8 Wrapp D, Wang N, Corbett KS. et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020; 367 (6483): 1260-1263
    CrossrefPubMedGoogle Scholar
  • 9 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020; 109 (06) 1088-1095
    CrossrefPubMedGoogle Scholar
  • 10 Spencer J, Choy M, Hussell T, Papadaki L, Kington JP, Isaacson PG. Properties of human thymic B cells. Immunology 1992; 75 (04) 596-600
    PubMedGoogle Scholar
  • 11 Nuñez S, Moore C, Gao B. et al. The human thymus perivascular space is a functional niche for viral-specific plasma cells. Sci Immunol 2016; 1 (06) eaah4447
    CrossrefPubMedGoogle Scholar
  • 12 de Jaegere TMH, Krdzalic J, Fasen BACM, Kwee RM. COVID-19 CT Investigators South-East Netherlands (CISEN) study group. Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with Reverse-Transcription Polymerase Chain Reaction. Radiol Cardiothorac Imaging 2020; 2 (03) e200213
    CrossrefPubMedGoogle Scholar
  • 13 Rubio A, Martínez-Moya M, Leal M. et al. Changes in thymus volume in adult HIV-infected patients under HAART: correlation with the T-cell repopulation. Clin Exp Immunol 2002; 130 (01) 121-126
    CrossrefPubMedGoogle Scholar
  • 14 Varga I, Toth F, Uhrinova A, Nescakova E, Polak S. Association among size of thymus, anthropometric dimensions and number of lymphocytes in peripheral blood in newborns from Slovakia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153 (03) 229-234
    CrossrefPubMedGoogle Scholar
  • 15 Thevarajan I, Nguyen THO, Koutsakos M. et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med 2020; 26 (04) 453-455
    CrossrefPubMedGoogle Scholar
  • 16 Fathi N, Rezaei N. Lymphopenia in COVID-19: therapeutic opportunities. Cell Biol Int 2020; 44 (09) 1792-1797
    CrossrefPubMedGoogle Scholar
  • 17 Jeffery LE, Burke F, Mura M. et al. 1,25-dihydroxyvitamin D3 and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3. J Immunol 2009; 183 (09) 5458-5467
    CrossrefPubMedGoogle Scholar
  • 18 Tan L, Wang Q, Zhang D. et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther 2020; 5 (01) 33
    CrossrefPubMedGoogle Scholar
  • 19 Lu X, Zhang L, Du H. et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665
    CrossrefPubMedGoogle Scholar
  • 20 Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020; 58 (07) 1135-1138
    CrossrefPubMedGoogle Scholar
  • 21 Diao B, Wang C, Tan Y. et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Front Immunol 2020; 11 (827) 827
    CrossrefPubMedGoogle Scholar
  • 22 Huang PC, Wang Y, Li PX. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): P497-P506
    CrossrefPubMedGoogle Scholar
  • 23 Zhang JJ, Dong X, Cao YY. et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020; 75 (07) 1730-1741
    CrossrefPubMedGoogle Scholar
  • 24 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 25 Liu Y, Pang Y, Hu Z. et al. Thymosin alpha 1 (Tα1) reduces the mortality of severe COVID-19 by restoration of lymphocytopenia and reversion of exhausted T cells. Clin Infect Dis 2020; x: 630
    PubMedGoogle Scholar
  • 26 Güneş H, Dinçer S, Acıpayam C, Yurttutan S, Özkars MY. What chances do children have against COVID-19? Is the answer hidden within the thymus?. Eur J Pediatr 2021; 180 (03) 983-986
    CrossrefPubMedGoogle Scholar
  • 27 Yang P, Liu P, Li D, Zhao D. Corona virus disease 2019, a growing threat to children?. J Infect 2020; 80 (06) 671-693
    CrossrefPubMedGoogle Scholar
  • 28 Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: focus on pregnant women and children. J Infect 2020; 80 (05) e7-e13
    CrossrefPubMedGoogle Scholar
  • 29 Garcia-Vidal C, Sanjuan G, Moreno-Garcia E. et al; COVID-19 Researchers Group. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021; 27 (01) 83-88
    CrossrefPubMedGoogle Scholar
  • 30 Fattorini L, Creti R, Palma C, Pantosti A. Unit of Antibiotic Resistance and Special Pathogens, Unit of Antibiotic Resistance and Special Pathogens of the Department of Infectious Diseases, Istituto Superiore di Sanità, Rome. Bacterial coinfections in COVID-19: an underestimated adversary. Ann Ist Super Sanita 2020; 56 (03) 359-364
    PubMedGoogle Scholar