The Role of Tonsils in the Development of Covid-19 Pneumonia

Yıl 2023, Cilt: 12 Sayı: 3, 480 - 484, 28.09.2023

Serap Bulut Çöbden İbrahim Özcan Mustafa Alkaya Altan Kaya Yunus Kantekin

https://doi.org/10.53424/balikesirsbd.1173346

Öz

Objective: Despite extensive research, the physiopathology and clinical course of novel coronavirus disease 2019 (COVID-19) is still not fully understood. It is not known why some COVID-19 patients develop pneumonia while others are asymptomatic or have only mild upper respiratory tract symptoms. The tonsils are an element of the immune system that provide first-line defense against microorganisms entering the body via the upper respiratory tract. This study aimed to evaluate the role of tonsils in preventing the development of COVID-19 pneumonia. Materials and Methods: The study included 198 patients aged 20-40 years who presented to the pandemic outpatient clinic, had confirmed COVID-19 infection, and had no comorbidities. The relationship between lung involvement and history of tonsillectomy was analyzed. Results: Of the 198 patients in the study, 108 were male, 90 were female, and the mean age was 34.7 years. Eighty-three (41.9%) of the patients did not have lung involvement and 115 (58.1%) had lung involvement. Twelve (10.4%) of the patients with lung involvement and 3 (3.6%) of the patients without lung involvement had a history of tonsillectomy. The prevalence of pneumonia did not differ statistically between the groups (p>0.05). Conclusion: Although there was no statistically significant relationship between COVID-19 pneumonia and tonsillectomy in this study, we observed that pneumonia developed in 80% of the 15 patients who underwent tonsillectomy. This suggests that greater caution in terms of lung involvement may be warranted for tonsillectomized patients with COVID-19.

Anahtar Kelimeler

covid-19, tonsillectomy, pnomonia, immunity

Covid-19 Pnömonisinin Gelişiminde Tonsillerin Rolü

Öz

Amaç: COVID-19 hastalığı fizyopatolojisi ve klinik seyri yapılan pek çok bilimsel araştırmaya rağmen henüz tam olarak çözülememiştir. Yeni tip coronavirüs pandemisinde neden bazı hastalarda pnömoni gelişirken, bazı hastalarda sadece üst solunum yolu bulguları ile hatta bazen asemptomatik seyrettiği bilinmemektedir. Bu klinik farklılığın sebeplerinin ortaya konabilmesi için çalışmalara ihtiyaç vardır. Bu çalışmada üst solunum yolu ile vücuda giren mikroorganizmalara karşı ilk savunmayı sağlayan, immün sistemin bir elemanı olan tonsillerin COVID-19 pnömonisi gelişimini önlemedeki rolünün araştırılması amaçlanmıştır.Gereç ve Yöntem: Pandemi polikliniğine başvuran, yeni tip koronavirüs ile enfekte, 20-40 yaş arası, ek hastalığı olmayan 198 hasta çalışmaya dahil edildi. Hastaların akciğer tutulumlarının olup olmadığı, tonsillektomi olup olmadığı incelenerek akciğer tutulumu ile tonsillektomi öyküsü arasındaki ilişki değerlendirildi. Bulgular: Çalışmaya dahil edilen 198 hastanın 108’i erkek, 90‘ı kadın ve yaş ortalaması 34,73 idi. Hastaların 83’ünde akciğer tutulumu bulunmazken, 115’inde akciğer tutulu idi. Akciğer tutulumu olan hastaların 12‘sinde tonsillektomi öyküsü mevcut iken, akciğer tutulumu olmayan hastaların 3’ünde tonsillektomi öyküsü mevcuttu. Sonuç: Pnomoni gelişmesi ve tonsillektomi arasında istatistiksel olarak anlamlı sonuç bulunamadı (p0.05), ancak tonsillektomi olan 15 hastanın %80’inde pnömoni gelişirken %20’sinde gelişmediği görüldü. Bu nedenle tonsillektomi öyküsü olan hastalarda COVID-19 enfeksiyonu gelişmesi durumunda akciğer tutulumu açısından daha dikkatli olunmalıdır.

Anahtar Kelimeler

covid-19, tonsillektomi, pnömoni, immünite

Kaynakça

• Böch A, Popp W, Herkner KR, (1994). Tonsillectomy and the immune system: a long-term follow up comparison between tonsillectomized and non-tonsillectomized children, European Archives of Oto-Rhino-Laryngology, 251(7):423427.
• Byars SG, Stearns SC, Boomsma JJ, (2018). Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood, JAMA Otolaryngol Head Neck Surg, 144(7):594-603.
• Cantani A, Bellioni P, Salvinelli F, et al., (1986). Serum immunoglobulins and secretory IgA deficiency in tonsillectomized children. Ann Allergy; 57 (6):413-416.
• Capriotti V, Mattioli F, Guida F, et al, (2021). COVID-19 in the tonsillectomised population, Acta Otorhinolaryngol. Ital; 41(3):197-205.
• Doblan S, Doblan A. (2021). History of Tonsillectomy is Associated with a Relatively Higher Risk of Symptomatic Disease in Patients with COVID-19, American Journal of Otolaryngology and Head and Neck Surgery; 4(5):1138.
• Guan WJ, Ni ZY, Hu Y et al, (2020). Clinical Characteristics of Coronavirus Disease 2019 in China, N Engl J Med; 382(18):1708-1720.
• Johansson E, Hultcrantz E. (2003). Tonsillectomy–clinical consequences twenty years after surgery?, International Journal of Pediatric Otorhinolaryngology; 67(9):981-988.
• Kaygusuz I, Alpay HC, Godekmerdan A, et al., (2009). Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study, International Journal of Pediatric Otorhinolaryngology; 73(3):445-449.
• Mattila PS, Tahkokallio O, Tarkhanen J, et al, (2001). Causes of tonsillar disease and frequency of tonsillectomy operations, Arch Otolaryngol Head Neck Surg; 127(1):37-44.
• Nave H, Gebert A, Pabst R, (2001). Morphology and immunology of the human palatine tonsil. Anat Embryol; 204(5):367-373.
• Ogra PL, (1971). Effect of tonsillectomy and adenoidectomy on nasopharyngeal antibody response to poliovirus, New England Journal of Medicine; 284(2):59-64.
• Özdemir YE, Balkan İİ, Bayramlar OF. (2021). Clinical Characteristics of Mild-Moderate COVID-19 Patients and Risk Factors for the Development of Pneumonia, Mikrobiyol Bul, 55(3):342-356.
• Polat C, Demirören K, Frequency of the tonsillectomy and adenoidectomy in children in Elazig province, in the east of Turkey, Dicle Medical Journal; 2010;37(3):263-266.
• Rosenfeld RM, Gren RP. (1990). Tonsillectomy and adenoidectomy: changing trends, Ann Oto Rhinol Laryngol, 99(3):187-191.
• Song J, Lim Y, Ko I, et al, (2021). Association of adenotonsillectomy with asthma and upper respiratory infection: A nationwide cohort study, Journal of Stroke and Cerebrovascular Diseases; 30(11):106080.
• Suzumoto M, Hotomi M, Fujihara K, et al., (2006). Functions of tonsils in the mucosal immune system of the upper respiratory tract using a novel animal model, Suncus murinus. Acta Otolaryngol; 126(11):1164-1170.
• Tan HX, Wragg KM, Kelly HG, Esterbauer R, Dixon BJ, Lau JSY, Flanagan KL, van de Sandt CE, Kedzierska K, McMahon JH, Wheatley AK, Juno JA, Kent, (2022). Cutting Edge: SARS-CoV-2 Infection Induces Robust Germinal Center Activity in the Human Tonsil, Scandinavian Journal of Immunology, 15;208(10):2267-2271. doi: 10.4049/jimmunol.2101199. Epub 2022 Apr 29.
• Xu Q, Milanez-Almeida P, Martins AJ, Radtke AJ, Hoehn KB, Oguz C, Chen J, Liu C, Tang J, Grubbs G, Stein S, Ramelli S, Kabat J, Behzadpour H, Karkanitsa M, Spathies J, Kalish H, Kardava L, Kirby M, Cheung F, Preite S, Duncker PC, Kitakule MM, Romero N, Preciado D, Gitman L, Koroleva G, Smith G, Shaffer A, McBain IT, McGuire PJ, Pittaluga S, Germain RN, Apps R, Schwartz DM, Sadtler K, Moir S, Chertow DS, Kleinstein SH, Khurana S, Tsang JS, Mudd P, Schwartzberg PL, Manthiram K. (2023). Adaptive immune responses to SARS-CoV-2 persist in the pharyngeal lymphoid tissue of children. Nat Immunol, 24(1):186-199. doi: 10.1038/s41590-022-01367-z. Epub 2022 Dec 19.
• Yan Y, Song Y, Liu Y, et al, (2019). Short- and long-term impacts of adenoidectomy with/without tonsillectomy on immune function of young children <3 years of age A cohort study, MD, Medicine. 2019;98(19):(e15530).
• Zielnik-Jurkiewicz B, Jurkiewicz D, (2002). Implication of immunological abnormalities after adenotonsillotomy, International Journal of Pediatric Otorhinolaryngology 64(2):127-132.