#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Clinical and epidemiological characteristics of pediatric SARS-CoV-2 infections in China: A multicenter case series


Autoři: Che Zhang aff001;  Jiaowei Gu aff002;  Quanjing Chen aff003;  Na Deng aff004;  Jingfeng Li aff002;  Li Huang aff002;  Xihui Zhou aff001
Působiště autorů: Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China aff001;  Department of Pediatrics, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China aff002;  Department of Pediatrics, Dongfeng Hospital of Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China aff003;  Pediatric Intensive Care Unit, Shiyan People Hospital, Shiyan, Hubei, People’s Republic of China aff004
Vyšlo v časopise: Clinical and epidemiological characteristics of pediatric SARS-CoV-2 infections in China: A multicenter case series. PLoS Med 17(6): e32767. doi:10.1371/journal.pmed.1003130
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003130

Souhrn

Background

As of April 18, 2020, over 2,000,000 patients had been diagnosed with coronavirus disease-2019 (COVID-19) globally, and more than 140,000 deaths had been reported. The clinical and epidemiological characteristics of adult patients have been documented recently. However, information on pediatric patients is limited. We describe the clinical and epidemiological characteristics of pediatric patients to provide valuable insight into the early diagnosis and assessment of COVID-19 in children.

Methods and findings

This retrospective, observational study involves a case series performed at 4 hospitals in West China. Thirty-four pediatric patients with COVID-19 were included from January 27 to February 23, 2020. The final follow-up visit was completed by March 16, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed for 34 pediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, interquartile range 10.00–94.25), among whom 14 males (41%) were included. All the patients in the current study presented mild (18%) or moderate (82%) forms of COVID-19. A total of 48% of patients were noted to be without a history of exposure to an identified source. Mixed infections of other respiratory pathogens were reported in 16 patients (47%). Comorbidities were reported in 6 patients (18%). The most common initial symptoms were fever (76%) and cough (62%). Expectoration (21%), vomiting (12%), and diarrhea (12%) were also reported in a considerable portion of cases. A substantial increase was detected in serum amyloid A for 17 patients (among 20 patients with available data; 85%) and in high-sensitivity C-reactive protein for 17 patients (among 29 patients with available data; 59%), whereas a decrease in prealbumin was noticed in 25 patients (among 32 patients with available data; 78%). In addition, significant increases in the levels of lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were detected in 28 patients (among 34 patients with available data; 82%) and 25 patients (among 34 patients with available data; 74%), respectively. Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82%). Ground-glass opacities, which were a typical feature in adults, were rare in pediatric patients (3%). Rapid radiologic progression and a late-onset pattern of lesions in the lobules were also noticed. Lesions in lobules still existed in 24 (among 32 patients with lesions; 75%) patients that were discharged, although the main symptoms disappeared a few days after treatment. All patients were discharged, and the median duration of hospitalization was 10.00 (8.00–14.25) days. The current study was limited by the small sample size and a lack of dynamic detection of inflammatory markers.

Conclusions

Our data systemically presented the clinical and epidemiological features, as well as the outcomes, of pediatric patients with COVID-19. Stratified analysis was performed between mild and moderate cases. The findings offer new insight into early identification and intervention in pediatric patients with COVID-19.

Klíčová slova:

Computed axial tomography – Fevers – Infectious disease epidemiology – Lesions – Pediatric epidemiology – Pediatric infections – Pediatrics – Respiratory infections


Zdroje

1. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. Epub 2020 Feb 28. doi: 10.1056/NEJMoa2002032 32109013.

2. WHO [Internet]. Novel coronavirus (2019-nCoV) situation report-11 [cited 2020 Apr 18]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200131-sitrep-11-ncov.pdf?sfvrsn=de7c0f7_4.

3. WHO [Internet]. Coronavirus disease 2019 (COVID-19) situation report-89 [cited 2020 Apr 19]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200418-sitrep-89-covid-19.pdf?sfvrsn=3643dd38_2.

4. Zhu N, Zhang DY, Wang WL, Li XW, Yang B, Song JD, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017 31978945

5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5 31986264

6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi: 10.1016/S0140-6736(20)30211-7 32007143

7. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061‐1069. doi: 10.1001/jama.2020.1585 32031570. Epub 2020 Feb 7.

8. WHO [Internet]. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected [cited 2020 Apr 18]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.

9. Pediatric Branch of Hubei Medical Association, Pediatric Branch of Wuhan Medical Association, Pediatric Medical Quality Control Center of Hubei. Recommendation for the diagnosis and treatment of novel coronavirus infection in children in Hubei (Trial version 1). Zhongguo Dang Dai Er Ke Za Zhi. 2020;22(2):96–99. 32051073

10. nhc.gov.cn [Internet]. National recommendations for diagnosis and treatment of COVID-2019 (version 7) [cited 2020 Apr 18]. Available from: www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf.

11. nhc.gov.cn [Internet]. Prevention and control strategy of 2019-novel coronavirus (version 5) [cited 2020 Apr 18]. Available from: http://www.nhc.gov.cn/jkj/s3577/202002/a5d6f7b8c48c451c87dba14889b30147.shtml.

12. Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335. doi: 10.1001/jama.2020.4344 32181795

13. CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12-March 16, 2020. Morb Mortal Wkly Rep. 2020;69:343–346.

14. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;e20200702. doi: 10.1542/peds.2020-0702 32179660

15. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663–1665. doi: 10.1056/NEJMc2005073 32187458. Epub 2020 Mar 18.

16. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015;282(1821). doi: 10.1098/rspb.2014.3085 26702035

17. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088–1095. doi: 10.1111/apa.15270 32202343. Epub 2020 Apr 14.

18. Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;26:502–505. doi: 10.1038/s41591-020-0817-4 32284613

19. Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS ONE. 2020;15(3):e230548. doi: 10.1371/journal.pone.0230548 32191764

20. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020;200370. doi: 10.1148/radiol.2020200370 32053470

21. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425–434. doi: 10.1016/S1473-3099(20)30086-4 32105637

22. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020;295(3):685–691. Epub 2020 Feb 20. doi: 10.1148/radiol.2020200463 32077789.

23. Yip TT, Chan JW, Cho WC, Yip TT, Wang Z, Kwan TL, et al. Protein chip array profiling analysis in patients with severe acute respiratory syndrome identified serum amyloid A protein as a biomarker potentially useful in monitoring the extent of pneumonia. Clin Chem. 2004;51(1):47–55. doi: 10.1373/clinchem.2004.031229 15364884

24. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med. Epub 2020 Mar 16. doi: 10.1515/cclm-2020-0272 32172227

25. Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119(3):670–673. doi: 10.1016/j.jfma.2020.02.009 32139299


Článek vyšel v časopise

PLOS Medicine


2020 Číslo 6
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#