Immunological and microbiological features of the mucous membranes of the oronasopharyngeal region of patients with postcovid syndrome

Background. One of the most frequent complaints of patients who have undergone COVID-19 are various purulent-inflammatory diseases of the organs of the oronasopharyngeal region of a recurrent nature, in connection with which it is relevant to investigate the causes of the failure of the protective potential of the upper respiratory tract, mucous membranes of this area. The aim of the study was to study the immunological and microbiological features of the mucous membranes of the oronazopharyngeal region in patients with postcovid syndrome who had suffered a severe form of COVID-19 and had complaints from the organs of the oronazopharyngeal region.
Materials and methods. Patients who suffered a severe form of new coronavirus infection (NCI) from 3 to 6 months ago were examined. Concentrations of local interleukins 1ß, interleukin-10, sIgA, facultative anaerobic microflora of mucous membranes of the oronazopharyngeal region were studied.
Results. The data obtained indicate that patients who have suffered a severe form of new coronavirus infection 3-6 months after discharge from the hospital have complaints of impaired sense of smell, taste, dysphonia, tinnitus. In the study of facultative anaerobic microflora of the nose and pharynx of patients with postcovid syndrome, data on the frequency of detection of strains of Staphylococcus aureus, Klebsiella pneumoniae and yeast-like fungi Candida albicans are noteworthy, regardless of the presence of acute stage diseases at the time of examination, unlike patients with rhinosinusitis or pharyngitis who have not undergone NCI. When assessing the concentration of sIgA in saliva and in the pharyngeal scraping material and local concentrations of IL-1β, it was found that in groups of patients with postcovid syndrome, the level of sIgA and IL-1β, regardless of the presence or absence of acute forms of bacterial infections, did not significantly differ from the norm (p > 0.05). That is, in response to the presence of pathogenic and conditionally pathogenic bacteria and their activation, an increase in the humoral immunity of the mucous membranes and activation of cytokine-mediated mucosal protection reactions were not detected, which is evidence of a local immunodeficiency condition.

1. Recommendations for the management of patients with COVID-19 coronavirus infection in the acute phase and with postcovid syndrome in outpatient settings. Problems of standardization in healthcare. 2021. P. 3-96. (In Russ.)

2. Li Y., Scherer N., Felix L., Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One. 2021; 16 (3): e0246454. DOI: 10.1371/journal.pone.0246454.

3. Alharbi K. S., Singh Y., Hassan Almalki W., Rawat S., Afzal O., Alfawaz Altamimi A. S., Kazmi I., Al-Abbasi F. A., Alzarea S. I., Singh S. K., Bhatt S., Chellappan D. K., Dua K., Gupta G. Gut Microbiota Disruption in COVID-19 or Post-COVID Illness Association with severity biomarkers: A Possible Role of Pre / Pro-biotics in manipulating microflora. Chem Biol Interact. 2022; 358: 109898. DOI: 10.1016/j.cbi.2022.109898.

4. Liu Q., Mak J. W. Y., Su Q., Yeoh Y. K., Lui G. C., Ng S. S. S., Zhang F., Li A. Y. L., Lu W., Hui D. S., Chan P. K., Chan F. K. L., Ng S. C. Gut microbiota dynamics in a prospective cohort of patients with postacute COVID-19 syndrome. Gut. 2022; 71 (3): 544-552. DOI: 10.1136/gutjnl-2021-325989.

5. Garg R., Bharangar S., Gupta S., Bhardwaj S. Post Covid-19 Infection Presenting as Rhino-Orbital Mycosis. Indian J Otolaryngol Head Neck Surg. 2022; 74 (Suppl 2): 3050-3057. DOI: 10.1007/s12070-021-02722-6.

6. Koumpa F. S., Forde C. T., Manjaly J. G. Sudden irreversible hearing loss post COVID-19. BMJ Case Rep. 2020; 13 (11): 238419. DOI: 10.1136/bcr-2020-238419.

7. Ozturk O. E., Bayındır Aslan M. T. The effect of COVID-19 on nasal mucociliary clearance. Acta Otolaryngol. 2022; 142 (3-4): 329-332. DOI: 10.1080/00016489.2022.2048072.

8. Peter R. S., Nieters A., Kräusslich H. G., Brockmann S. O., Göpel S., Kindle G., Merle U., Steinacker J. M., Rothenbacher D., Kern W. V; EPILOC Phase 1 Study Group. Post-acute sequelae of covid-19 six to 12 months after infection: population based study. BMJ. 2022; 379: e071050. DOI: 10.1136/bmj-2022-071050.

9. Gaber T., Ashish A., Unsworth A. Persistent post-covid symptoms in healthcare workers. Occup Med (Lond), 2021; 71 (3): 144-146. DOI: 10.1093/occmed/kqab043.

10. Parums D. V. Editorial: Long COVID, or Post-COVID Syndrome, and the Global Impact on Health Care. Med Sci Monit. 2021; 27: e933446. DOI: 10.12659/MSM.933446.

11. Date Y., Ebisawa M., Fukuda S., Shima H., Obata Y., Takahashi D., Kato T., Hanazato M., Nakato G., Williams I. R., Hase K., Ohno H. NALT M cells are important for immune induction for the common mucosal immune system. Int Immunol., 2017; 29 (10): 471-478. DOI: 10.1093/intimm/dxx064.

12. Wang R., Proud D. Editorial: The Response of Mucosal Epithelial Cells to Infections. Front Cell Infect Microbiol. 2020; 10: 602312. DOI: 10.3389/fcimb.2020.602312.

13. Bamias G., Arseneau K. O., Cominelli F. Cytokines and mucosal immunity. Curr Opin Gastroenterol. 2014; 30 (6): 547-552. DOI: 10.1097/MOG.0000000000000118.

14. Berkiten G., Kumral T. L., Saltürk Z., Atar Y., Yildirim G., Uyar Y., Aydoğdu I., Arslanoğlu A. Effect of Deviated Nasal Septum Type on Nasal Mucociliary Clearance, Olfactory Function, Quality of Life, and Efficiency of Nasal Surgery. J Craniofac Surg. 2016; 27 (5): 1151-1155. DOI: 10.1097/SCS.0000000000002696.

15. Gutiérrez-Meza J. M., Jarillo-Luna R. A., Rivera-Aguilar V., Miliar-García A., Campos-Rodríguez R. Cytokine profile of NALT during acute stress and its possible effect on IgA secretion. Immunol Lett. 2017; 188: 68-78. DOI: 10.1016/j.imlet.2017.04.016.

16. Narozny W., Sićko Z., Stankiewicz C. Z., Przewoźny T., Pegiel-Sićko E. The effect of hyperbaric oxygen on nasal mucociliary transport. Clin Otolaryngol Allied Sci. 2002; 27 (3): 140-146. DOI: 10.1046/j.1365-2273.2002.00548.x.

17. Khasanova A. А., Kostinov M. P., Soloveva I. L., Nikitina T. N., Khromova E. A. Dynamics of clinical symptoms and secretory immunoglobulin A in COVID-19 convalescent patients. Russian Journal of Infection and Immunity Infektsiya i immunitet. 2022; 12 (6): 1113-1122. (In Russ.) DOI: 10.15789/2220-7619-DOC-2042

18. Kovács T., Mikó E., Ujlaki G., Sári Z., Bai P. The Microbiome as a Component of the Tumor Microenvironment. Adv Exp Med Biol. 2020; 1225: 137-153. DOI: 10.1007/978-3-030-35727-6_10.

19. Lopez-Castejon G., Brough D. Understanding the mechanism of IL-1β secretion. Cytokine Growth Factor Rev. 2011; 22 (4): 189-195. DOI: 10.1016/j.cytogfr.2011.10.001.

20.