A differential and diagnostic significance of monocytosis in treatment of moderate COVID-19 forms

Cover Page


Cite item

Full Text

Abstract

Despite the relatively rare comorbidity with bacterial infections, in most cases treatment of COVID-19-associated pneumonia is accompanied by empirical antibiotic therapy. In addition, the occurrence of leukocytosis in response to glucocorticosteroid (GCS) therapy is often perceived as comorbid bacterial flora and is a reason for initiating antibiotic therapy. Therefore, an urgent task is to properly interpret leukocytosis in response to GCS therapy in COVID-19. The aim of the study was to examine dynamic changes in count of venous blood leukocytes, neutrophils and monocytes in patients with moderate COVID-19 after systemic GCS. We analyzed parameters of complete blood count in 154 patients with verified moderate COVID-19, at the Temporary Infectious Diseases Hospital, the “Patriot” Park of the Moscow Region. The comparison group (I) consisted of 128 patients without clinical signs of bacterial infection and leukocytosis observed on admission, who were prescribed GCS therapy. The control group (II) consisted of 26 subjects showing on admission signs of bacterial infection — a cough with purulent sputum combined with neutrophilic leukocytosis. The dynamics in venous blood cell count was assessed in group I of patients before the onset, 3 and 6 days after beginning GCS therapy. We also compared count of leukocytes, neutrophils and monocytes between patients with developed leukocytosis in group I vs. group II. As a result, an increased count of leukocytes, neutrophils and monocytes was revealed according to assessing complete blood count test in patients from group I on days 3 and 6 of ongoing GCS therapy. All patients with developed leukocytosis after GCS admission (103 subjects) had no clinical signs of bacterial infection. Patients with developed leukocytosis from group I had increased count of monocytes (0.90 (0.84; 1.02) on day 3 after GCS onset and 0.94 (0.87; 1.26) on day 6 of GCS) compared with group II (0.61 [0.50; 0.71]), p < 0.001. The inter-group count of leukocytes and neutrophils did not differ. Monocytosis after GCS therapy may serve as a differential diagnostic criterion to distinguish between glucocorticoid-induced leukocytosis and comorbid bacterial infection. This may be one of the factors influencing a decision to prescribe antibiotic therapy.

About the authors

M. I. Shperling

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Author for correspondence.
Email: mersisaid@yandex.ru
ORCID iD: 0000-0002-3274-2290

Maksim I. Shperling - Resident Physician in Therapy, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

195027, St. Petersburg, Akademika Lebedeva str., 6Zh.

Phone: +7 911 817-00-34.

SPIN-code: 7658-7348

Russian Federation

E. A. Shperling

Children’s Polyclinic No. 68

Email: ekaterinaormanzhi@gmail.com
ORCID iD: 0000-0002-9858-810X

Pediatrician, Children’s Polyclinic No. 68.

St. Petersburg.

Russian Federation

A. V. Kovalev

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

Resident Physician in Therapy, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

A. A. Vlasov

33 rd Central Research Test Institute of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

PhD (Medicine), Senior Researcher, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

Volsk-18.

Russian Federation

A. S. Polyakov

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

PhD (Medicine), Head of the Hematology Department, Intermediate Level Therapy Department, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

Ya. A. Noskov

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

PhD (Medicine), Senior Resident Physician, Hematology Department, Intermediate Level Therapy Department, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

A. D. Morozov

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

PhD (Medicine), Head of the Otorhinolaryngology Department, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

V. S. Merzlyakov

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

5th Grade Military Student, Physician Training Faculty, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

D. P. Zvyagintsev

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: mersisaid@yandex.ru

5th Grade Military Student, Physician Training Faculty, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

V. V. Tishko

S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia

Email: vtishko@gmail.com

PhD, MD (Medicine), Assosiate Professor, Deputy Head of the Intermediate Level Therapy Department, S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia.

St. Petersburg.

Russian Federation

References

  1. Зайцев А.А., Чернов С.А., Стец В.В., Паценко М.Б., Кудряшов О.И., Чернецов В.А., Крюков Е.В. Алгоритмы ведения пациентов с новой коронавирусной инфекцией COVID-19 в стационаре: методические рекомендации // Consilium Medicum. 2020. Т. 22, № 11. С. 91–97. doi: 10.26442/20751753.2020.11.200520
  2. Поляков А.С., Козлов К.В., Лобачев Д.Н., Демьяненко Н.Ю., Носков Я.А., Бондарчук С.В., Жданов К.В., Тыренко В.В. Прогностическое значение некоторых гематологических синдромов при инфекции, вызванной SARS-CoV-2 // Гематология. Трансфузиология. Восточная Европа. 2020. Т. 6, № 3. С. 161–171. doi: 10.34883/PI.2020.6.2.001
  3. Профилактика, диагностика и лечение новой коронавирусной инфекции COVID-19: временные методические рекомендации. Версия 10 от 08.02.2021. Утверждено заместителем Министра здравоохранения РФ Е.Г. Камкиным. Минздрав РФ, 2021. 261 с.
  4. Crotty M.P., Akins R., Nguyen A., Slika R., Rahmanzadeh K., Wilson M.H., Dominguez E.A. Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients. medRxiv, 2020, vol. 2. doi: 10.1101/2020.05.29.20117176
  5. Ehrchen J.M., Roth J., Barczyk-Kahlert K. More than suppression: glucocorticoid action on monocytes and macrophages. Front. Immunol., 2019, vol. 10: 2028. doi: 10.3389/fimmu.2019.02028
  6. 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). Zhonghua Liu Xing Bing Xue Za Zhi, 2020, vol. 2, no. 8, pp. 113–122. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003
  7. Gómez-Rial J., Rivero-Calle I., Salas A. Role of monocytes/macrophages in Covid-19 pathogenesis: implications for therapy. Infect. Drug Resist., 2020, vol. 13, pp. 2485–2493. doi: 10.2147/IDR.S258639
  8. Lansbury L., Lim B., Baskaran V., Lim W.S. Co-infections in people with COVID-19: a systematic review and meta-analysis. J. Infect., 2020, vol. 81, no. 2, pp. 266–275. doi: 10.1016/j.jinf.2020.05.046
  9. Liu B., Dhanda A., Hirani S., Williams E.L., Sen H.N., Martinez Estrada F., Ling D., Thompson I., Casady M., Li Z., Si H., Tucker W., Wei L., Jawad S., Sura A., Dailey J., Hannes S., Chen P., Chien J.L., Gordon S., Lee R.W., Nussenblatt R.B. CD14++CD16+ monocytes are enriched by glucocorticoid treatment and are functionally attenuated in driving effector T cell responses. J. Immunol., 2015, vol. 194, no. 11, pp. 5150–5160. doi: 10.4049/jimmunol.1402409
  10. Martinez F.O., Combes T.W., Orsenigo F., Gordon S. Monocyte activation in systemic COVID-19 infection: assay and rationale. EBioMedicine, 2020, vol. 59: 102964. doi: 10.1016/j.ebiom.2020.102964
  11. Qin C., Zhou L., Hu Z., Zhang S., Yang S., Tao Y., Xie C., Ma K., Shang K., Wang W., Tian D.S. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin. Infect. Dis., 2020, vol. 71, no. 15, pp. 762–768. doi: 10.1093/cid/ciaa248
  12. Shoenfeld Y., Gurewich Y., Gallant L.A., Pinkhas J. Prednisone-induced leukocytosis. Am. J. Med., 1981, vol. 71, no. 5, pp. 773– 778. doi: 10.1016/0002-9343(81)90363-6
  13. Solinas C., Perra L., Aiello M., Migliori E., Petrosillo N. A critical evaluation of glucocorticoids in the management of severe COVID-19. Cytokine Growth Factor Rev., 2020, vol. 54, pp. 8–23. doi: 10.1016/j.cytogfr.2020.06.012
  14. Vazzana N., Dipaola F., Ognibene S. Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes. Acta Clin. Belg., 2020: 1-5. doi: 10.1080/17843286.2020.1824749
  15. Youngs J., Wyncoll D., Hopkins P., Arnold A., Ball J., Bicanic T. Improving antibiotic stewardship in COVID-19: bacterial coinfection is less common than with influenza. J. Infect., 2020, vol. 81, no. 3, pp. e55–e57. doi: 10.1016/j.jinf.2020.06.056

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2021 Shperling M.I., Shperling E.A., Kovalev A.V., Vlasov A.A., Polyakov A.S., Noskov Y.A., Morozov A.D., Merzlyakov V.S., Zvyagintsev D.P., Tishko V.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 64788 от 02.02.2016.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies