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Shhada E, Hamdar H, Nahle AA, Mourad D, Khalil B, Ali S. Clinical presentation and management of multisystem inflammatory syndrome in children associated with covid-19: a retrospective observational descriptive study in a pediatric hospital in Syria. BMC Infect Dis 2024; 24:322. [PMID: 38491367 PMCID: PMC10943909 DOI: 10.1186/s12879-024-09197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is a rare and serious medical condition. This study aims to review the clinical presentation, laboratory parameters, outcomes, and management of MIS-C cases in a pediatric hospital in Syria. METHODS This retrospective observational study aimed to investigate MIS-C between May 2020 and October 2021. Data collection involved extracting information from medical records, and patients were identified based on the case definition established by the World Health Organization (WHO). Various laboratory investigations, diagnostic evaluations, clinical presentations, and treatments were performed to assess patients. Descriptive statistical analysis was conducted using Microsoft Excel. RESULTS A total of 232 COVID-19 cases were reported with COVID-19 Infection. Among these cases, 25 (10.77%) were identified as MIS-C. The median age of the patients was 5.5 years, with the majority being male patients (72%). Patients experienced fever (100%), bilateral conjunctivitis (88%), rash (84%), gastrointestinal symptoms (76%), and cardiac dysfunction (72%). Other notable findings included oral cavity changes (64%), edema (36%), cervical lymphadenopathy (36%), and neurological manifestations (28%). Respiratory symptoms were uncommon (16%). All patients recovered, with no recorded deaths. CONCLUSION The predominant presence of positive SARS-CoV-2 IgG in the majority of patients in this study supports the post-infectious nature of MIS-C. Respiratory symptoms were less prevalent in both pediatric COVID-19 and MIS-C patients. Early supportive care is crucial in management, although additional research is needed to establish definitive guidelines. Larger studies are necessary to overcome the limitations of this study and to enhance our understanding of MIS-C in pediatric COVID-19 patients.
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Affiliation(s)
- Eman Shhada
- Pediatric Intensive Care Department, Faculty of Medicine, Children's Hospital, Damascus University, Damascus, Syria
| | - Hussein Hamdar
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | | | - Diana Mourad
- Pediatric Department, Children's Damascus University Hospital, Damascus University, Damascus, Syria
| | - Basheer Khalil
- Rheumatology Pediatric Department, Children's Damascus University Hospital, Damascus University, Damascus, Syria
| | - Sawssan Ali
- Pulmonary Pediatrics Department, Children's Damascus University Hospital, Damascus University, Damascus, Syria
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Cai Y, Huang Z, Wu B, Wu P, Zhang Y, Lin Y, Wang Q, Liang S, Chen S. Increased nutrition risk is associated with a prolonged negative conversion of viral RNA in children and adolescents with COVID-19. Nutr Clin Pract 2023; 38:1073-1081. [PMID: 37039702 DOI: 10.1002/ncp.10994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 03/19/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to determine the factors affecting the time to negative conversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents, with particular reference to nutrition risk assessment on admission. METHODS This retrospective observational study was conducted in a sentinel hospital for novel coronavirus in Quanzhou, China. The study population comprised children and adolescents with COVID-19 admitted to the isolation wards between March 25 and April 12, 2022. Based on the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), nutrition risk screening was performed within 24 h of admission. Univariate and multivariate analyses were used to identify independent factors for the time to negative viral RNA conversion. RESULTS A total of 185 patients with confirmed COVID-19 were included in this study. The median time to viral RNA conversion (from the first day of a positive nucleic acid test to the first day of consecutive negative results) was 15 days (IQR 12-18 days), ranging from 4 to 25 days. High nutrition risk (hazard ratio [HR]: 0.543, 95% CI: 0.334-0.881) and fever (HR: 0.663; 95% CI: 0.483-0.910) were independent factors influencing the negative conversion of SARS-CoV-2 RNA. CONCLUSION High nutrition risk and fever were independently associated with delayed viral clearance in children and adolescents with SARS-CoV-2 infection, so these factors should be considered during the treatment plans for infected children and adolescents.
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Affiliation(s)
- Yanliang Cai
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhifeng Huang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Bin Wu
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peilin Wu
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yifei Zhang
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yueli Lin
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingwen Wang
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shishan Liang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Suqing Chen
- Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Hantoosh S. COVID-19 infections among Iraqi school students: Severity, types, and symptoms. J Med Life 2023; 16:1552-1560. [PMID: 38313185 PMCID: PMC10835548 DOI: 10.25122/jml-2023-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 02/06/2024] Open
Abstract
The prevalence of COVID-19 infections among school students has become a significant and ongoing concern. This study aimed to assess the severity and types of COVID-19 cases and associated symptoms among school students in Iraq. A comprehensive study was conducted by the Public Health Directorate of AL-Muthanna Governorate from November 29, 2020, to February 12, 2021, utilizing RT-PCR-based COVID-19 surveys. The survey included 9,357 students (4,261 male and 5,096 female) and 83 schools. The retrospective analysis of the survey records indicated that male and female students had a mean age of 9.2±1.16 years with notably higher rates of asymptomatic infections than older students. Male students showed lower odds of asymptomatic infection but higher odds of symptomatic and pre-symptomatic infections compared to their female peers, particularly among elementary students. Fever, abdominal pain, diarrhea, loss of taste and smell, shortness of breath, and muscle pain were significantly associated with COVID-19 infection. Sneezing was significantly associated with a lack of infection. Home nursing by parents and self-care practices have proven to be highly effective in controlling COVID-19 infection among children. These findings highlight the need for age- and gender-specific considerations in COVID-19 prevention and management strategies in schools.
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Affiliation(s)
- Saad Hantoosh
- Department of Science, Open Educational College, Ministry of Education, Samawa, Iraq
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Chen YC, Wang X, Teng YS, Jia DS, Li L, Pan HG. Otolaryngology-related symptoms of COVID-19 in children in the post-epidemic era: a cross-sectional web-based survey study. Front Pediatr 2023; 11:1190734. [PMID: 37601127 PMCID: PMC10436526 DOI: 10.3389/fped.2023.1190734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose China adjusted and optimized its prevention and control strategies in December 2022, and it entered a new era of the coronavirus epidemic. Here, we describe the general and otolaryngology-related symptoms of coronavirus disease 2019 (COVID-19) in children during the first pandemic in the post-epidemic era, focusing on the frequency and severity of smell and taste loss, as well as the recovery process and its influencing factors. Patients and methods From 2 January to 7 January 2023, we conducted a cross-sectional online questionnaire survey through Questionnaire Stars in order to collect relevant information about COVID-19 in children in Shenzhen. Results A total of 1,247 valid questionnaires were received, with an effective response rate of 78.72%. All of the diagnoses were confirmed by nucleic acid or antigen test for COVID-19. Among the subjects, the sex ratio of male to female was more inclined to male (1.35:1), and the age was 3-16 years, with an average of 10.13 ± 2.82 years old. The most common symptoms were cough (58.24%), stuffy nose (56.18%), headache (42.09%), fatigue (40.44%), and sore throat (31.63%). Approximately 6.43% of the children reported dysosmia, the mean time of the duration of dysosmia was 5.38 ± 2.92 days, and the mean score of the severity of the dysosmia as assessed by visual analogue scale (VAS) was 4.63 ± 2.29. Approximately 13.34% reported dysgeusia, the mean time of the duration of dysgeusia was 4.77 ± 3.98 days, and the mean score of the severity of the dysgeusia as assessed by VAS was 5.12 ± 2.29. Univariate and multivariate logistic regression analysis showed that the prevalence of taste and olfactory disorders increased with age, mainly in children with severe symptoms and older children. Conclusion In the post-epidemic era, due to weakening of the pathogenicity of the subvariant of Omicron, overall condition of children with COVID-19 was mild, incidence of olfactory and taste disorders was low, recovery was faster, and prognosis was better. In our study, cough, runny nose, and sore throat were the most common symptoms, and the prevalence of taste and olfactory disorders increased with age, mainly in older children with severe symptoms.
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Affiliation(s)
- Yong-chao Chen
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Yi-shu Teng
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
| | - De-sheng Jia
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Lan Li
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Hong-guang Pan
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, China
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Thiriard A, Meyer B, Eberhardt CS, Loevy N, Grazioli S, Adouan W, Fontannaz P, Marechal F, L’Huillier AG, Siegrist CA, Georges D, Putignano A, Marchant A, Didierlaurent AM, Blanchard-Rohner G. Antibody response in children with multisystem inflammatory syndrome related to COVID-19 (MIS-C) compared to children with uncomplicated COVID-19. Front Immunol 2023; 14:1107156. [PMID: 37006315 PMCID: PMC10050384 DOI: 10.3389/fimmu.2023.1107156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesTo comprehensively analyze the quality of the antibody response between children with Multisystem inflammatory syndrome (MIS-C) and age-matched controls at one month after SARS-CoV-2 exposure, and infected in the same time-period.MethodsSerum from 20 MIS-C children at admission, and 14 control children were analyzed. Antigen specific antibody isotypes and subclasses directed against various antigens of SARS-CoV-2 as well as against human common coronavirus (HCoVs) and commensal or pathogenic microorganisms were assessed by a bead-based multiplexed serological assay and by ELISA. The functionality of these antibodies was also assessed using a plaque reduction neutralization test, a RBD-specific avidity assay, a complement deposition assay and an antibody-dependent neutrophil phagocytosis (ADNP) assay.ResultsChildren with MIS-C developed a stronger IgA antibody response in comparison to children with uncomplicated COVID-19, while IgG and IgM responses are largely similar in both groups. We found a typical class-switched antibody profile with high level of IgG and IgA titers and a measurable low IgM due to relatively recent SARS-CoV-2 infection (one month). SARS-CoV-2-specific IgG antibodies of MIS-C children had higher functional properties (higher neutralization activity, avidity and complement binding) as compared to children with uncomplicated COVID-19. There was no difference in the response to common endemic coronaviruses between both groups. However, MIS-C children had a moderate increase against mucosal commensal and pathogenic strains, reflecting a potential association between a disruption of the mucosal barrier with the disease.ConclusionEven if it is still unclear why some children develop a MIS-C, we show here that MIS-C children produce higher titers of IgA antibodies, and IgG antibodies with higher functionality, which could reflect the local gastro-intestinal mucosal inflammation potentially induced by a sustained SARS-CoV-2 gut infection leading to continuous release of SARS-CoV-2 antigens.
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Affiliation(s)
- Anaïs Thiriard
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Christiane S. Eberhardt
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Natasha Loevy
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Wafae Adouan
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Paola Fontannaz
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Fabienne Marechal
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Daphnée Georges
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Enzymology and Protein Folding, Centre for Protein Engineering, InBioS, University of Liège, Liège, Belgium
| | - Antonella Putignano
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud M. Didierlaurent
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Pediatric Immunology and Vaccinology Unit, Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- *Correspondence: Geraldine Blanchard-Rohner,
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Marhaeni W, Felicia FV, Sumadi Jap AL, Hartoyo E, Andayani P. Comparing serum ferritin levels during COVID-19 infection and recovery period in pediatric patients with transfusion-dependent thalassemia, a single-center study. Front Med (Lausanne) 2023; 10:1056599. [PMID: 36844235 PMCID: PMC9947356 DOI: 10.3389/fmed.2023.1056599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Background Ferritin has been recognized as a predictor of severity among Coronavirus-19 disease (COVID-19) patients. Studies have shown higher levels of ferritin in patients with COVID-19 than in healthy children. Patients with transfusion-dependent thalassemia (TDT) basically have high ferritin level due to iron overload. It is uncertain whether serum ferritin level in these patients is associated with COVID-19 infection. Objective To evaluate ferritin levels in TDT with COVID-19 before, during, and after the course of infection. Methods This retrospective study enrolled all TDT children with COVID-19 infection that were hospitalized in Ulin General Hospital Banjarmasin during the COVID-19 pandemic (March 2020 to June 2022). Data were collected from medical records. Results There were 14 patients included in this study, 5 patients had mild symptoms and 9 patients were asymptomatic. The mean of hemoglobin level upon admission was 8.1 ± 3 g/dL and serum ferritin level were 5148.5 ± 2651.8 ng/mL. The average serum ferritin level during COVID-19 infection was 2373.2 ng/mL higher than before infection and then decreased by 952.4 ng/mL after infection. We found no association of increasing serum ferritin with patients' symptoms (p = 0.27). The severity of anemia also was not correlated with the presentation of COVID-19 infection (p = 0.902). Conclusion Serum ferritin levels in TDT children may not reflect disease severity or predict poor outcomes during COVID-19 infection. However, the presence of other co-morbid conditions/confounders warrants cautious interpretation.
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Affiliation(s)
- Wulandewi Marhaeni
- Division of Hematology and Oncology, Department of Pediatrics of Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia,*Correspondence: Wulandewi Marhaeni,
| | - Fabiola Vania Felicia
- Department of Pediatrics of Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Arvin Leonard Sumadi Jap
- Department of Pediatrics of Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Edi Hartoyo
- Division of Tropic Infection, Department of Pediatrics of Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Pudji Andayani
- Department of Pediatrics of Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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Di Pietro GM, Ronzoni L, Meschia LM, Tagliabue C, Lombardi A, Pinzani R, Bosis S, Marchisio PG, Valenti L. SARS-CoV-2 infection in children: A 24 months experience with focus on risk factors in a pediatric tertiary care hospital in Milan, Italy. Front Pediatr 2023; 11:1082083. [PMID: 36873632 PMCID: PMC9981971 DOI: 10.3389/fped.2023.1082083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is characterized by a wide variety of expressions ranging from asymptomatic to, rarely, critical illness. The basis of this variability is not yet fully understood. The aim of this study was to identify clinical and genetic risk factors predisposing to disease susceptibility and progression in children. METHODS We enrolled 181 consecutive children aged less than 18 years hospitalized with or for SARS-CoV-2 infection during a period of 24 months. Demographic, clinical, laboratory, and microbiological data were collected. The development of coronavirus disease 2019 (COVID-19)-related complications and their specific therapies were assessed. In a subset of 79 children, a genetic analysis was carried out to evaluate the role of common COVID-19 genetic risk factors (chromosome 3 cluster; ABO-blood group system; FUT2, IFNAR2, OAS1/2/3, and DPP9 loci). RESULTS The mean age of hospitalized children was 5.7 years, 30.9% of them being under 1 year of age. The majority of children (63%) were hospitalized for reasons different than COVID-19 and incidentally tested positive for SARS-CoV-2, while 37% were admitted for SARS-CoV-2 infection. Chronic underlying diseases were reported in 29.8% of children. The majority of children were asymptomatic or mildly symptomatic; only 12.7% developed a moderate to critical disease. A concomitant pathogen, mainly respiratory viruses, was isolated in 53.3%. Complications were reported in 7% of children admitted for other reasons and in 28.3% of those hospitalized for COVID-19. The respiratory system was most frequently involved, and the C-reactive protein was the laboratory test most related to the development of critical clinical complications. The main risk factors for complication development were prematurity [relative risk (RR) 3.8, 95% confidence interval (CI) 2.4-6.1], comorbidities (RR 4.5, 95% CI 3.3-5.6), and the presence of coinfections (RR 2.5, 95% CI 1.1-5.75). The OAS1/2/3 risk variant was the main genetic risk factor for pneumonia development [Odds ratio (OR) 3.28, 95% CI 1-10.7; p value 0.049]. CONCLUSION Our study confirmed that COVID-19 is generally less severe in children, although complications can develop, especially in those with comorbidities (chronic diseases or prematurity) and coinfections. Variation at the OAS1/2/3 genes cluster is the main genetic risk factor predisposing to COVID-19 pneumonia in children.
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Affiliation(s)
- Giada Maria Di Pietro
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Ronzoni
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Maria Meschia
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Claudia Tagliabue
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Lombardi
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Marchisio
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Luca Valenti
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
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Karimi M, Sanaei Dashti A, Haghpanah S, Mansoori Y, Zarei T, Amanati A, Bordbar M. Thromboprophylaxis Outcome in Childhood SARS-CoV-2 Infection: A Single-Center Experience. J Pediatr Hematol Oncol 2023; 45:e97-e102. [PMID: 36162044 DOI: 10.1097/MPH.0000000000002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/22/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The SARS-CoV-2 infection has been associated with potentially endothelial damage and coagulation cascade activation that cause thrombosis. There is limited information on thrombosis and anticoagulant therapy in children with coronavirus disease 2019 (COVID-19). AIMS This study evaluates the outcome of thromboprophylaxis in children younger than 18-year old with COVID-19 infection. METHODS A retrospective study was conducted on 184 hospitalized pediatric patients with confirmed COVID-19 infection. A designed questionnaire was made to collect all demographic, clinical, and laboratory data. According to World Health Organization, the patients were classified as asymptomatic/mild, moderate, severe, and critically ill. RESULTS The mean age of the patients was 7.04±5.9 (1 wk to younger than 18 y). Overall, 33 patients received anticoagulant therapy. All patients who passed away (n=19) belonged to the critical group. One patient (1.28%) was complicated with deep vein thrombosis despite taking thromboprophylaxis, and 1 (1.28%) with pulmonary thromboembolism while the patient did not take an anticoagulant. CONCLUSIONS Our data showed a lower rate of thrombosis (1.4%) than adult patients with COVID-19. It may underline the role of anticoagulants in moderate to severe/critically ill children with COVID-19 infection. Expert opinion and personal experience are necessary, while we have a significant knowledge gap in understanding COVID-19-associated coagulopathy and thrombotic risk in children.
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Tiryaki Demir S, Dalgic N, Keles Yesiltas S, Akbas Ozyurek EB, Karapapak M, Uke Uzun S, Guven D. OCT and OCTA evaluation of vascular and morphological structures in the retina in recovered pediatric patients with COVID-19. Photodiagnosis Photodyn Ther 2022; 40:103157. [PMID: 36244680 DOI: 10.1016/j.pdpdt.2022.103157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Using OCT and OCTA imaging, we aimed to determine whether COVID-19 induces pathological changes in vascular and morphological structures in the pediatric retina. METHODS The current prospective, cross-sectional, observational clinical study included recovered pediatric patients with COVID-19 evaluated between May 2020 and June 2020. Retinal vascular (radial peripapillary, superficial, and deep capillary plexus vessel densities) and morphological (peripapillary retinal nerve fiber, ganglion cell layer, retinal, and choroidal thickness) in the optic disk and macula regions were quantitively assessed using OCT and OCTA. Data were compared between COVID-19 patients and age-matched controls. RESULTS The COVID-19 group included 32 eyes of 16 patients and the control group included 32 eyes of 16 cases. Fundus and biomicroscopic examinations revealed no signs of pathology in the COVID-19 group. Mean peripapillary retinal nerve fiber, ganglion cell layer, and choroidal thickness values were significantly greater in the COVID-19 group than in the control group (p<0.05). OCTA indicated that mean superficial and deep capillary plexus vessel densities, and choriocapillaris flow area values were significantly lower in the COVID-19 group than in the control group, whereas mean radial peripapillary capillary plexus vessel density values were significantly higher (p<0.05). CONCLUSIONS Even if fundus examination results appear normal in pediatric patients with COVID-19, vascular and morphological changes may be observed in the retina. Further studies with larger numbers of patients are needed to elucidate the clinical significance of vascular and morphological changes in this population.
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Fadel FI, Sabry S, Mawla MAA, Galal REE, Salah DM, Helmy R, Ramadan Y, Elzayat W, Abdelfattah M, Abd Alazem EA. Covid-19 in Egyptian hemodialysis and kidney transplant children: retrospective analysis of single center experience. Ital J Pediatr 2022; 48:149. [PMID: 35986373 PMCID: PMC9389481 DOI: 10.1186/s13052-022-01345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. Methods Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. Results Conclusion Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.
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Shams S, Azari-Yam A, Safavi M, Zamani Z, Sotoudeh-Anvari M, Sharifzadeh Ekbatani M, Haghi-Ashtiani MT, Mozafari F, Yaghmaie B, Shafeghat L. Alteration of Plasma Amino Acid Concentrations in Iranian Children with COVID-19. Int J Pediatr 2022; 2022:9390327. [PMID: 35915604 DOI: 10.1155/2022/9390327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 is an acute viral disease that has so far infected more than 200 million and killed more than four million worldwide. It affects the immune system and other organs. Here, we investigated the level of free plasma amino acids in COVID-19 patients and compared them with non-COVID-19 subjects. We also compared amino acids levels in critically ill patients admitted to the intensive care unit (ICU) with non-ICU patients and expired and recovered patients. Twenty-six COVID-19 patients and 32 non-COVID-19 subjects were included in the study. The mean of glutamic acid, serine, glycine, threonine, phenylalanine, leucine, lysine, alanine, arginine, aspartic acid, and ornithine was significantly higher in cases than controls. In addition, the mean of glutamine was significantly lower in patients than controls (443.89 ± 254.31 vs. 651.73 ± 107.38, PV < 0.001). Low level of glutamine and isoleucine was seen in the majority of ICU and expired patients, respectively. Logistic regression analysis showed low level of isoleucine as a predictor variable in mortality (P = 0.02, EXP (B) = 16.5, and CI 95% = (1.48, -183.07)). There was a positive and significant relationship between some amino acids levels, serum liver enzymes, and sodium concentrations. There was also a significant but negative correlation between histidine levels, ESR, and ferritin. Phenylalanine had a highly positive relationship with serum procalcitonin in patients (R 2 = 0.534, PV = 0.015). Our studies have shown the alteration of plasma amino acids concentration in COVID-19 patients. These changes are more evident in critically ill and at-risk patients.
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12
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Ines M, Leila J, Rania G, Imen C, Leila A, Hajer A, Thouraya K. Guillain-Barré Syndrome in a Child With Multisystem Inflammatory Syndrome Related to COVID-19. Pediatr Infect Dis J 2022; 41:e324-e325. [PMID: 35544724 PMCID: PMC9281419 DOI: 10.1097/inf.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/25/2022]
Abstract
Guillain-Barré syndrome has been associated with acute severe acute respiratory syndrome coronavirus 2 infection in children. Here, we report a 4-year-old boy who developed Guillain-Barré syndrome in the course of multisystem inflammatory syndrome related to COVID-19.
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Affiliation(s)
| | | | - Gargouri Rania
- Department of Cardiology, Faculty of Medicine of Sfax, Tunisia
| | | | - Abid Leila
- Department of Cardiology, Faculty of Medicine of Sfax, Tunisia
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13
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Schonfeld D, Fernández H, Ramírez J, Acosta D, Becerra J, Wettstein M, Strella T, Vaccaro M, Arias S, Rodríguez Calvo V, Neme R, Pérez-chada D. SARS-CoV-2 seroprevalence in the city of Puerto Madryn: Underdiagnosis and relevance of children in the pandemic. PLoS One 2022; 17:e0263679. [PMID: 35286328 PMCID: PMC8920177 DOI: 10.1371/journal.pone.0263679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/25/2022] [Indexed: 12/18/2022] Open
Abstract
Background Reported cases of COVID-19 may be underestimated due to mild or asymptomatic cases and a low testing rate in the general population. Research question What is the seroprevalence of SARS-CoV-2 infection in the general population and how it compares with the data on SARS-CoV-2 cases reported by a national health surveillance system (SNVS 2.0). Study design and methods This was a population-based, seroepidemiological, cross-sectional study in the city of Puerto Madryn, a middle size city in the Province of Chubut, Argentina. The study period was between March 3 and April 17, 2021. The sample size was calculated using the technique of calculation of confidence intervals for a proportion. Participants were selected using stratified and cluster probability sampling. A total of 1405 subjects were invited to participate in the study. Participants were divided into the following four age groups: 1) 0 to 14, 2) 15 to 39, 3) 40 to 64, and 4) 65 or older. After informed consent was obtained, a blood sample was taken by puncture of the fingertip, and a structured questionnaire was administered to evaluate demographics, socioeconomic status, level of education, comorbidities and symptoms suggestive of COVID-19. COVID-19 seroprevalence was documented using an immunoenzymatic test for the in vitro detection of IgG antibodies specific to the spike protein of SARS-CoV-2. Results A total of 987 participants completed the survey. Seropositivity in the full study population was 39,2% and in those under 15 years of age, 47.1%. Cases reported by the SNSV 2.0 amounted to 9.35% of the total population and 1.4% of those under 15 years of age. Interpretation The prevalence of COVID-19 infection in the general population is four times higher than the number of cases reported by the SNVS 2.0 in the city of Puerto Madryn. For each child under the age of 15 identified by the SNVS 2.0 with COVID-19, there are more than 30 unrecognized infections. Seroepidemiological studies are important to define the real extent of SARS-CoV-2 infection in a particular community. Children may play a significant role in the progression of the current pandemic.
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14
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Helfgott D, Capozzoli G, Madray J, Baig A, Uppaluri L, Gaur S, Simon M, Amorosa J, Ramagopal M. E-cigarette or vaping product use associated lung injury (EVALI) in the time of COVID-19: A clinical dilemma. Pediatr Pulmonol 2022; 57:623-630. [PMID: 34964550 DOI: 10.1002/ppul.25804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022]
Abstract
AIM To report on the clinical, laboratory, and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of Coronavirus disease 2019 (COVID-19), did not test positive for the infection, and were diagnosed with E-cigarette and vaping product use associated lung injury (EVALI). METHODS A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children's Hospital between February 2020 and June 2020 was conducted. RESULTS The ages of the patients ranged from 14 to 19 years. There were six males and six females. Three patients had a past history of anxiety, depression, or other psychiatric/mental health disorder, 9 had prolonged coagulation profile (prothrombin time, partial thromboplastin time, and/or International Normalized Ratio), and 11 had elevated inflammatory markers. Eight needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine tetrahydrocannabinol was positive in all cases. Chest X-ray and computed tomography findings showed ground glass opacities. CONCLUSIONS Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with "typical" COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health-care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.
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Affiliation(s)
- Daniel Helfgott
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gabrielle Capozzoli
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jovanna Madray
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Aisha Baig
- Department of Pediatrics, Division of Pulmonology and Cystic Fibrosis Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lakshmi Uppaluri
- Department of Pediatrics, Division of Pulmonology and Cystic Fibrosis Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sunanda Gaur
- Department of Infectious Diseases, Allergy and Immunology, Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mitchell Simon
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Judith Amorosa
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Maya Ramagopal
- Department of Pediatrics, Division of Pulmonology and Cystic Fibrosis Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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15
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Clyne B, Jordan K, Ahern S, Walsh KA, Byrne P, Carty PG, Drummond L, O'Brien KK, Smith SM, Harrington P, Ryan M, O'Neill M. Transmission of SARS-CoV-2 by children: a rapid review, 30 December 2019 to 10 August 2020. Euro Surveill 2022; 27. [PMID: 35115076 PMCID: PMC8815097 DOI: 10.2807/1560-7917.es.2022.27.5.2001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BackgroundThe role of children in the transmission of SARS-CoV-2 during the early pandemic was unclear.AimWe aimed to review studies on the transmission of SARS-CoV-2 by children during the early pandemic.MethodsWe searched MEDLINE, Embase, the Cochrane Library, Europe PubMed Central and the preprint servers medRxiv and bioRxiv from 30 December 2019 to 10 August 2020. We assessed the quality of included studies using a series of questions adapted from related tools. We provide a narrative synthesis of the results.ResultsWe identified 28 studies from 17 countries. Ten of 19 studies on household and close contact transmission reported low rates of child-to-adult or child-to-child transmission. Six studies investigated transmission of SARS-CoV-2 in educational settings, with three studies reporting 183 cases from 14,003 close contacts who may have contracted COVID-19 from children index cases at their schools. Three mathematical modelling studies estimated that children were less likely to infect others than adults. All studies were of low to moderate quality.ConclusionsDuring the early pandemic, it appeared that children were not substantially contributing to household transmission of SARS-CoV-2. School-based studies indicated that transmission rates in this setting were low. Large-scale studies of transmission chains using data collected from contact tracing and serological studies detecting past evidence of infection would be needed to verify our findings.
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Affiliation(s)
- Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority, Dublin, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Dublin, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Dublin, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Dublin, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Máirín Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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16
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Öztürk GK, Beken B, Doğan S, Akar HH. Pulmonary function tests in the follow-up of children with COVID-19. Eur J Pediatr 2022; 181:2839-47. [PMID: 35522314 DOI: 10.1007/s00431-022-04493-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
The SARS-CoV-2 virus has infected more than 235 million people since it was accepted as a pandemic in March 2020. Although a milder disease is seen in the pediatric age group, the extent of lung damage and its long-term effects are still unknown. In this study, persistent respiratory symptoms and pulmonary function tests were investigated in children with COVID-19. Fifty children with a confirmed diagnosis of COVID-19 were included in the study. Patients were evaluated for ongoing respiratory symptoms and pulmonary function tests 3 months after infection. Patients with and without persistent symptoms were compared in terms of demographic, clinical, laboratory, and radiological characteristics and also disease severity. Three months after infection, persistent respiratory symptoms were found to be present in 28% of patients; cough, chest pain and tightness, dyspnea, and exertional dyspnea were the most common symptoms. Three patients had an obstructive deficit, and one had a restrictive deficit. Four patients had impaired diffusing capacity of the lungs for carbon monoxide (DLCO). A significant decrease in FEV1/FVC and an increase in lung clearance index were found in the patients with persistent respiratory symptoms. Persistent respiratory symptoms were present in 50% of patients who had severe disease and 12.5% with non-severe disease. DLCO was also significantly lower in the severe disease group. Conclusions: Our study suggests that the persistence of respiratory symptoms is not related to the severity of acute COVID-19 in children. The inflammatory process due to COVID-19 may continue regardless of its severity, and consequently, peripheral airways may be affected. What is Known: • As compared with adults, children with COVID-19 exhibit a milder disease course and lower mortality rates. However, due to the lack of follow-up studies on children, the long-term effects of their contracting the disease are unknown. What is New: • Although COVID-19 has been thought to have a milder course in children, respiratory system symptoms persist in approximately 30% of patients 3 months after infection. The persistent respiratory symptoms suggest that the inflammatory process due to COVID-19 may continue in some children, even if the clinical findings at admission are not severe, and that the peripheral airways may be affected accordingly.
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17
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Katsuta T, Shimizu N, Okada K, Tanaka-Taya K, Nakano T, Kamiya H, Amo K, Ishiwada N, Iwata S, Oshiro M, Okabe N, Kira R, Korematsu S, Suga S, Tsugawa T, Nishimura N, Hishiki H, Fujioka M, Hosoya M, Mizuno Y, Mine M, Miyairi I, Miyazaki C, Morioka I, Morishima T, Yoshikawa T, Wada T, Azuma H, Kusuhara K, Ouchi K, Saitoh A, Moriuchi H. The clinical characteristics of pediatric coronavirus disease 2019 in 2020 in Japan. Pediatr Int 2022; 64:e14912. [PMID: 34233075 PMCID: PMC8446955 DOI: 10.1111/ped.14912] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the lives of people of all ages. Most reports on pediatric cases suggest that children experience fewer and milder symptoms than do adults. This is the first nationwide study in Japan focusing on pediatric cases reported by pediatricians, including cases with no or mild symptoms. METHODS We analyzed the epidemiological and clinical characteristics and transmission patterns of 840 pediatric (<16 years old) COVID-19 cases reported between February and December 2020 in Japan, using a dedicated database which was maintained voluntarily by members of the Japan Pediatric Society. RESULTS Almost half of the patients (47.7%) were asymptomatic, while most of the others presented mild symptoms. At the time of admission or first outpatient clinic visit, 84.0% of the cases were afebrile (<37.5°C). In total, 609 cases (72.5%) were exposed to COVID-19-positive household members. We analyzed the influence of nationwide school closures that were introduced in March 2020 on COVID-19 transmission routes among children in Japan. Transmission within households occurred most frequently, with no significant difference between the periods before and after declaring nationwide school closures (70.9% and 74.5%, respectively). CONCLUSIONS COVID-19 symptoms in children are less severe than those in adults. School closure appeared to have a limited effect on transmission. Controlling household transmission from adult family members is the most important measure for prevention of COVID-19 among children.
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Affiliation(s)
- Tomohiro Katsuta
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Shimizu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenji Okada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Keiko Tanaka-Taya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takashi Nakano
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Hajime Kamiya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kiyoko Amo
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric emergency, Osaka City General Hospital, Osaka, Japan
| | - Naruhiko Ishiwada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Satoshi Iwata
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Oshiro
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Nobuhiko Okabe
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Kawasaki City Institute for Public Health, Kanagawa, Japan
| | - Ryutaro Kira
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Seigo Korematsu
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Nakatsu Municipal Hospital, Oita, Japan
| | - Shigeru Suga
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Clinical Research, Infectious Disease Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Takeshi Tsugawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Naoko Nishimura
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Konan Kosei Hospital, Aichi, Japan
| | - Haruka Hishiki
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| | - Masashi Fujioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Fujioka Pediatric Clinic, Osaka, Japan
| | - Mitsuaki Hosoya
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Yumi Mizuno
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatric infectious diseases and immunology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Mahito Mine
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Mine Pediatric Clinic, Saitama, Japan
| | - Isao Miyairi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Miyazaki
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Fukuoka-city Social Welfare Agency, Fukuoka, Japan
| | - Ichiro Morioka
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tsuneo Morishima
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Tetsushi Yoshikawa
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan
| | - Taizo Wada
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Azuma
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Koichi Kusuhara
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazunobu Ouchi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Akihiko Saitoh
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroyuki Moriuchi
- The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Tokyo, Japan.,Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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18
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Jones N, Cohen J, Chapman JI. Empowering High School Students to Address Racial Disparities During the COVID-19 Pandemic. Pediatrics 2022; 149:183820. [PMID: 34904155 DOI: 10.1542/peds.2021-050483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nathaniel Jones
- Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children's National Hospital
| | - Joanna Cohen
- Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children's National Hospital.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Jennifer I Chapman
- Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children's National Hospital.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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19
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Ramirez-Suarez KI, Miranda-Schaeubinger M, Rapp JB, Sodhi KS, Saul D, Andronikou S. Publication timeline of chest imaging reporting in children with coronavirus disease 2019 (COVID-19): a systematic review spanning 2020. Pediatr Radiol 2022; 52:1998-2008. [PMID: 35953542 PMCID: PMC9371962 DOI: 10.1007/s00247-022-05466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/14/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Amid the coronavirus disease 2019 (COVID-19) pandemic, numerous publications of imaging findings in children have surfaced in a very short time. Publications discuss populations of overlapping age groups and describe different imaging patterns. We aim to present an overview of the quantity and type of literature available regarding COVID-19 chest imaging findings in children according to a 2020 publication timeline. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched terminology related to COVID-19, chest, children and imaging modalities in PubMed and Embase. The included papers were published online in 2020 and described imaging findings specific to children and reported five or more cases. Two researchers reviewed each abstract to determine inclusion or exclusion, and a radiologist reconciled any disagreements. Then we reviewed full articles for the main analysis. Eligible study designs included original articles, case series (≥5 cases), systematic reviews and meta-analyses. We excluded non-English manuscripts, retracted articles, and those without available full text. The remaining articles were distributed to four pediatric radiologists (on the Society for Pediatric Radiology Thoracic Committee), who summarized chest imaging findings. Eighty-two articles were included in the final analysis - 28% in radiology journals and 71% in non-radiology journals; 71% contained original data and 29% were review-style papers. There was a disproportionate contribution of review-style papers in April (55%), considering the paucity of preceding publications with original data in March (5 papers). June had the highest number of publications (n=14), followed by April (n=11) and July (n=11). Most (52%) original papers were from China and most individual pediatric imaging descriptions were from China (57%), while the majority of review papers (83%) were international. Imaging descriptions were available for 2,199 children (1,678 CT descriptions and 780 chest radiography descriptions). Findings included a 25% normal CT scan reports vs. 40% normal chest radiography reports. Ground-glass opacification was the most common CT finding (33%) and was reported in only a minority of chest radiographs (9%). A significant amount of information on pediatric COVID-19 chest imaging has become rapidly available over a short period. Most publications in 2020 were original articles, but they were published more often in non-radiology journals. A disproportionate number of review articles were published early on and were based on little original pediatric imaging data. CT scan reports, which represent the standard, outnumbered radiographic reports and indicated that ground-glass opacification is the main imaging finding and that only a quarter of scans are normal in children with COVID-19.
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Affiliation(s)
- Karen I. Ramirez-Suarez
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Monica Miranda-Schaeubinger
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Jordan B. Rapp
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David Saul
- Department of Medical Imaging, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE USA
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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20
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Esposito S, Abate L, Laudisio SR, Ciuni A, Cella S, Sverzellati N, Principi N. COVID-19 in Children: Update on Diagnosis and Management. Semin Respir Crit Care Med 2021; 42:737-746. [PMID: 34918317 DOI: 10.1055/s-0041-1741371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In December 2019, a new infectious disease called coronavirus disease 2019 (COVID-19) attributed to the new virus named severe scute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected. The gold standard for the diagnosis of SARS-CoV-2 infection is the viral identification in nasopharyngeal swab by real-time polymerase chain reaction. Few data on the role of imaging are available in the pediatric population. Similarly, considering that symptomatic therapy is adequate in most of the pediatric patients with COVID-19, few pediatric pharmacological studies are available. The main aim of this review is to describe and discuss the scientific literature on various imaging approaches and therapeutic management in children and adolescents affected by COVID-19. Clinical manifestations of COVID-19 are less severe in children than in adults and as a consequence the radiologic findings are less marked. If imaging is needed, chest radiography is the first imaging modality of choice in the presence of moderate-to-severe symptoms. Regarding therapy, acetaminophen or ibuprofen are appropriate for the vast majority of pediatric patients. Other drugs should be prescribed following an appropriate individualized approach. Due to the characteristics of COVID-19 in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics for an appropriate diagnosis and therapeutic management represents a priority.
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Affiliation(s)
- Susanna Esposito
- Department of Medicine and Surgery, University of Parma, Paediatric Clinic, Pietro Barilla Children's Hospital, Parma, Italy
| | - Luciana Abate
- Department of Medicine and Surgery, University of Parma, Paediatric Clinic, Pietro Barilla Children's Hospital, Parma, Italy
| | - Serena Rosa Laudisio
- Department of Medicine and Surgery, University of Parma, Paediatric Clinic, Pietro Barilla Children's Hospital, Parma, Italy
| | - Andrea Ciuni
- Unit of Paediatric Radiology, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Simone Cella
- Unit of Paediatric Radiology, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Nicola Sverzellati
- Unit of Paediatric Radiology, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
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21
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Wang L, Li G, Yuan C, Yang Y, Ling G, Zheng J, Zhou Y, Zhang T, Lin W, Lin Z. Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review. Int J Gen Med 2021; 14:8097-8108. [PMID: 34795516 PMCID: PMC8594783 DOI: 10.2147/ijgm.s335888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been circulating in many countries around the world, characterized by long incubation period, strong infectivity, strong variability, high population susceptibility and diversified transmission methods. Its causative agent is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Compared with adult patients, the clinical manifestations of COVID-19 in children are often dominated by mild or asymptomatic infections, but children are also important virus carriers and play an important role in the transmission of the virus. In addition, some children will show excessive inflammatory response and experience serious complications such as multisystem inflammatory syndrome in children (MIS-C). At present, the research on COVID-19 in children is still imperfect. This article will review epidemiological characteristics, the mechanism of action, variant characteristics, clinical manifestations, auxiliary examinations and treatment of children with COVID-19, in order to provide help for the diagnosis, treatment and research of children with COVID-19.
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Affiliation(s)
- Libo Wang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gan Li
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Chang Yuan
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yuele Yang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gongxia Ling
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jinyu Zheng
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yiyang Zhou
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Tianlei Zhang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhenlang Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
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22
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Meyyazhagan A, Pushparaj K, Balasubramanian B, Kuchi Bhotla H, Pappusamy M, Arumugam VA, Easwaran M, Pottail L, Mani P, Tsibizova V, Di Renzo GC. COVID-19 in pregnant women and children: Insights on clinical manifestations, complexities, and pathogenesis. Int J Gynaecol Obstet 2021; 156:216-224. [PMID: 34735717 PMCID: PMC9087615 DOI: 10.1002/ijgo.14007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/16/2022]
Abstract
Pregnancy changes the body's immune system to counteract the spectrum of infections, including COVID-19, which can pose complications. Pregnant women are less likely to contract COVID-19 infections than the general public. However, pregnant women are at slightly increased risk of becoming severely unwell if they do catch COVID-19, and congenital conditions in pregnant women may worsen the state of infection and lead to critical stages and even mortality. The possibility of vertical transmission has been reported in only a few cases of COVID-19; however, it was not noted in cases of SARS and MERS. Vaccination coverage in pregnant women remains a challenge. Children are the next suspected and vulnerable population to acquire infection after the first and second waves. Children are disproportionately infected compared with older populations, but the severity of infection is less compared to adults. This review highlights the complexities of COVID-19 in pregnant women and the underlying reasons why children tend to be comparatively less severely affected. Ethnicity, nutrition, lifestyle, and therapeutics influence the severity of infection in children. Low expression of angiotensin-converting enzyme 2 receptors, indigenous virus competence, and maternal immunity is the first-line defense for children against COVID-19. Habituating herbal medicines from childhood may help support a robust and defensive immune system to counteract novel antigens and encourage healthy generations.
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Affiliation(s)
- Arun Meyyazhagan
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Karthika Pushparaj
- Department of Zoology, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | | | - Haripriya Kuchi Bhotla
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Manikantan Pappusamy
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Vijaya Anand Arumugam
- Medical Genetics and Epigenetics Laboratory, Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Murugesh Easwaran
- Nutritional Improvement of Crops, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Lalitha Pottail
- Department of Chemistry, School of Physical and Computational Sciences, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | - Poonkothai Mani
- Department of Zoology, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | - Valentina Tsibizova
- Institute of Perinatology and Pediatrics, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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23
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Tzoulis P. Prevalence, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19. Acta Biomed 2021; 92:e2021474. [PMID: 34738553 PMCID: PMC8689294 DOI: 10.23750/abm.v92i5.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
Hyponatraemia is frequently encountered in adults with coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. This review aims to describe for the first time the prevalence, aetiology, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19, taking into account all relevant studies published in PubMed and Cochrane Library studies until 26th September 2021. Literature search did not detect any studies evaluating the prevalence and prognostic value of sodium disorders in paediatric patients with COVID-19. A broader literature review showed a high prevalence of hyponatraemia in children with bacterial pneumonia, while some studies have reported that hyponatraemia is relatively common in Multisystem Inflammatory Syndrome in Children (MIS-C). In adults with COVID-19, an inverse association between sodium and interleukin-6 levels has been found, indicating that hyponatraemia could be used as a surrogate marker for the risk of cytokine storm and may facilitate the identification of patients who could benefit from immunomodulatory agents. Studies are urgently needed to evaluate the frequency and prognostic impact of electrolyte abnormalities in children with COVID-19. In the meantime, clinicians are urged to consider hyponatraemia in children with COVID-19 as a potential red flag, investigate the cause and administer fluids and other therapies accordingly.
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24
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Farzan S, Rai S, Cerise J, Bernstein S, Coscia G, Hirsch JS, Jeanty J, Makaryus M, McGeechan S, McInerney A, Quizon A, Santiago MT. Asthma and COVID-19: An early inpatient and outpatient experience at a US children's hospital. Pediatr Pulmonol 2021; 56:2522-2529. [PMID: 34062054 PMCID: PMC8242640 DOI: 10.1002/ppul.25514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Initially, persistent asthma was deemed a risk factor for severe COVID-19 disease. However, data suggests that asthmatics do not have an increased risk of COVID-19 infection or disease. There is a paucity of data describing pediatric asthmatics with COVID-19. OBJECTIVE The objectives of this study were to determine the prevalence of asthma among hospitalized children with acute symptomatic COVID-19, compare demographic and clinical outcomes between asthmatics and nonasthmatics, and characterize behaviors of our outpatient pediatric population. METHODS We conducted a single-center retrospective study of pediatric patients admitted to the Cohen Children's Medical Center at Northwell Health with symptomatic COVID-19 within 4 months of the surge beginning in March 2020 and a retrospective analysis of pediatric asthma outpatients seen in the previous 6 months. Baseline demographic variables and clinical outcomes for inpatients, and medication compliance, health behaviors, and asthma control for outpatients were collected. RESULTS Thirty-eight inpatients and 95 outpatients were included. The inpatient prevalence of asthma was 34.2%. Asthmatics were less likely to have abnormal chest x-rays (CXRs), require oxygen support, and be treated with remdesivir. Among outpatients, 41% reported improved asthma control and decreased rescue medication use, with no COVID-19 hospitalizations, despite six suspected infections. CONCLUSIONS Among children hospitalized for acute symptomatic COVID-19 at our institution, 34.2% had a diagnosis of asthma. Asthmatics did not have a more severe course and required a lower level of care. Outpatients had improved medication compliance and control and a low risk of hospitalization. Biological and behavioral factors may have mitigated against severe disease.
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Affiliation(s)
- Sherry Farzan
- Division of Allergy & Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA.,Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Northwell Health System, Manhasett, New York, USA.,Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Shipra Rai
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Jane Cerise
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Shari Bernstein
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Gina Coscia
- Division of Allergy & Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA.,Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Northwell Health System, Manhasett, New York, USA
| | - Jamie S Hirsch
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Northwell Health System, Manhasett, New York, USA.,Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Judith Jeanty
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Mary Makaryus
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Stacy McGeechan
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Alissa McInerney
- Division of Allergy & Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA.,Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Northwell Health System, Manhasett, New York, USA
| | - Annabelle Quizon
- Division of Pediatric Pulmonology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Maria Teresa Santiago
- Division of Pediatric Pulmonology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
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25
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Mosalli RM, Kobeisy SAN, Al-Dajani NM, Ateeg MA, Ahmed MA, Meer WM, Al-Saeedi HY, Al-Harbi SA. Coronavirus Disease in Children: A Single-Center Study from Western Saudi Arabia. Int J Pediatr 2021; 2021:9918056. [PMID: 34394360 DOI: 10.1155/2021/9918056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/14/2021] [Accepted: 07/18/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Local data in Saudi Arabia regarding pediatric SARS-CoV-2 infection is limited. This study is aimed at adding insight regarding the effect of the novel coronavirus on pediatric patients by studying the presentation, laboratory parameters, and disposition of SARS-CoV-2-infected pediatric patients in one center in Jeddah, Saudi Arabia. Methodology. A retrospective study was conducted at the International Medical Center (IMC) in Jeddah, Saudi Arabia, to assess features of pediatric patients admitted with COVID-19 from April 2020 to September 2020. Results A total of 43 patients were found to meet the study inclusion criteria. The most common presenting symptom was fever (53.5%) in study participants followed by complaints of cough, runny nose, and shortness of breath (37.2%). Lymphocytopenia was evident among 60% of those studied. Elevated C-Reactive Protein was remarkable in 24.9%. More than half of those (53.5%) studied required only supportive treatment. Conclusion COVID-19 disease for the most part is mild in children with a varying clinical picture and nonspecific laboratory parameters. Further, large-scale national-based studies are needed to help in the early identification of pediatric cases at risk of complication due to COVID-19 infection hence providing proper and timely management, identifying population-specific disease pattern and perhaps targeted immunization.
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26
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Abstract
Background The 2019 novel coronavirus disease (COVID-19) imaging data is dispersed in numerous publications. A cohesive literature review is to be assembled. Objective To summarize the existing literature on Covid-19 pneumonia imaging including precautionary measures for radiology departments, Chest CT's role in diagnosis and management, imaging findings of Covid-19 patients including children and pregnant women, artificial intelligence applications and practical recommendations. Methods A systematic literature search of PubMed/med line electronic databases. Results The radiology department's staff is on the front line of the novel coronavirus outbreak. Strict adherence to precautionary measures is the main defense against infection's spread. Although nucleic acid testing is Covid-19's pneumonia diagnosis gold standard; kits shortage and low sensitivity led to the implementation of the highly sensitive chest computed tomography amidst initial diagnostic tools. Initial Covid-19 CT features comprise bilateral, peripheral or posterior, multilobar ground-glass opacities, predominantly in the lower lobes. Consolidations superimposed on ground-glass opacifications are found in few cases, preponderantly in the elderly. In later disease stages, GGO transformation into multifocal consolidations, thickened interlobular and intralobular lines, crazy paving, traction bronchiectasis, pleural thickening, and subpleural bands are reported. Standardized CT reporting is recommended to guide radiologists. While lung ultrasound, pulmonary MRI, and PET CT are not Covid-19 pneumonia's first-line investigative diagnostic modalities, their characteristic findings and clinical value are outlined. Artificial intelligence's role in strengthening available imaging tools is discussed. Conclusion This review offers an exhaustive analysis of the current literature on imaging role and findings in COVID-19 pneumonia. Chest computed tomography is a highly sensitive Covid −19 pneumonia's diagnostic tool. Initial Covid-19 CT features are bilateral, multifocal, peripheral or posterior ground-glass opacities, mainly in the lower lobes. Multifocal consolidations, bronchiectasis, pleural thickening, and subpleural bands are late disease stages features. Standardized CT reporting is recommended to guide radiologists. Artificial intelligence could strengthen available imaging tools.
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Affiliation(s)
- Hanae Ramdani
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Nazik Allali
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Latifa Chat
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Siham El Haddad
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
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27
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Ozcan S, Emeksiz S, Perk O, Uyar E, Kanik Yüksek S. Severe Coronavirus Disease Pneumonia in Pediatric Patients in a Referral Hospital. J Trop Pediatr 2021; 67:6291667. [PMID: 34081145 PMCID: PMC8194880 DOI: 10.1093/tropej/fmab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the characteristics and outcomes of critically ill children managed in an intensive care unit because of coronavirus disease (COVID-19) pneumonia with respiratory support requirements. METHODS We performed a single-center retrospective observational study in a pediatric intensive care unit (PICU) with 32 beds in Ankara City Hospital, Ankara, Turkey, from 13 March 2020 to 31 December 2020. Patients who needed positive-pressure ventilation (PPV) therapy for COVID-19 pneumonia were included in the study. Demographic, clinical and laboratory data were extracted from the patients' electronic medical records. As outcomes, the hospitalization rate of all pediatric patients diagnosed as having with COVID-19 by Polymerase Chaın Reactıon(PCR), PICU admission rate for COVID-19 pneumonia among all hospitalized patients, PPV support rate, intensive care hospitalization duration (days), total hospitalization duration (days), survival rate and tracheotomy requirement were evaluated. RESULTS During the study period, 7033 children tested positive for COVID-19 in PCR tests. Of these patients, 1219 were hospitalized for COVID-19. Seventeen patients needed PPV support because of COVID-19 pneumonia. High proportion (65%) of patients admitted to the PICU had comorbid diseases. Noninvasive ventilation was applied in 15 patients (88%). The hospitalization rate among the children with COVID-19 was 17%, of whom 1.6% were admitted to the PICU. Mortality rates were 0.056% of all the cases and 0.32% of the hospitalized patients in our hospital. CONCLUSION The presence of a comorbid disease could be a sign of severe disease in children with higher lethality. Very few children required PPV support because of severe COVID-19 pneumonia.
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Affiliation(s)
- Serhan Ozcan
- Department of Pediatric Intensive Care, Ankara City Hospital Ankara, Turkey,Corresponding author: Serhan OZCAN, Department of Pediatric Intensive Care, Ankara City Hospital, Cankaya/Ankara, Turkey, E-mail: Tel: +0905327869253
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care, Ankara City Hospital Ankara, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care, Ankara City Hospital Ankara, Turkey
| | - Emel Uyar
- Department of Pediatric Intensive Care, Ankara City Hospital Ankara, Turkey
| | - Saliha Kanik Yüksek
- Department of Pediatric Infectious Disease, Ankara City Hospital Ankara, Turkey
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28
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Guerrón N, Figueroa LM. Intussusception and COVID19, Successful Mechanic Reduction, Case Report. Glob Pediatr Health 2021; 8:2333794X211019693. [PMID: 34104695 PMCID: PMC8165835 DOI: 10.1177/2333794x211019693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 04/30/2021] [Indexed: 01/06/2023] Open
Abstract
The COVID 19 pandemic has greatly affected the world population. SARS CoV2 infection in pediatric patients is related to the development of mild symptoms and in some cases gastrointestinal manifestations. We present the case of a patient with intussusception as a manifestation associated with SARS CoV2 infection, treated by ultrasound-guided hydrostatic reduction with successful results.
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Affiliation(s)
- Nicolás Guerrón
- Universidad del Valle-Hospital Universitario del Valle-Evaristo García, Valle del Cauca, Colombia
| | - Luis Mauricio Figueroa
- Universidad del Valle-Hospital Universitario del Valle-Evaristo García, Valle del Cauca, Colombia.,Pediatric Surgery Section, Department of Surgery, Hospital Universitario del Valle-Evaristo García, Valle del Cauca, Colombia
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29
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Ghazizadeh Esslami G, Mamishi S, Mahmoudi S, Navaeian A, Behfar M, Hamidieh AA, Alimadadi H, Mahmoudieh Y. COVID-19 in transplant recipient children: An Iranian referral hospital-based study. Acta Biomed 2021; 92:e2021095. [PMID: 33988141 PMCID: PMC8182621 DOI: 10.23750/abm.v92i2.11189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
To our knowledge, there is still very limited information on the severity, mortality, laboratory, and radiologic findings of COVID-19 infection in transplant patients, particularly children. In this study, we reported 7 transplant recipients with laboratory-confirmed COVID-19 infection. The median age was 7.5 years (IQR: 31month-10 years), and 71% of the patients were male. All cases presented with a fever. The median duration of fever before admission was 2 days (IQR:1-8 days). Five patients (71%) experienced cough and dyspnea. Lymphocytopenia (Median of 0.6 (IQR: 0.14-2.0 × 109 cells per L) and thrombocytopenia (Median of 65 (IQR: 49-201 × 109 cells per L) were the most common CBC findings (both seen in 5 out of the 7 patients. Among 4 of the patients who underwent CT scans, 2 had ground glass opacity and consolidations. The mean number of lobe involvement in our patients was 3 (0-5), and 75% of the cases showed bilateral lung involvement in the imaging. In 4 patients (51%) the disease course manifested severely, and 2 patients are now deceased (28.6%). In conclusion, immunocompromised pediatric subgroups may experience higher rates of disease severity and mortality in comparison with the immunocompetent pediatric population. (www.actabiomedica.it)
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Affiliation(s)
| | - Setareh Mamishi
- a:1:{s:5:"en_US";s:37:"Tehran University of Medical sciences";}.
| | | | | | | | | | | | - Yasmine Mahmoudieh
- 7- Department of Molecular and Cell Biology, University of California, Berkeley .
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30
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Lopes AGD, Celestino CSH, Barros TTA, Fevereiro AG, Gejer DH, Oliveira FMF, Brasil JM, Bossolan RM, Pinto GCC, Santos ACEZ, Divan LA, Alves IAB, Oliveira DBL, Machado RRG, Thomazelli LM, Hiyane MI, Brelaz-Abreu L, Bragança-Jardim E, Heinen LBS, Barrientos ACM, Mau LB, Camara NOS, Bueno DF, Amano MT. Case Report: A Severe SARS-CoV-2 Infection in a Teenager With Angelman Syndrome. Front Med (Lausanne) 2021; 8:629112. [PMID: 33777976 PMCID: PMC7994262 DOI: 10.3389/fmed.2021.629112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
Teenagers generally present mild to no symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the present report, we present the case of a 14-year-old boy with Angelman syndrome (AS) who presented with severe COVID-19 symptoms. He spent 20 days in the ICU with elevated inflammatory biomarkers (C-reactive protein and D-dimer) and increased peaks of neutrophil-to-lymphocyte ratio, which is uncommon for teenagers diagnosed with COVID-19. Although he showed physiological instability, he was able to produce neutralizing antibodies, suggesting a functional immune response. The literature concerning the immune response to infections in patients with AS is still poor, and to our knowledge, this was the first report of a patient with AS diagnosed with COVID-19. As such, the present study may alert other patients with AS or other rare diseases that they lack a competent immune response and could suffer severe consequences of SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Tiago T A Barros
- Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Debora H Gejer
- Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | | | | | | | | | - Luis A Divan
- Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | - Danielle B L Oliveira
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael R G Machado
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Luciano M Thomazelli
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Meire I Hiyane
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Luciana B Mau
- Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Niels O S Camara
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Daniela F Bueno
- Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
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31
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Athamnah MN, Masade S, Hamdallah H, Banikhaled N, Shatnawi W, Elmughrabi M, Al Azzam HSO. COVID-19 presenting as intussusception in infants: A case report with literature review. J Pediatr Surg Case Rep 2021; 66:101779. [PMID: 33520650 PMCID: PMC7834375 DOI: 10.1016/j.epsc.2021.101779] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
The novel Corona virus disease 2019 (COVID-19) first presented in Wuhan, China. The virus was able to spread throughout the world, causing a global health crisis. The virus spread widely in Jordan after a wedding party held in northern Jordan. In most cases of COVID-19 infection, respiratory symptoms are predominant. However, in rare cases the disease may present with non-respiratory symptoms. The presentation of COVID-19 as a case of intussusception in children is a strange and rare phenomenon. We present here a case of a two-and-a-half month old male baby who was brought to hospital due to fever, frequent vomiting, dehydration and blood in stool. He was diagnosed as intussusception. The child was tested for corona due to the large societal spread of the virus and because he was near his mother, who was suffering from symptoms similar to corona or seasonal flu (she did not conduct a corona test). Patient was treated without surgery and recovered quickly. The COVID-19 infection was without respiratory symptoms, and there was no need for the child to remain in hospital after treatment of intussusception. The relationship between viruses, mesenteric lymphoid hyperplasia, and intussusception is a confirmed relation. ACE2 is the key receptor required for SARA-COV-2 to enter the host cells. ACE2 has been also found in the brush border of the intestinal mucosa, as well as it is a key inflammatory regulator in the intestine. This may suggest that SARSA-COV-2 could invade the respiratory tract as well as gastrointestinal tract or both. Few case reports documented the presentation of COVID-19 as intussusception in children. In the light of the wide-spread of corona virus, performing COVID-19 tests for children with intussusception can help linking the two entities. Development of gastrointestinal symptoms in COVID-19 positive children should raise concern about the development of intussusception.
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Affiliation(s)
- Mohammad N Athamnah
- General Surgery Department, Princess Basma Teaching Hospital, Jordan Ministry of Health, Irbid, Jordan
| | | | | | - Nasser Banikhaled
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Jordan
| | | | | | - Hussein S O Al Azzam
- General Surgery Department, Princess Basma Teaching Hospital, Jordan Ministry of Health, Irbid, Jordan
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Smith BK, Janowski AB, Danis JE, Harvey IB, Zhao H, Dai YN, Farnsworth CW, Gronowski AM, Roper S, Fremont DH, Wang D. Seroprevalence of SARS-CoV-2 Antibodies in Children and Adults in St. Louis, Missouri, USA. mSphere 2021; 6:e01207-20. [PMID: 33536325 PMCID: PMC7860990 DOI: 10.1128/msphere.01207-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
Reported coronavirus disease 2019 (COVID-19) case counts likely underestimate the true prevalence because mild or asymptomatic cases often go untested. Here, we use a sero-survey to estimate the seroprevalence of IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the St. Louis, MO, metropolitan area in a symptom-independent manner. Five hundred three adult and 555 pediatric serum/plasma samples were collected from patients presenting to Barnes-Jewish Hospital or St. Louis Children's Hospital between 14 April 2020 and 12 May 2020. We developed protocols for in-house enzyme-linked immunosorbent assays (ELISAs) using spike and nucleoprotein and used the assays to estimate a seroprevalence rate based on our samples. Overall IgG seropositivity was estimated to be 1.71% (95% credible interval [CI], 0.04% to 3.38%) in pediatric samples and 3.11% (95% CI, 0.92% to 5.32%) in adult samples. Seropositivity was significantly lower in children under 5 years of age than in adults, but rates between adults and children aged 5 or older were similar. Of the 176 samples tested from children under 4 years of age, none were positive.IMPORTANCE This study determined the percentages of both children and adult samples from the greater St. Louis metropolitan area who had antibodies to SARS-CoV-2 in late April to early May 2020. Approximately 1.7 to 3.1% of the tested individuals had antibodies, indicating that they had previously been infected by SARS-CoV-2. These results demonstrate that the extent of infection was about 10 times greater than the number of confirmed cases at that time. Furthermore, it demonstrated that by 5 years of age, children were infected to an extent similar to that of adults.
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Affiliation(s)
- Brittany K Smith
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew B Janowski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonathan E Danis
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ian B Harvey
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Haiyan Zhao
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ya-Nan Dai
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Roper
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daved H Fremont
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biochemistry & Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Wang
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Gupta P, Bhinder O, Gupta V, Ahuja A, Pandey A, Mandal Ravi RN. Symptomatology and outcome of acute COVID-19 illness in children at Faridabad, India. Acta Med Int 2021. [DOI: 10.4103/amit.amit_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Le Maréchal M, Morand P, Epaulard O, Némoz B. COVID-19 in clinical practice: A narrative synthesis. Med Mal Infect 2020; 50:639-647. [PMID: 33007400 PMCID: PMC7524428 DOI: 10.1016/j.medmal.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) was first reported in the city of Wuhan, China. The disease rapidly spread to the rest of China, to Southern-East Asia, then to Europe, America, and on to the rest of the world. COVID-19 is associated with a betacoronavirus named SARS-CoV-2. The virus penetrates the organism through the respiratory tract, conveyed by contaminated droplets. The main cell receptor targeted is the surface-bound ACE-2. As of the 26th July 2020, 15,200,000 COVID-19 cases and 650,000 deaths were reported worldwide. The mortality rate is estimated between 1.3 and 18.3%. The reproductive rate without any public health intervention is estimated around 4-5.1 in France. Most hospitalized patients for COVID-19 present respiratory symptoms, which in some cases is associated with fever. Up to 86% of admissions to ICU are related to acute respiratory failure. To date, no anti-viral therapy has proven its efficacy considering randomized trials. Only immunomodulatory treatments such as corticosteroids have shown to cause significant improvement in patient outcome.
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Affiliation(s)
- M Le Maréchal
- Service de Maladies Infectieuses, CHU de Grenoble-Alpes, France.
| | - P Morand
- Laboratoire de Virologie, Institut de Biologie et de Pathologie, CHU de Grenoble-Alpes, France
| | - O Epaulard
- Service de Maladies Infectieuses, CHU de Grenoble-Alpes, France
| | - B Némoz
- Laboratoire de Virologie, Institut de Biologie et de Pathologie, CHU de Grenoble-Alpes, France
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35
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Han H, Xu Z, Cheng X, Zhong Y, Yuan L, Wang F, Li Y, Liu F, Jiang Y, Zhu C, Xia Y. Descriptive, Retrospective Study of the Clinical Characteristics of Asymptomatic COVID-19 Patients. mSphere. 2020;5. [PMID: 33028689 PMCID: PMC7568656 DOI: 10.1128/msphere.00922-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential problem for pandemic control through public health strategies. Our results demonstrate that asymptomatic COVID-19 patients have better outcomes than symptomatic patients. This may have been due to more active cellular immune responses and normal liver function. Since asymptomatic patients have no clinical symptoms which can easily prevent timely diagnosis and treatment, they may cause a greater risk of virus transmission than symptomatic patients, which poses a major challenge to infection control. Evidence suggests that nonpharmaceutical public health interventions, like social distancing and face mask ordinances, play important roles in the control of COVID-19. Looking forward, it may be necessary to proceed cautiously while reopening businesses in areas of epidemicity to prevent potential waves of COVID-19 in the future. Since the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, it has rapidly spread around the world. Persons with asymptomatic disease exhibit viral shedding, resulting in transmission, which presents disease control challenges. However, the clinical characteristics of these asymptomatic individuals remain elusive. We collected samples of 25 asymptomatic and 27 symptomatic COVID-19 patients. Viral titers of throat swabs were determined by quantitative reverse transcription-PCR (qRT-PCR). COVID-19 IgG and IgM were examined. Complete blood counts were determined, and serum biochemistry panels were performed. Cytokines, including gamma interferon (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin 2 (IL-2), IL-4, IL-6, and IL-10 were evaluated. T cell, B cell, and NK cell counts were measured using flow cytometry. Although similar viral loads were detected, asymptomatic patients had significantly faster virus turnover than symptomatic patients. Additionally, asymptomatic patients had higher counts of lymphocytes, T cells, B cells, and NK cells. While liver damage was observed in symptomatic patients, as indicated by elevated liver enzymes and decreased liver-synthesized proteins in the blood, asymptomatic patients showed normal liver measurements. Lactate dehydrogenase, a COVID-19 risk factor, was significantly lower in asymptomatic patients. These results suggest that asymptomatic COVID-19 patients had normal clinical indicators and faster viral clearance than symptomatic patients. Lymphocytes may play a role in their asymptomatic phenotype. Since asymptomatic patients may be a greater risk of virus transmission than symptomatic patients, public health interventions and a broader range of testing may be necessary for the control of COVID-19. IMPORTANCE Asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential problem for pandemic control through public health strategies. Our results demonstrate that asymptomatic COVID-19 patients have better outcomes than symptomatic patients. This may have been due to more active cellular immune responses and normal liver function. Since asymptomatic patients have no clinical symptoms which can easily prevent timely diagnosis and treatment, they may cause a greater risk of virus transmission than symptomatic patients, which poses a major challenge to infection control. Evidence suggests that nonpharmaceutical public health interventions, like social distancing and face mask ordinances, play important roles in the control of COVID-19. Looking forward, it may be necessary to proceed cautiously while reopening businesses in areas of epidemicity to prevent potential waves of COVID-19 in the future.
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36
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Khesrani LS, Chana K, Sadar FZ, Dahdouh A, Ladjadj Y, Bouguermouh D. Intestinal ischemia secondary to Covid-19. J Pediatr Surg Case Rep 2020; 61:101604. [PMID: 32839689 PMCID: PMC7439099 DOI: 10.1016/j.epsc.2020.101604] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
With the wide spread of the current SARS-Cov (Covid-19), It was found that about 2% of children was affected according to several studies, it should be mentioned that Those children are most often asymptomatic, but the current concern is about a vascular inflammatory disease which is similar to Kawasaki disease observed in children with Covid-19. we report a case of a 9-year-old girl, known to have idiopathic medullar aplasia, admitted to the emergency department for a pseudo appendicular syndrome with shock, neurological abnormalities and skin lesions. She underwent an emergency surgery; the peroperative exploration suggested an ischemic bowel lesion of the ileal loop and a healthy appendix. The link involving a Covid-19 infection was well established (RT-PCR +). We shared in common our clinical, radiological, biological and pathological data to draw attention towards the intestinal vasculitis that can be a part in the MIS-C related to Covid 19. To our best knowledge, this is the first case encountered of combination between Covid-19 with intestinal ischemic in children.
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Affiliation(s)
| | - Karima Chana
- Pediatric Surgical Intensive Care Unit, CHU Mustapha, Algiers, Algeria
| | | | | | - Yasmina Ladjadj
- Pediatric Surgery Département, CHU Mustapha, Algiers, Algeria
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37
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Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J, Zhang J, Dong C, Na R, Zheng L, Li W, Liu Z, Ma J, Wang J, He S, Xu Y, Si P, Shen Y, Cai C. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol 2020; 93:1057-1069. [PMID: 32761898 PMCID: PMC7436402 DOI: 10.1002/jmv.26398] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
Abstract
To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings, and imaging features of coronavirus disease 2019 (COVID-19) in pediatric patients. A meta-analysis was carried out to identify studies on COVID-19 from 25 December 2019 to 30 April 2020. A total of 48 studies with 5829 pediatric patients were included. Children of all ages were at risk for COVID-19. The main illness classification ranged as: 20% (95% confidence interval [CI]: 14%-26%; I2 = 91.4%) asymptomatic, 33% (95% CI: 23%-43%; I2 = 95.6%) mild and 51% (95% CI: 42%-61%; I2 = 93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45%-57%; I2 = 78.9%) and cough 41% (95% CI: 35%-47%, I2 = 81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64%-75%; I2 = 58.5%), lymphopenia 16% (95% CI: 11%-21%; I2 = 76.9%) and elevated creatine-kinase MB 37% (95% CI: 25%-48%; I2 = 59.0%). The frequent imaging features were normal images 41% (95% CI: 30%-52%; I2 = 93.4%) and ground-glass opacity 36% (95% CI: 25%-47%; I2 = 92.9%). Among children under 1 year old, critical cases account for 14% (95% CI: 13%-34%; I2 = 37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18%-67%; I2 = 0.0%) cases that may also need attention. Pediatric patients with COVID-19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1 year old.
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Affiliation(s)
- Xiaojian Cui
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Zhihu Zhao
- Department of Orthopaedic, Tianjin Hospital, Tianjin, PR China
| | - Tongqiang Zhang
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Department of Pediatrics, Graduate School of Tianjin Medical University, Tianjin, PR China
| | - Wei Guo
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Wenwei Guo
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jiafeng Zheng
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jiayi Zhang
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Cuicui Dong
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Ren Na
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Lisheng Zheng
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Wenliang Li
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Zihui Liu
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jia Ma
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Jinhu Wang
- Department of Neonatal Surgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Sijia He
- Department of National Center for Biodefense and Infectious Diseases, School of Systems Biology, George Mason University, Manassas, Virginia
| | - Yongsheng Xu
- Department of Respiratory, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Ping Si
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Yongming Shen
- Department of Clinical Lab, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China
| | - Chunquan Cai
- Department of Neurosurgery, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Institute of Pediatrics, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, PR China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, PR China
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38
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Cui X, Zhang T, Zheng J, Zhang J, Si P, Xu Y, Guo W, Liu Z, Li W, Ma J, Dong C, Shen Y, Cai C, He S. Children with coronavirus disease 2019: A review of demographic, clinical, laboratory, and imaging features in pediatric patients. J Med Virol 2020; 92:1501-1510. [PMID: 32418216 PMCID: PMC7276885 DOI: 10.1002/jmv.26023] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
There is a current outbreak of coronavirus disease 2019 (COVID-19), with a global spread. With the rapid increase in the number of infections, an increase is observed in the number of children with COVID-19. Most research findings are regarding adult cases, which are not always transferrable to children. Evidence-based studies are still expected to formulate clinical decisions for pediatric patients. In this review, we included 2597 pediatric patients that reported recently and evaluated the demographic, clinical, laboratory, and imaging features of children with COVID-19. We found that even lymphopenia was the most common lab finding in adults; it infrequently occurred in children (9.8%). Moreover, elevated creatine kinase MB isoenzyme was much more commonly observed in children (27.0%) than that in adults, suggesting that heart injury would be more likely to occur in pediatric patients. Our analysis may contribute to determine the spectrum of disease in children and to develop strategies to control the disease transmission.
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Affiliation(s)
- Xiaojian Cui
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Tongqiang Zhang
- Department of RespiratoryChildren's Hospital of Tianjin UniversityTianjinChina
- Graduate School of Tianjin Medical UniversityTianjinChina
| | - Jiafeng Zheng
- Department of RespiratoryChildren's Hospital of Tianjin UniversityTianjinChina
| | - Jiayi Zhang
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Ping Si
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Yongsheng Xu
- Department of RespiratoryChildren's Hospital of Tianjin UniversityTianjinChina
| | - Wei Guo
- Department of RespiratoryChildren's Hospital of Tianjin UniversityTianjinChina
| | - Zihui Liu
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Wenliang Li
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Jia Ma
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Cuicui Dong
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Yongming Shen
- Department of Clinical LabChildren's Hospital of Tianjin UniversityTianjinChina
| | - Chunquan Cai
- Department of NeurosurgeryChildren's Hospital of Tianjin UniversityTianjinChina
| | - Sijia He
- School of Systems BiologyNational Center for Biodefense and Infectious Diseases, George Mason UniversityManassasVirginia
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39
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Moazzam Z, Salim A, Ashraf A, Jehan F, Arshad M. Intussusception in an infant as a manifestation of COVID-19. J Pediatr Surg Case Rep 2020; 59:101533. [PMID: 32834997 PMCID: PMC7305758 DOI: 10.1016/j.epsc.2020.101533] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal manifestations of COVID-19 are rare and have primarily been limited to diarrhea or vomiting. Intussusception is the most common cause of bowel obstruction in infants, with up to 30% of pediatric intussusception cases having a preceding viral illness. We present the rare case of intussusception in a SARS-CoV-2 positive infant. This is the first documented case of survival in a SARS-CoV-2 positive patient presenting with intussusception as the primary manifestation. As our knowledge of this disease evolves, surgeons need to remain suspicious for possible gastrointestinal manifestations of COVID-19.
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Affiliation(s)
- Zorays Moazzam
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Areej Salim
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Alina Ashraf
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Fyezah Jehan
- Section of Pediatric Infectious Diseases, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Arshad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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40
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Zare-Zardini H, Soltaninejad H, Ferdosian F, Hamidieh AA, Memarpoor-Yazdi M. Coronavirus Disease 2019 (COVID-19) in Children: Prevalence, Diagnosis, Clinical Symptoms, and Treatment. Int J Gen Med 2020; 13:477-482. [PMID: 32848446 PMCID: PMC7425102 DOI: 10.2147/ijgm.s262098] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
In this article, we have reviewed the prevalence, diagnosis, symptoms, and treatment of COVID-19 in children. The incidence of COVID-19 among children under 18 years was 2.1% based on the reported studies, where the mortality rate in the same age group was 0.2%. No death has been reported in children under 9-years old. There are some articles that report children with COVID-19 having symptoms similar to Kawasaki's disease. In these cases, heart complications were observed. The best markers for diagnosing the severity of the disease in children are the levels of bilirubin and hepatic enzymes. Large number of angiotensin converting enzyme 2 (ACE2) receptors on cell surfaces, effective innate immune system, and high level of blood lymphocyte have been reported to be the potent reasons for lower incidence of severe symptoms of COVID-19 among children. Children can very well be the carriers of this virus. Children with severe COVID-19 clinical symptoms, especially those suffering from pneumonia, must be hospitalized similar to adults, while quarantine is required for those having mild symptoms. Antiviral medication (lopinavir, darunavir, favipiravir, remdesivir, ribavirin, oseltamivir, tocilizumab, and umifenovir), ACE inhibitors, interferon-α2b, co-therapy with azithromycin, inhaling iNO, and oxygen therapy can be used for treatment. For the treatment of children without any clinical and infection symptoms, home isolation protocol has been recommended.
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Affiliation(s)
- Hadi Zare-Zardini
- Department of Sciences, Farhangian University, Isfahan, Iran.,Hematology and Oncology Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Soltaninejad
- Stem Cell and Regenerative Medicine Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Ferdosian
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
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41
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George S, Ansari MS, Kalliath A, Khan MJ, Abdullah MS, Asli R, Momin RN, Mani BI, Chong PL, Chong VH. COVID-19 in children in Brunei Darussalam: Higher incidence but mild manifestations. J Med Virol 2020; 93:199-201. [PMID: 32687229 PMCID: PMC7405023 DOI: 10.1002/jmv.26310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Shaji George
- Department of Pediatrics, PMMPMHAMB Hospital, Tutong, Brunei
| | | | - Anto Kalliath
- Department of Pediatrics, PMMPMHAMB Hospital, Tutong, Brunei
| | | | - Muhammad Syafiq Abdullah
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei.,Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Rosmonaliza Asli
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | | | - Babu Ivan Mani
- Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Pui Lin Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - Vui Heng Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei.,Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, Brunei.,Department of Medicine, PMMPHAMB Hospital, Tutong, Brunei
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