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Kaya G, Issi F, Guven B, Ozkaya E, Buruk CK, Cakir M. SARS-CoV-2 Antibodies in Children with Chronic Disease from a Pediatric Gastroenterology Outpatient Clinic. Pediatr Gastroenterol Hepatol Nutr 2022; 25:422-431. [PMID: 36148294 PMCID: PMC9482828 DOI: 10.5223/pghn.2022.25.5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE At the beginning of the Coronavirus disease (COVID-19) epidemic, physicians paid close attention to children with chronic diseases to prevent transmission or a severe course of infection. We aimed to measure the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels in children with chronic gastrointestinal and liver diseases to analyze the risk factors for infection and its interaction with their primary disease. METHODS This cross-sectional study analyzed SARS-CoV-2 antibody levels in patients with gastrointestinal and liver diseases (n=141) and in healthy children (n=48) between January and February 2021. RESULTS During the pandemic, 10 patients (7%) and 1 child (2%) had confirmed COVID-19 infection (p=0.2). The SARS-CoV-2 antibody test was positive in 36 patients (25.5%) and 11 children (22.9%) (p=0.7). SARS-CoV-2 antibody positivity was found in 20.4%, 26.6%, 33.3%, and 33.3% of patients with chronic liver diseases, chronic gastrointestinal tract diseases, cystic fibrosis, and liver transplantation recipients, respectively (p>0.05, patients vs. healthy children). Risk factors for SARS-CoV-2 antibody positivity were COVID-19-related symptoms (47.2% vs. 14.2%, p=0.00004) and close contact with SARS-CoV-2 polymerase chain reaction-positive patients (69.4% vs. 9%, p<0.00001). The use, number, and type of immunosuppressants and primary diagnosis were not associated with SARS-CoV-2 antibody positivity. The frequency of disease activation/flare was not significant in patients with (8.3%) or without (14.2%) antibody positivity (p=0.35). CONCLUSION SARS-CoV-2 antibodies in children with chronic gastrointestinal and liver diseases are similar to that in healthy children. Close follow-up is important to understand the long-term effects of past COVID-19 infection in these children.
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Affiliation(s)
- Gulay Kaya
- Department of Pediatrics, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Fatma Issi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Burcu Guven
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Esra Ozkaya
- Department of Microbiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Celal Kurtulus Buruk
- Department of Microbiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Murat Cakir
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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3
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Wald ER, Schmit KM, Gusland DY. A Pediatric Infectious Disease Perspective on COVID-19. Clin Infect Dis 2021; 72:1660-1666. [PMID: 32766824 PMCID: PMC7454399 DOI: 10.1093/cid/ciaa1095] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
This review highlights the clinical and epidemiologic characteristics of coronavirus disease 2019 (COVID-19) in children and neonates and contrasts these features with other common respiratory viruses. Although the majority of infections in children are mild, there are many important, as yet, unanswered questions (specifically, the attack rate in children and the role of children as vectors of infection) that will have a major impact on disease in adults. There are no distinctive clinical characteristics that will allow the infectious disease consultant to make the diagnosis without laboratory testing. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to be less common, with lower morbidity and mortality than respiratory syncytial virus or influenza, and causes less-severe disease in children with cancer than these more common viruses. The range of severity of infection during pregnancy is comparable to infection in nonpregnant cohorts. Intrauterine infection has been documented but is uncommon. A theme of less-severe disease in individuals with modulated immune systems is emerging.
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Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kathryn M Schmit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Daniele Y Gusland
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Marques HHDS, Pereira MFB, dos Santos AC, Fink TT, de Paula CSY, Litvinov N, Schvartsman C, Delgado AF, Gibelli MABC, de Carvalho WB, Odone V, Tannuri U, Carneiro-Sampaio M, Grisi S, Duarte AJDS, Antonangelo L, Francisco RPV, Okay TS, Batisttella LR, de Carvalho CRR, Brentani AVM, Silva CA. Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital. Clinics (Sao Paulo) 2021; 76:e3488. [PMID: 34852143 PMCID: PMC8595603 DOI: 10.6061/clinics/2021/e3488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
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Affiliation(s)
| | | | | | - Thais Toledo Fink
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Nadia Litvinov
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudio Schvartsman
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Artur Figueiredo Delgado
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Vicente Odone
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Uenis Tannuri
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Magda Carneiro-Sampaio
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sandra Grisi
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Leila Antonangelo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Thelma Suely Okay
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | | | - Clovis Artur Silva
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Shadmanfar S, Jonaidi-Jafari N, Jafari R, Rastgar-Moqaddam Z, Saburi A. COVID-19 in rheumatoid arthritis cases: an Iranian referral center experience. Clin Rheumatol 2020; 40:2979-2984. [PMID: 33219453 PMCID: PMC7679060 DOI: 10.1007/s10067-020-05464-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
Coronavirus infections, known as COVID-19, can induce a fatal respiratory system infection and also affect other organs, such as the kidney and heart. The mortality rate has been estimated between 1 and 5% in previous reports; however, the mortality and morbidity can be higher in patients with the immune-deficiency condition. Rheumatoid arthritis (RA) is one of the most rheumatoid disorders, and it is important to report their clinical and paraclinical data when affected with COVID-19. Evidence about their laboratory and radiologic findings is limited. In this case series, 10 cases of chronic and approved rheumatoid arthritis (RA) affected by COVID-19 are presented. Only 40% had dry cough, but myalgia and weakness as the general first presentation of infections was reported in most cases (80%). Gastrointestinal symptoms, including nausea/vomiting, diarrhea, anorexia, and abdominal pain, were reported in 50% of individuals. In blood cell count, 30% of cases had thrombocytopenia, and ESR in all cases was positive. Abnormal CRP and elevated LDH were seen in 90% of cases. In HRCT assessment, all cases had an abnormal parenchymal pattern, and 90% of cases presented the usual pattern of COVID-19 (bilateral multifocal GGO/consolidation). Although it is a limited report, these findings are helpful for comparison of clinical and paraclinical cases in RA cases with normal cases.
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Affiliation(s)
- Soraya Shadmanfar
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Rheumatology Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nematollah Jonaidi-Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramezan Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Radiology Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Amin Saburi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. .,Dr Saburi Radiology & Ultrasound Clinic, Mashhad, Iran.
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Niknam R, Malek-Hosseini SA, Hashemieh SS, Dehghani M. COVID-19 in Liver Transplant Patients: Report of 2 Cases and Review of the Literature. Int Med Case Rep J 2020; 13:317-321. [PMID: 32801943 PMCID: PMC7410393 DOI: 10.2147/imcrj.s265910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus 2019 (COVID-19) is caused by a novel coronavirus. Although liver injury is common in patients with COVID-19, little is known about its clinical presentation and management in liver transplantation. This is the first report from Iran that presented two cases of liver transplantation with COVID-19, neither of which had pulmonary signs and symptoms, but after diagnostic imaging, both had lung involvement. We also reviewed some literature on the management of COVID-19 in liver transplant patients. In conclusion, our patients improved after starting hydroxychloroquine and continuing to take all immunosuppressive agents except mycophenolate based on the multidisciplinary team’s decision.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Malek-Hosseini
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Saeid Hashemieh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Dehghani
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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