COVID-19 associated pediatric complications: Difference between revisions
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* Presentation of [[COVID-19]] is less severe in children as compared to adults. | * Presentation of [[COVID-19]] is less severe in children as compared to adults. | ||
*According to CDC, as of April 2, 2020, 1.7% confirmed cases of [[COVID-19]] were reported in children aged <18 years age among the total number of confirmed cases of [[COVID-19]]. | *According to [[Centers for Disease Control and Prevention|CDC]], as of April 2, 2020, 1.7% confirmed cases of [[COVID-19]] were reported in children aged <18 years age among the total number of confirmed cases of [[COVID-19]]. | ||
* Illness severity of [[COVID-19]] in children ranges from [[asymptomatic]] to critical. | * Illness severity of [[COVID-19]] in children ranges from [[asymptomatic]] to critical. | ||
=== Symptoms === | |||
* | |||
* | *[[Fever]] and [[Cough]] are one of the most common symptoms reported in children. One study showed [[fever]] is prevalent in 47.5% of children and [[cough]] in 41.5% among the 1124 children with [[COVID-19]].According to the CDC, [[fever]], and [[cough]] was reported in 56% and 54% of children with COVID 19 | ||
*'''[[Gastrointestinal symptoms]]'''-The gastrointestinal manifestation in [[COVID-19]] positive children are [[diarrhea]], [[vomiting]], [[abdominal pain]], [[nausea]], and [[anorexia]]. Children can present with gastrointestinal symptoms in the absence of respiratory symptoms. | *[[Dyspnea]], [[nasal congestion]], [[Erythema|pharyngeal erythema]], and [[sore throat]] are also common presentations in children. | ||
*'''[[Gastrointestinal symptoms]]'''-The gastrointestinal manifestation in [[COVID-19]] positive children are [[diarrhea]], [[vomiting]], [[abdominal pain]], [[nausea]], and [[anorexia]]. Children can present with [[Gastrointestinal disorders and of COVID-19|gastrointestinal]] symptoms in the absence of [[COVID-19 Pulmonary Complications|respiratory]] symptoms. | |||
*'''[[Cutaneous Findings]]''' | *'''[[Cutaneous Findings]]''' | ||
=== '''Clinical Course of COVID-19 in children.''' === | |||
*'''Asymptomatic presentation'''- | *'''Asymptomatic presentation'''- | ||
**Children present with no clinical signs or symptoms with normal chest imaging.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | **Children present with no clinical signs or [[Symptom|symptoms]] with normal chest imaging.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
** Among 2143 children with COVID-19 infection 4% of children were asymptomatic.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ** Among 2143 children with [[COVID-19|COVID]]-19 infection 4% of children were [[asymptomatic]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
** According to one study 14.2% of children were asymptomatic | ** According to one study 14.2% of children were asymptomatic. Another study showed 18% of asymptomatic children with [[COVID-19|COVID]]-19. | ||
*'''Mild Disease''' | *'''Mild Disease''' | ||
** Children present with mild symptoms including [[fever]], [[fatigue]], [[myalgia]], [[cough]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ** Children present with mild symptoms including [[fever]], [[fatigue]], [[myalgia]], [[cough]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
** Among 2143 children with COVID-19 infection 51% of children had a mild disease of COVID-19.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ** Among 2143 children with [[COVID-19|COVID]]-19 infection 51% of children had a mild disease of [[COVID-19|COVID]]-19.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
**A study showed 36.3% of children present with a mild form of the disease<ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref>. | **A study showed 36.3% of children present with a mild form of the disease<ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref>. | ||
*'''Severe''' | *'''Severe''' | ||
**Children present with [[dyspnea]], [[central cyanosis]], [[hypoxia]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | **Children present with [[dyspnea]], [[central cyanosis]], [[hypoxia]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
**Among 2143 children with COVID-19 infection 5% of children had a severe presentation.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | **Among 2143 children with [[COVID-19|COVID]]-19 infection 5% of children had a severe presentation.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
** 2.1% of children present with a severe form of COVID-19 disease<ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref>. | ** 2.1% of children present with a severe form of [[COVID-19|COVID]]-19 disease<ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref>. | ||
** Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease. | ** Children with underlying comorbidities are more susceptible to getting severe [[COVID-19|COVID]]-19 disease. | ||
*'''Critical''' | *'''Critical''' | ||
**Children present with [[acute respiratory distress syndrome]](ARDS), [[respiratory failure]], [[shock]], or [[multi-organ dysfunction]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | **Children present with [[acute respiratory distress syndrome]](ARDS), [[respiratory failure]], [[shock]], or [[multi-organ dysfunction]].<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
**Among 2143 children with COVID-19 infection 0.6%% of children had a critical presentation.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | **Among 2143 children with [[COVID-19|COVID]]-19 infection, 0.6%% of children had a critical presentation.<ref name="EastinEastin2020">{{cite journal|last1=Eastin|first1=Carly|last2=Eastin|first2=Travis|title=Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China|journal=The Journal of Emergency Medicine|volume=58|issue=4|year=2020|pages=712–713|issn=07364679|doi=10.1016/j.jemermed.2020.04.006}}</ref> | ||
===Complications=== | ===Complications=== | ||
Some of the complications associated with [[COVID-19|COVID]]-19 pediatric population are | |||
*[[Multisystem Inflammatory Syndrome in Children (MISC-C)]] | *[[Multisystem Inflammatory Syndrome in Children (MISC-C)]] | ||
*[[Exacerbation of the underlying conditions]] | *[[Exacerbation of the underlying conditions]] | ||
| Line 48: | Line 51: | ||
*[[Secondary Bacterial infections]]. | *[[Secondary Bacterial infections]]. | ||
; '''Multisystem Inflammatory Syndrome in Children(MIS-C)''' | <br /> | ||
*It is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes. | |||
*According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past. | ;'''Multisystem Inflammatory Syndrome in Children (MIS-C)''' | ||
*It is a condition that causes [[inflammation]] of some parts of the body like [[heart]], [[blood vessels]], [[Kidney|kidneys]], digestive system, [[brain]], [[skin]], or [[Eye|eyes]]. | |||
*According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had [[COVID-19|COVID]]-19 infection in the past. | |||
'''Symptoms''' | '''Symptoms''' | ||
*[[Fever]] lasting 24 hours or longer. | *[[Fever]] lasting 24 hours or longer. | ||
| Line 64: | Line 71: | ||
*[[Difficulty Breathing]] | *[[Difficulty Breathing]] | ||
*[[Chest pain]] | *[[Chest pain]] | ||
*[[New onset confusion]] | *[[Confusion|New onset confusion]] | ||
*[[Lethargy]] | *[[Lethargy]] | ||
*[[Cyanosis]] | *[[Cyanosis]] | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
'''Prevention of MIS-C''' | '''Prevention of MIS-C''' | ||
* | *MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection. | ||
==Diagnosis== | ==Diagnosis== | ||
<br /> | <br /> | ||
Most of the children with [[SARS-CoV-2]] infection are either asymptomatic or produce mild symptoms. As asymptomatic patients do not get tested for [[COVID-19]] and are potential carriers for [[viral transmission]], high clinical suspicion is required to prevent such transmissions to a population at risk of developing severe disease. A [[pediatrician]] should be cautious to eliminate other causes of [[respiratory illnesses]] like [[seasonal influenza]] before any diagnostic tests. No diagnostic test is required for a kid with mild illness and no history of exposure to [[SARS-CoV-2]]. | Most of the children with [[SARS-CoV-2]] infection are either [[asymptomatic]] or produce mild symptoms. As [[asymptomatic]] patients do not get tested for [[COVID-19]] and are potential carriers for [[viral transmission]], high clinical suspicion is required to prevent such transmissions to a population at risk of developing severe disease. A [[pediatrician]] should be cautious to eliminate other causes of [[respiratory illnesses]] like [[seasonal influenza]] before any diagnostic tests. No diagnostic test is required for a kid with mild illness and no history of exposure to [[SARS-CoV-2]]. | ||
===Reverse-Transcriptase Polymerase Chain Reaction=== | ===Reverse-Transcriptase Polymerase Chain Reaction=== | ||
[[U.S. Food and Drug Administration]] [[(FDA)]] has approved [[real-time Reverse-Transcription Polymerase Chain Reaction]] [[(RT-PCR)]] as the preferred test for diagnosing [[COVID-19]] in children | [[U.S. Food and Drug Administration]] [[(FDA)]] has approved [[Polymerase Chain Reaction|real-time Reverse-Transcription Polymerase Chain Reaction]] [[(RT-PCR)]] as the preferred test for diagnosing [[COVID-19]] in children | ||
*[[RT-PCR]] has high [[specificity]] and [[sensitivity]] of 66-80% in diagnosing [[SARS-CoV-2]] infection | *[[RT-PCR]] has high [[specificity]] and [[sensitivity]] of 66-80% in diagnosing [[SARS-CoV-2]] infection | ||
*The test is negative during the first 7-10 days of the infection and remains positive for several weeks after the infection subsides | *The test is negative during the first 7-10 days of the infection and remains positive for several weeks after the infection subsides | ||
*[[Swab contamination]] may produce [[false-positive]] results | *[[Swab contamination]] may produce [[false-positive]] results | ||
*High levels of [[SARS-CoV-2]] [[RNA]] were obtained in the samples from the [[upper respiratory tract]] in both symptomatic and asymptomatic patients | *High levels of [[SARS-CoV-2]] [[RNA]] were obtained in the samples from the [[upper respiratory tract]] in both symptomatic and asymptomatic patients | ||
*[[Nasopharyngeal swabs]] and [[oropharyngeal swabs]] or [[throat swab]] are the preferred samples for the diagnostic test | *[[Nasopharyngeal|Nasopharyngeal swabs]] and [[oropharyngeal swabs]] or [[throat swab]] are the preferred samples for the diagnostic test | ||
*[[Nasopharyngeal swab]] is collected in children less than 2 years of age | *[[Nasopharyngeal swab]] is collected in children less than 2 years of age | ||
*A [[throat swab]] is preferred for children above 2 years | *A [[throat swab]] is preferred for children above 2 years | ||
| Line 94: | Line 99: | ||
*Alternatively, some researchers suggest using [[metagenomic next-generation sequencing]] [[(mNGS)]] of viral [[RNA]] for the diagnosis | *Alternatively, some researchers suggest using [[metagenomic next-generation sequencing]] [[(mNGS)]] of viral [[RNA]] for the diagnosis | ||
===Lab abnormalities=== | ===Lab abnormalities=== | ||
Studies reportedly showed following lab abnormalities in pediatric patients with COVID-19 <ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc=7300659 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref> | Studies reportedly showed following lab abnormalities in pediatric patients with [[COVID-19|COVID]]-19 <ref name="pmid32492251">{{cite journal| author=de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB| title=Clinical manifestations of children with COVID-19: A systematic review. | journal=Pediatr Pulmonol | year= 2020 | volume= | issue= | pages= | pmid=32492251 | doi=10.1002/ppul.24885 | pmc=7300659 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32492251 }} </ref> | ||
*[[Leucocytosis]](7.5%) or [[Leucopenia]](16.6%) | *[[Leucocytosis]](7.5%) or [[Leucopenia]](16.6%) | ||
*Increased (27.4%) or decreased (24%) [[neutrophils]] | *Increased (27.4%) or decreased (24%) [[neutrophils]] | ||
| Line 108: | Line 113: | ||
*Increased [[D-dimer]] levels (12%) | *Increased [[D-dimer]] levels (12%) | ||
===Co-infections=== | ===Co-infections=== | ||
[[Co-infection]] with other [[pathogens]] were reported in 27% of cases | [[Co-infection]] with other [[pathogens]] were reported in 27% of cases. Some common [[microorganisms]] associated with [[SARS-CoV-2]] infection in children are: | ||
*[[Mycoplasma pneumoniae]] | *[[Mycoplasma pneumoniae]] | ||
*[[Influenza B virus]] | *[[Influenza B virus]] | ||
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*Local [[patchy shadows]] (18.7%) | *Local [[patchy shadows]] (18.7%) | ||
*Bilateral [[patchy shadows]] (12.3%) | *Bilateral [[patchy shadows]] (12.3%) | ||
*[[Consolidation]] (33%) | *[[Consolidation (medicine)|Consolidation]] (33%) | ||
*[[Ground glass opacities]] (28%) | *[[Ground glass opacities]] (28%) | ||
*[[Interstitial abnormalities]] (1.2%) | *[[Interstitial abnormalities]] (1.2%) | ||
Revision as of 08:42, 25 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Harmeet Kharoud M.D.[2]; Abdelrahman Ibrahim Abushouk, MD[3]
Overview
Epidemiology and Demographics
Mode of transmission
Presentations
- Presentation of COVID-19 is less severe in children as compared to adults.
- According to CDC, as of April 2, 2020, 1.7% confirmed cases of COVID-19 were reported in children aged <18 years age among the total number of confirmed cases of COVID-19.
- Illness severity of COVID-19 in children ranges from asymptomatic to critical.
Symptoms
- Fever and Cough are one of the most common symptoms reported in children. One study showed fever is prevalent in 47.5% of children and cough in 41.5% among the 1124 children with COVID-19.According to the CDC, fever, and cough was reported in 56% and 54% of children with COVID 19
- Dyspnea, nasal congestion, pharyngeal erythema, and sore throat are also common presentations in children.
- Gastrointestinal symptoms-The gastrointestinal manifestation in COVID-19 positive children are diarrhea, vomiting, abdominal pain, nausea, and anorexia. Children can present with gastrointestinal symptoms in the absence of respiratory symptoms.
- Cutaneous Findings
Clinical Course of COVID-19 in children.
- Asymptomatic presentation-
- Mild Disease
- Severe
- Children present with dyspnea, central cyanosis, hypoxia.[1]
- Among 2143 children with COVID-19 infection 5% of children had a severe presentation.[1]
- 2.1% of children present with a severe form of COVID-19 disease[2].
- Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease.
- Critical
- Children present with acute respiratory distress syndrome(ARDS), respiratory failure, shock, or multi-organ dysfunction.[1]
- Among 2143 children with COVID-19 infection, 0.6%% of children had a critical presentation.[1]
Complications
Some of the complications associated with COVID-19 pediatric population are
- Multisystem Inflammatory Syndrome in Children (MISC-C)
- Exacerbation of the underlying conditions
- Sepsis
- Septic shock
- Secondary Bacterial infections.
- Multisystem Inflammatory Syndrome in Children (MIS-C)
- It is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes.
- According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past.
Symptoms
- Fever lasting 24 hours or longer.
- Vomiting
- Diarrhea
- Abdominal pain
- Skin rash
- Red eyes
- Redness or swelling of the lips and tongue
- Lethargy
- Redness or swelling of the hands or feet
Emergency Warning Signs
Prevention of MIS-C
- MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection.
Diagnosis
Most of the children with SARS-CoV-2 infection are either asymptomatic or produce mild symptoms. As asymptomatic patients do not get tested for COVID-19 and are potential carriers for viral transmission, high clinical suspicion is required to prevent such transmissions to a population at risk of developing severe disease. A pediatrician should be cautious to eliminate other causes of respiratory illnesses like seasonal influenza before any diagnostic tests. No diagnostic test is required for a kid with mild illness and no history of exposure to SARS-CoV-2.
Reverse-Transcriptase Polymerase Chain Reaction
U.S. Food and Drug Administration (FDA) has approved real-time Reverse-Transcription Polymerase Chain Reaction (RT-PCR) as the preferred test for diagnosing COVID-19 in children
- RT-PCR has high specificity and sensitivity of 66-80% in diagnosing SARS-CoV-2 infection
- The test is negative during the first 7-10 days of the infection and remains positive for several weeks after the infection subsides
- Swab contamination may produce false-positive results
- High levels of SARS-CoV-2 RNA were obtained in the samples from the upper respiratory tract in both symptomatic and asymptomatic patients
- Nasopharyngeal swabs and oropharyngeal swabs or throat swab are the preferred samples for the diagnostic test
- Nasopharyngeal swab is collected in children less than 2 years of age
- A throat swab is preferred for children above 2 years
- Due to the difficulty in obtaining samples and poor cooperation of children, it is advised to use saliva samples to diagnose SARS-CoV-2 infection
- Saliva samples reportedly showed higher positive rates than Nasopharyngeal swabs in adults. It is quick and non-invasive that deceases the risk of exposure and contamination
- In patients with a high risk of exposure, one negative test result does not exclude the infection. The test should be repeated or lower respiratory tract samples like Bronchoscopic Alveolar Lavage (BAL) should be used as a specimen in such patients
- Due to the increased risk of exposure for both patient and health care worker, bronchoscopy is not recommended to diagnose SARS-CoV-2 infection
- In patients on mechanical ventilation, bronchoscopic alveolar lavage fluid or endotracheal aspirates can be used
- The virus RNA was also detected in blood and stools specimen
- Real-time Fluorescent RT-PCR is used in children with atypical symptoms
- Alternatively, some researchers suggest using metagenomic next-generation sequencing (mNGS) of viral RNA for the diagnosis
Lab abnormalities
Studies reportedly showed following lab abnormalities in pediatric patients with COVID-19 [2]
- Leucocytosis(7.5%) or Leucopenia(16.6%)
- Increased (27.4%) or decreased (24%) neutrophils
- Lymphopenia (12.9%) or Lymphocytosis (11.7%)
- Increased (9.5%) or decreased (3.2%) platelets
- Increased CRP levels (19.3%)
- Increased procalcitonin levels (49.8%)
- Increased liver enzymes (19.2%)
- Increased Serum Creatinine (4%)
- Increased blood urea nitrogen (5%)
- Increased lactate dehydrogenase (LDH) levels (29%)
- Increased Creatine kinase levels (21%)
- Increased D-dimer levels (12%)
Co-infections
Co-infection with other pathogens were reported in 27% of cases. Some common microorganisms associated with SARS-CoV-2 infection in children are:
- Mycoplasma pneumoniae
- Influenza B virus
- Influenza A virus
- Respiratory syncytial virus (RSV)
- Cytomegalovirus (CMV)
- Enterobacter aerogenes
Radiological findings
CT chest is an important diagnostic modality in pediatric patients with COVID-19. Chest CT scans has reportedly shown higher positive rates in suspected patients than RT-PCR. It has better sensitivity. CT chest and a series of chest X-rays can be used to monitor the progression of the disease. Imaging findings reported in the studies are[2][3]
- Local patchy shadows (18.7%)
- Bilateral patchy shadows (12.3%)
- Consolidation (33%)
- Ground glass opacities (28%)
- Interstitial abnormalities (1.2%)
- Pleural effusion was reported in a 2-month old child who had a co-infection with RSV along with SARS-CoV-2
Children are at increased risk of radiation and its effects, so CT scans and X-rays should be judiciously used in them. It is advised to perform Pulmonary Ultrasonography (USG) in newborns. It has better sensitivity and is safer than CT scans and Chest X-rays.
Treatment
Prevention
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Eastin, Carly; Eastin, Travis (2020). "Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China". The Journal of Emergency Medicine. 58 (4): 712–713. doi:10.1016/j.jemermed.2020.04.006. ISSN 0736-4679.
- ↑ 2.0 2.1 2.2 2.3 de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB (2020). "Clinical manifestations of children with COVID-19: A systematic review". Pediatr Pulmonol. doi:10.1002/ppul.24885. PMID 32492251 Check
|pmid=value (help). - ↑ Zhang L, Peres TG, Silva MVF, Camargos P (2020). "What we know so far about Coronavirus Disease 2019 in children: A meta-analysis of 551 laboratory-confirmed cases". Pediatr Pulmonol. doi:10.1002/ppul.24869. PMC 7300763 Check
|pmc=value (help). PMID 32519809 Check|pmid=value (help).