Coronavirus infectious disease 2019 (COVID-19) confirmed cases are characterized by T lymphopenia. Total apoptotic and cytotoxic T-lymphocyte antigen-4 (CTLA-4) expressing cells among CD4 + /CD8 + cells were analyzed in 24 COVID-19 patients (16 out-patients and 8 in-patients) and 18 healthy volunteers using flow cytometry to detect their possible role in T lymphopenia. Hospitalized patients did not show significant difference compared to non-hospitalized patients. While the percentage and absolute count of CD4 + /CD8 + cells were significantly reduced in COVID-19 cases compared to healthy control (P < .05), the proportion of apoptotic and CTLA-4 expressing CD4 + /CD8 + cells were significantly up-regulated in COVID-19 patients (P < .05). In addition, apoptotic and CTLA-4 + /CD4 + cells were directly related to dyspnea duration, chest CT score, ferritin, and C-reactive protein and inversely correlated with platelet count in COVID-19 patients. While apoptotic and CTLA-4 + /CD8 + cells were directly related to lymphocyte count in COVID-19 patients. The apoptotic and CTLA-4 + cells were directly related to each other in CD4 + / CD8 + cells (P < .05). White blood cells (WBCs) (×10 3 /L), eosinophils (ratio and count), lymphocyte ratio, neutrophil ratio, neutrophil/ lymphocyte ratio, neutrophil/CD4 ratio, neutrophil/CD8 ratio, CD4 + cells ratio, and CTLA-4 + cells percentage), and CD8 + cells (ratio, count, total apoptotic cell, and CD152 + cells) were all found to be significantly altered in association with COVID-19. Total lymphopenia and depletion of CD4 + /CD8 + cells are characterizing COVID-19 patients. Increased apoptosis and CTLA-4 expression in CD4 + /CD8 + cells in COVID-19 and their correlations with reduced cell count and severity indicators as CRP and ferritin can be used for diagnosis and follow up of the clinical severity. Our current study proposes promising future diagnostic and therapeutic targets. Abbreviation: CD4 + = cluster of differentiation 4 + , CD8 + = cluster of differentiation 8 + , COVID-19 = coronavirus infectious disease 2019 novel coronavirus, CRP = C reactive protein, CTLA-4 = cytotoxic T-lymphocyte antigen-4, FITC = fluoroisothiocyanate, PI = propidium iodide, RT-PCR = reverse transcriptase-polymerase chain reaction, SARS-CoV-2 = severe acute respiratory syndrome coronavirus-2.

Background: Patients with cirrhosis are at high risk for the development of infections, acute pharyngitis is probably the most common infection presented to the everyday clinic. Objectives: To evaluate the role of CRP and ESR, in differentiation between bacterial and viral pharyngitis in patients with liver cirrhosis. Patients and methods: This study conducted on 80 participants. Group A: (cirrhotic patients) involve forty patients, twenty of them presented to the clinic with acute pharyngitis and the other twenty have no signs or symptoms suggestive acute pharyngitis. Group B: (immune-competent [non cirrhotic] patients) includes forty patients. Half of them have acute pharyngitis and the other half is clinically free. Acute viral and bacterial pharyngitis was differentiated clinically. ESR, CRP and throat culture were done for all participants Results: The mean ESR value in viral and bacterial pharyngitis-infected hepatic patients was 50. 55 ± 36.89 and 38.35 ± 28.69 respectively (p=0.242). The mean CRP value in viral and bacterial pharyngitis-infected hepatic patients was 47. 38 ± 9.58, and 53.91 ± 36.37 respectively (p=0.684). The mean ESR level in the bacterial and viral non-hepatic infected patients were 32.35 ± 2.16 and 19.25 ± 10.72 respectively with significant p-value (P=0.0001). The mean CRP value in viral and bacterial non-hepatic infected patients were 3.53 ± 3.01 and 20.35 ± 18.81 respectively with significant p-value (P=0.0001). Conclusion:In immunocompromised patient complaining of sore throat must undergo throat culture to identify the organism and apply the most suitable treatment to avoid antibiotic abuse, misuse and bacterial resistance.