In parallel with the increase in CD4+ TCM observed in the LC cohort (Fig. 3g) we observed a substantial expansion in the population of the CD4+CXCR5+ circulating follicular helper cells (cTFH) in LC participants in contrast to CONV (p=0.0352; Fig. 3i) possibly indicative of an ongoing germinal center (GC) reaction and B cell activation, even though the total numbers of circulating B cells or B cell subsets were not different between LC and CONV (Fig. 3j). Here, CD4 is linked to laryngotracheoesophageal cleft.