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Features of Appendix and the Characteristics of Appendicitis Development in Children with COVID-19
Grigory Demyashkin1,2, Konstantin Gorokhov1, Vladimir Shchekin2
1Department of Pathomorphology, National Medical Research Centre of Radiology, Ministry of Health of Russia, 249036 Obninsk, Russia.
Insights
COVID-19 infection in children causes appendicitis with destructive changes and increased immune cells and cytokines in the appendix. These SARS-CoV-2 effects are most severe in children aged 6-12 years.
Area of Science:
- Pediatric Pathology
- Infectious Diseases
- Immunology
Background:
- Investigating SARS-CoV-2 influence on pediatric homeostasis is crucial.
- Pathomorphological changes in the appendix of children with COVID-19 require further study.
Purpose of the Study:
- To perform morphological and molecular biological evaluation of the appendix in children with COVID-19 across different age groups.
Main Methods:
- Compared three groups: COVID-19 patients (n=42), acute appendicitis patients (n=55, pre-pandemic), and controls (n=38).
- Conducted histological and immunohistochemical analyses using antibodies for immune cells (CD3, CD4, CD68, CD163, CD20, CD138) and cytokines (IL-1, IL-6, IL-4, IL-10).
Main Results:
- COVID-19-affected appendixes showed destructive phlegmonous-ulcerative and gangrenous appendicitis.
- Increased CD3+, CD4+, CD68+, CD163+, CD20+, and CD138+ cells were observed in COVID-19 cases.
- Elevated levels of pro-inflammatory (IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines were detected.
Conclusions:
- Pathological and immunohistochemical changes were most pronounced in children aged 6-12 years.
- COVID-19 significantly impacts appendix morphology and immune response in children.
Background:
Research on the subject of the influence of SARS-CoV-2 mechanisms on human homeostasis remains an actual problem. Particular interest is the study of pathomorphological changes in the appendix in children with COVID-19.
Objectives:
Aim of this study: morphological and molecular biological evaluation of the appendix in children of different age groups with COVID-19.
Methods:
Groups were formed on the basis of anamnestic, clinical, and morphological data: I (n = 42; aged 2 to 18 years, average age-10.8 ± 4.79)-with an established clinical diagnosis: coronavirus infection (COVID-19; PCR+); II (n = 55; aged 2 to 18 years, average age-9.7 ± 4.77)-with a confirmed clinical diagnosis of acute appendicitis; collected before the onset of the COVID-19 pandemic in 2017-2019; and III (n = 38; aged 2 to 18 years, average age-10.3 ± 4.62)-the control group. Histological and immunohistochemical studies were conducted using primary antibodies to CD3, CD4, CD68, CD163, CD20, and CD138 and to pro-inflammatory (IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines.
Results:
In most samples of appendixes in children with COVID-19, signs of destructive phlegmonous-ulcerative and gangrenous appendicitis were discovered. An increase in CD3+, CD4+, CD68+, CD163+, and CD20+ CD138+ immunocompetent cells was found in the appendix of children with COVID-19. As well, there was an increase in pro-inflammatory (IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines.
Conclusions:
The aforementioned pathological and immunohistochemical changes were more pronounced in the group of children aged 6-12 years (childhood).
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