Treatment of COVID-19-associated pneumonia in the overwhelming majority of cases is accompanied by empirical prescription of antibiotic therapy. According to a number of studies carried out, the addition of a bacterial infection in this disease is noted less often than in other viral pneumonias, in particular, caused by the influenza virus. In addition, the occurrence of leukocytosis in response to therapy with glucocorticosteroids (GCS) is often perceived as an attachment of bacterial flora and is the reason for initiating antibiotic therapy. Therefore, an urgent task is the correct interpretation of leukocytosis in response to GCS therapy in COVID-19. The purpose of the work was to study the dynamics of changes in the number of leukocytes, neutrophils and monocytes of venous blood in patients with moderate COVID-19 with systemic use of GCS. Also we aimed to determine the differences in these indicators between the group of patients with indirect signs of bacterial infection and the group of patients receiving GCS. We analyzed the indicators of the complete blood count of 154 patients in the temporary infectious diseases hospital in the “PATRIOT” Park of the Moscow region with confirmed moderate form of COVID-19. The comparison group (1) consisted of 128 patients without clinical signs of bacterial infection and leukocytosis on admission, who were prescribed GCS therapy. The control group (2) consisted of 26 people who, upon admission, showed signs of a bacterial infection - a cough with purulent sputum in combination with neutrophilic leukocytosis. The dynamics of cells in venous blood was assessed in patients of group (1) before the start, 3 and 6 days after the start of GCS therapy. We also compared the number of leukocytes, neutrophils and monocytes between patients with developed leukocytosis from group (1) in response to GCS therapy and group (2). As a result of the study, an increase in the number of leukocytes, neutrophils and monocytes was revealed according to the data of the complete blood count test in patients of the group (1) on days 3 and 6 of GCS therapy. All patients with developed leukocytosis (103 people) had no clinical signs of bacterial infection. In patients with developed leukocytosis from group (1), an increase in the number of monocytes was revealed (0.90 (0.84; 1.02) on day 3 of GCS and 0.94 (0.87; 1.26) on day 6 of GCS) compared with group (2) (0.61 (0.50; 0.71)), p <0.001. The number of leukocytes and neutrophils did not differ between the groups. The appearance of monocytosis when taking GCS may be due to the presence of macrophage activation syndrome in the pathogenesis of COVID-19 and, therefore, increased activation of monocytes. The use of GCS in this case leads to inhibition of the migration of monocytes to the inflammation area and to the stimulation of the production of their anti-inflammatory pool (M2 cells) by the bone marrow. This fact causes an increase in the number of monocytes in the peripheral blood. Monocytosis in response to GCS therapy can be a differential diagnostic criterion between glucocorticoid-induced leukocytosis and the addition of a bacterial infection. This may be one of the factors influencing the decision to prescribe antibiotic therapy, and may also be a criterion for the effectiveness of GCS immunosuppressive therapy in COVID-19, which requires further study.
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