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A literature review of 2019 novel coronavirus (SARS-CoV2) infection in neonates and children. Pediatr Res 2021; 89:1101-1108. [PMID: 32679582 DOI: 10.1038/s41390-020-1065-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
At the time of writing, there are already millions of documented infections worldwide by the novel coronavirus 2019 (2019-nCoV or severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)), with hundreds of thousands of deaths. The great majority of fatal events have been recorded in adults older than 70 years; of them, a large proportion had comorbidities. Since data regarding the epidemiologic and clinical characteristics in neonates and children developing coronavirus disease 2019 (COVID-19) are scarce and originate mainly from one country (China), we reviewed all the current literature from 1 December 2019 to 7 May 2020 to provide useful information about SARS-CoV2 viral biology, epidemiology, diagnosis, clinical features, treatment, prevention, and hospital organization for clinicians dealing with this selected population. IMPACT: Children usually develop a mild form of COVID-19, rarely requiring high-intensity medical treatment in pediatric intensive care unit. Vertical transmission is unlikely, but not completely excluded. Children with confirmed or suspected COVID-19 must be isolated and healthcare workers should wear appropriate protective equipment. Some clinical features (higher incidence of fever, vomiting and diarrhea, and a longer incubation period) are more common in children than in adults, as well as some radiologic aspects (more patchy shadow opacities on CT scan images than ground-glass opacities). Supportive and symptomatic treatments (oxygen therapy and antibiotics for preventing/treating bacterial coinfections) are recommended in these patients.
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52
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Sly PD, Trottier BA, Bulka CM, Cormier SA, Fobil J, Fry RC, Kim KW, Kleeberger S, Kumar P, Landrigan PJ, Lodrop Carlsen KC, Pascale A, Polack F, Ruchirawat M, Zar HJ, Suk WA. The interplay between environmental exposures and COVID-19 risks in the health of children. Environ Health 2021; 20:34. [PMID: 33771185 PMCID: PMC7996114 DOI: 10.1186/s12940-021-00716-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/07/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. OBJECTIVES To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. METHODS An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. DISCUSSION Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life. CONCLUSION A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.
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Affiliation(s)
- Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Brittany A Trottier
- Superfund Research Program, National Institute of Environmental Health Sciences, 530 Davis Drive, Durham, NC, 27709, USA
| | - Catherine M Bulka
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, USA
| | - Stephania A Cormier
- LSU Superfund Research Program, Louisiana State University, Baton Rouge, USA
| | - Julius Fobil
- Department of Biological, Environmental and Occupational Health Science, University of Ghana, Accra, Ghana
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, USA
| | - Kyoung-Woong Kim
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Steven Kleeberger
- Immunity, Inflammation, and Disease Laboratory, National Institute of Environmental Health Sciences, Durham, USA
| | | | - Philip J Landrigan
- Schiller Institute for Integrated Science and Society, Boston College, Chestnut Hill, USA
| | - Karin C Lodrop Carlsen
- Division of Paediatric and Adolescent Medicine, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Antonio Pascale
- Department of Toxicology, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | | | | | - Heather J Zar
- Dept of Paediatrics & Child Health and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - William A Suk
- Superfund Research Program, National Institute of Environmental Health Sciences, 530 Davis Drive, Durham, NC, 27709, USA.
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53
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Doagooyan M, Alavizadeh SH, Akhtari J, Sahebkar A, Kiade SGH, Kochesfahani PH, Gheybi F. Investigation of structural, treatment and clinical characteristics of COVID-19 along with the challenges caused by its prevalence. Infect Disord Drug Targets 2021; 22:e220321192415. [PMID: 33749564 DOI: 10.2174/1871526521666210322160038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/11/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022]
Abstract
In the late 2019, a report from China was published stating a disease with unknown cause. After that,the outbreak of the COVID-19 caused a pandemic in the world. On March 11, 2020, the outbreak of this virus was reported in 100 countries. The virus is currently spreading rapidly around the world.In the past, coronaviruses caused life-threatening diseases such as SARS and MERSsome areas.Although there is still a debate about the origin of this new coronavirus, it is most likely linked with some animals including bats, civet and pangolin. In this review, we try to simply describe the features of the new coronavirusas well as the recent diagnostic and therapeutic findings.
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Affiliation(s)
- Maham Doagooyan
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran
| | - Seyedeh Hoda Alavizadeh
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad. Iran
| | - Javad Akhtari
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari. Iran
| | | | | | | | - Fatemeh Gheybi
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad. Iran
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54
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Friston KJ, Parr T, Zeidman P, Razi A, Flandin G, Daunizeau J, Hulme OJ, Billig AJ, Litvak V, Price CJ, Moran RJ, Lambert C. Second waves, social distancing, and the spread of COVID-19 across the USA. Wellcome Open Res 2021; 5:103. [PMID: 33954262 PMCID: PMC8063524 DOI: 10.12688/wellcomeopenres.15986.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
We recently described a dynamic causal model of a COVID-19 outbreak within a single region. Here, we combine several instantiations of this (epidemic) model to create a (pandemic) model of viral spread among regions. Our focus is on a second wave of new cases that may result from loss of immunity-and the exchange of people between regions-and how mortality rates can be ameliorated under different strategic responses. In particular, we consider hard or soft social distancing strategies predicated on national (Federal) or regional (State) estimates of the prevalence of infection in the population. The modelling is demonstrated using timeseries of new cases and deaths from the United States to estimate the parameters of a factorial (compartmental) epidemiological model of each State and, crucially, coupling between States. Using Bayesian model reduction, we identify the effective connectivity between States that best explains the initial phases of the outbreak in the United States. Using the ensuing posterior parameter estimates, we then evaluate the likely outcomes of different policies in terms of mortality, working days lost due to lockdown and demands upon critical care. The provisional results of this modelling suggest that social distancing and loss of immunity are the two key factors that underwrite a return to endemic equilibrium.
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Affiliation(s)
- Karl J. Friston
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Thomas Parr
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Peter Zeidman
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Adeel Razi
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
| | - Guillaume Flandin
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Jean Daunizeau
- Institut du Cerveau et de la Moelle épinière, INSERM UMRS 1127, Paris, France
| | - Oliver J. Hulme
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- London Mathematical Laboratory, Hammersmith, UK
| | | | - Vladimir Litvak
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Catherine J. Price
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Rosalyn J. Moran
- Centre for Neuroimaging Science, Department of Neuroimaging, IoPPN, King's College London, London, UK
| | - Christian Lambert
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
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55
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Friston KJ, Parr T, Zeidman P, Razi A, Flandin G, Daunizeau J, Hulme OJ, Billig AJ, Litvak V, Price CJ, Moran RJ, Lambert C. Second waves, social distancing, and the spread of COVID-19 across the USA. Wellcome Open Res 2021; 5:103. [PMID: 33954262 PMCID: PMC8063524 DOI: 10.12688/wellcomeopenres.15986.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/12/2023] Open
Abstract
We recently described a dynamic causal model of a COVID-19 outbreak within a single region. Here, we combine several instantiations of this (epidemic) model to create a (pandemic) model of viral spread among regions. Our focus is on a second wave of new cases that may result from loss of immunity-and the exchange of people between regions-and how mortality rates can be ameliorated under different strategic responses. In particular, we consider hard or soft social distancing strategies predicated on national (Federal) or regional (State) estimates of the prevalence of infection in the population. The modelling is demonstrated using timeseries of new cases and deaths from the United States to estimate the parameters of a factorial (compartmental) epidemiological model of each State and, crucially, coupling between States. Using Bayesian model reduction, we identify the effective connectivity between States that best explains the initial phases of the outbreak in the United States. Using the ensuing posterior parameter estimates, we then evaluate the likely outcomes of different policies in terms of mortality, working days lost due to lockdown and demands upon critical care. The provisional results of this modelling suggest that social distancing and loss of immunity are the two key factors that underwrite a return to endemic equilibrium.
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Affiliation(s)
- Karl J. Friston
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Thomas Parr
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Peter Zeidman
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Adeel Razi
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
| | - Guillaume Flandin
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Jean Daunizeau
- Institut du Cerveau et de la Moelle épinière, INSERM UMRS 1127, Paris, France
| | - Oliver J. Hulme
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- London Mathematical Laboratory, Hammersmith, UK
| | | | - Vladimir Litvak
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Catherine J. Price
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Rosalyn J. Moran
- Centre for Neuroimaging Science, Department of Neuroimaging, IoPPN, King's College London, London, UK
| | - Christian Lambert
- The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3BG, UK
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56
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Sinaei R, Pezeshki S, Parvaresh S, Sinaei R. Why COVID-19 is less frequent and severe in children: a narrative review. World J Pediatr 2021; 17:10-20. [PMID: 32978651 PMCID: PMC7518650 DOI: 10.1007/s12519-020-00392-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the streaks of severity, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is, in general, less frequent and severe in children than in adults. We searched for causal evidence of this mystery. DATA SOURCES An extensive search strategy was designed to identify papers on coronavirus disease 2019 (COVID-19). We searched Ovid MEDLINE, PubMed, EMBASE databases, and Cochrane library and carried out a review on the causes of this dilemma. RESULTS Our searches produced 81 relevant articles. The review showed that children accounted for a lower percentage of reported cases, and they also experienced less severe illness courses. Some potential explanations, including the tendency to engage the upper airway, the different expression in both receptors of angiotensin-converting enzyme and renin-angiotensin system, a less vigorous immune response, the lower levels of interleukin (IL)-6, IL-10, myeloperoxidase, and P-selectin and a higher intracellular adhesion molecule-1, a potential protective role of lymphocytes, and also lung infiltrations might have protective roles in the immune system-respiratory tract interactions. Finally, what have shed light on this under representation comes from two studies that revealed high-titer immunoglobulin-G antibodies against respiratory syncytial virus and mycoplasma pneumonia, may carry out cross-protection against SARS-CoV-2 infection, just like what suggested about the vaccines. CONCLUSIONS These results require an in-depth look. Properties of the immune system including a less vigorous adaptive system beside a preliminary potent innate response and a trained immunity alongside a healthier respiratory system, and their interactions, might protect children against SARS-CoV-2 infection. However, further studies are needed to explore other possible causes of this enigma.
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Affiliation(s)
- Reza Sinaei
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Saeedeh Parvaresh
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Sinaei
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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57
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Kloc M, Ghobrial RM, Lipińska-Opałka A, Wawrzyniak A, Zdanowski R, Kalicki B, Kubiak JZ. Effects of vitamin D on macrophages and myeloid-derived suppressor cells (MDSCs) hyperinflammatory response in the lungs of COVID-19 patients. Cell Immunol 2021; 360:104259. [PMID: 33359760 PMCID: PMC7738277 DOI: 10.1016/j.cellimm.2020.104259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022]
Abstract
Vitamin D regulates homeostasis, anti-microbial response, and inflammation. The vitamin D receptors are expressed in the macrophages and other immune cells, regulating the transcription of many different genes, including those coding the anti-microbial peptides. One of the most severe complications of the SARS-CoV-2 infection is the acute respiratory distress syndrome (ARDS) caused by the hyperinflammatory response (commonly called cytokine storm) of the lung macrophages. Studies showed that Vitamin D deficiency increases the severity of the ARDS in COVID-19 infection. We discuss here how the vitamin D supplementation may influence macrophage and myeloid-derived suppressor cells (MDSCs) inflammatory response, subdue the hyperinflammatory response, and lessen the ARDS in COVID-19 patients.
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Affiliation(s)
- Malgorzata Kloc
- The Houston Methodist Research Institute, Houston, TX 77030, USA; The Houston Methodist Hospital, Department of Surgery, Houston, TX, USA; The University of Texas, M.D. Anderson Cancer Center, Department of Genetics, Houston, TX, USA.
| | - Rafik M Ghobrial
- The Houston Methodist Research Institute, Houston, TX 77030, USA; The Houston Methodist Hospital, Department of Surgery, Houston, TX, USA
| | - Agnieszka Lipińska-Opałka
- Military Institute of Medicine, Clinic of Paediatrics, Nephrology and Child Allergology, Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Agata Wawrzyniak
- Military Institute of Medicine, Clinic of Paediatrics, Nephrology and Child Allergology, Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Robert Zdanowski
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine (WIM), Warsaw, Poland
| | - Boleslaw Kalicki
- Military Institute of Medicine, Clinic of Paediatrics, Nephrology and Child Allergology, Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Jacek Z Kubiak
- Laboratory of Regenerative Medicine and Cell Biology, Military Institute of Hygiene and Epidemiology (WIHE), Warsaw, Poland; UnivRennes, UMR 6290, CNRS, Institute of Genetics and Development of Rennes, Cell Cycle Group, Faculty of Medicine, Rennes, France.
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58
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Leung C. The younger the milder clinical course of COVID-19: Even in newborns? Pediatr Allergy Immunol 2021; 32:358-362. [PMID: 32931058 DOI: 10.1111/pai.13371] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/13/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Milder symptoms were observed in children with COVID-19. However, whether this also holds true for neonates is not known. METHODS The clinical data of a total of 3213 patients aged 2 years or below, including 749 neonates, in Brazil nationwide were studied. Comparisons were made between neonate and infant patients by conducting statistical tests. RESULTS Neonates appeared to bear more severe clinical courses. In addition to higher case fatality rates, newborns with COVID-19 had much shorter time from symptom onset to death and longer time from symptom onset to discharge. Dyspnoea, sore throat and cough were more prominent in neonate patients, suggestive of both upper and lower respiratory tract infection, as opposed to upper respiratory tract symptoms mostly observed in children. CONCLUSION Findings suggested that trained immunity provides a possible explanation because the innate immune system in newborns is not "well-trained" while that in adult tends to hyperactive.
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Affiliation(s)
- Char Leung
- Deakin University, Burwood, Vic, Australia
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59
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Cardenas MC, Bustos SS, Enninga EAL, Mofenson L, Chakraborty R. Characterising and managing paediatric SARSCoV-2 infection: Learning about the virus in a global classroom. Acta Paediatr 2021; 110:409-422. [PMID: 33175403 DOI: 10.1111/apa.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023]
Abstract
AIM This study is a comprehensive review with the purpose of collecting the most relevant data in several sections including current treatment guidelines in the paediatric population. METHODS Literature was systematically searched in different databases. Results were limited to 2019+ and English, French and Spanish language. RESULTS Children can exhibit mild and less severe COVID-19 disease than adults and also have asymptomatic carriage of SARS-CoV-2, while severe disease is more frequently noted during infancy (<1 year). SARS-CoV-2 binds the angiotensin-converting enzyme 2 (ACE-2) receptor; age-, racial-, and gender-specific differences in ACE-2 expression need to be elucidated in order to explain the differential clinical profiles between children and adults. Multisystem inflammatory syndrome in children (MIS-C) is an important condition to recognise in children. The decision to use antiviral or immunomodulatory therapy in a child or adolescent should be individualised based on the clinical scenario. Remdesivir is the only FDA-approved therapy available for children older than 12 years old who require hospitalisation for COVID-19. CONCLUSION Further studies are urgently required to address prevention and treatment in at-risk and infected children, especially with underlying comorbidities. The chapter on the overall impact of COVID-19 in children has not yet been written. Nevertheless, SARS-CoV-2 has now joined a long list of human pandemics, which may forever change the world's history.
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Affiliation(s)
- Maria C. Cardenas
- Division of Pediatric Infectious Diseases Department of Mayo Clinic Rochester Minnesota USA
| | - Samyd S. Bustos
- Department of Surgery Mayo Clinic Rochester Minnesota USA
- Center for Regenerative Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation Washington District of Columbia USA
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases Department of Mayo Clinic Rochester Minnesota USA
- Department of Obstetrics and Gynecology Mayo Clinic Rochester Minnesota USA
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60
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Santos JC, Ribeiro ML, Gambero A. The Impact of Polyphenols-Based Diet on the Inflammatory Profile in COVID-19 Elderly and Obese Patients. Front Physiol 2021; 11:612268. [PMID: 33584335 PMCID: PMC7874176 DOI: 10.3389/fphys.2020.612268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
The World Health Organization declared the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated disease (coronavirus disease 2019 - COVID-19) as a pandemic in March 2020. COVID-19 is characterized by cytokine storm, acute respiratory distress syndrome (ARDS), and systemic inflammation-related pathology and already kills more than 1.5 million of people worldwide. Since aged and obese COVID-19 patients exhibit an enhanced inflammatory status, they represent a high-risk cluster for rapidly progressive clinical deterioration. These individuals present comorbid disorders and immunosenescence that may promote viral-induced cytokine storm and expression of molecules acting as virus receptor as angiotensin I converting enzyme 2 (ACE2) and CD26 (dipeptidyl-peptidase 4), resulting in respiratory failure and increased morbidity and mortality. A better knowledge of SARS-CoV-2 infection in inflammatory-associated high-risk population is essential in order to develop the therapies needed to combat or prevent severe COVID-19. Here, we review the pathogenesis and clinical implications of inflammatory disorders and disease markers associated to senescence in COVID-19 patients and the emerging evidence to argue that a high intake of polyphenols may have a protective effect on SARS-CoV-2 illness severity.
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Affiliation(s)
- Juliana Carvalho Santos
- Lymphoma Translational Group, Josep Carreras Leukaemia Research Institute (IJC), Badalona, Spain
| | - Marcelo Lima Ribeiro
- Laboratory of Immunopharmacology and Molecular Biology, Sao Francisco University, Bragança Paulista, Brazil
| | - Alessandra Gambero
- Life Science Center, Pontifical Catholic University of Campinas (PUCCAMP), Campinas, Brazil
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61
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Platt DE, Parida L, Zalloua P. Lies, Gosh Darn Lies, and not enough good statistics: why epidemic model parameter estimation fails. Sci Rep 2021; 11:408. [PMID: 33432032 PMCID: PMC7801491 DOI: 10.1038/s41598-020-79745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/02/2020] [Indexed: 12/03/2022] Open
Abstract
We sought to investigate whether epidemiological parameters that define epidemic models could be determined from the epidemic trajectory of infections, recovery, and hospitalizations prior to peak, and also to evaluate the comparability of data between jurisdictions reporting their statistics. We found that, analytically, the pre-peak growth of an epidemic underdetermines the model variates, and that the rate limiting variables are dominated by the exponentially expanding eigenmode of their equations. The variates quickly converge to the ratio of eigenvector components of the positive growth mode, which determines the doubling time. Without a sound epidemiological study framework, measurements of infection rates and other parameters are highly corrupted by uneven testing rates, uneven counting, and under reporting of relevant values. We argue that structured experiments must be performed to estimate these parameters in order to perform genetic association studies, or to construct viable models accurately predicting critical quantities such as hospitalization loads.
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Affiliation(s)
- Daniel E Platt
- Computational Genomics, IBM T. J. Watson Research Center, New York, USA.
| | - Laxmi Parida
- Computational Genomics, IBM T. J. Watson Research Center, New York, USA
| | - Pierre Zalloua
- TH Chan Harvard School of Public Health, Harvard University, Cambridge, USA.
- School of Medicine, University of Balamand, P.O. Box 33, Amioun, Lebanon.
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62
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Pinna G, Sanfilippo L, Bassareo PP, Fanos V, Marcialis MA. COVID-19 and Comorbidities: Is Inflammation the Underlying Condition in Children? A Narrative Review. Curr Pediatr Rev 2021; 17:38-44. [PMID: 33183207 DOI: 10.2174/1573396316666201112093920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023]
Abstract
This paper examines the potential link between COVID-19 and the presence of comorbidities and assesses the role of inflammation in this correlation. In COVID-19 patients, the most frequently associated diseases share a pathogenic inflammatory basis and apparently act as a risk factor in the onset of a more severe form of the disease, particularly in adulthood. However, in children, the understanding of the underlying pathogenic mechanisms is often complicated by the milder symptoms presented. A series of theories have, therefore, been put forward with a view of providing a better understanding of the role played by inflammation in this dramatic setting. All evidence available to date on this topic is discussed in this review.
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Affiliation(s)
- Giulia Pinna
- Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy
| | | | - Pier Paolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy
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63
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Parisi GF, Indolfi C, Decimo F, Leonardi S, Miraglia del Giudice M. Neumonía por COVID-19 en niños: De su etiología a su manejo. KOMPASS NEUMOLOGÍA 2021. [PMCID: PMC8089434 DOI: 10.1159/000516059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
El COVID-19 es menos serio en niños que en adultos. Sin embargo, las afecciones respiratorias dominan el cuadro clínico de pacientes hospitalizados por COVID-19, aun en niños. En algunas series de casos, el deterioro del estado clínico, donde la disnea, la cianosis y el inicio del síndrome de dificultad respiratoria aguda (SDRA) emergieron ∼8–10 días después del inicio de la infección por SARS-CoV-2, pudo progresar rápidamente hasta la falla multiorgánica y la muerte. Esta revisión tiene como objetivo evaluar las características de la neumonía por COVID-19 en poblaciones pediátricas, comenzando con su etiología y sus mecanismos patológicos, para cerrar con su manejo clínico.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Departamento de Medicina Clínica y Experimental, Universidad de Catania, Catania, Italia
| | - Cristiana Indolfi
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | - Fabio Decimo
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | - Salvatore Leonardi
- Departamento de Medicina Clínica y Experimental, Universidad de Catania, Catania, Italia
| | - Michele Miraglia del Giudice
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
- * Ass. Prof. Dr. Michele Miraglia del Giudice,
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64
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Ha JF. COVID-19 in Children: A Narrative Review. Curr Pediatr Rev 2021; 17:212-219. [PMID: 34042036 DOI: 10.2174/1573396317666210526155313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/31/2020] [Accepted: 03/06/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic is caused by the third known zoonotic coronavirus. It is a disease that does not spare any age group. The scientific community has been inundated with information since January. This review aims to summarise pertinent information related to COVID-19 in children. METHODS A literature search was conducted in 2020 on the PubMed, MEDLINE, and Embase databases, with the keyword "COVID 19" and "children". A bibliographic search of articles included was also undertaken. The abstracts were scanned to assess their appropriateness to be included in this narrative review. This was updated on the 11th April, 2020. RESULTS The aetiology, transmission, incubation, pathophysiology, clinical features and complications, and management are discussed. CONCLUSION Our understanding of COVID-19 is evolving as more reports are published. The growth of SARS-CoV2 is limited in children and they are often asymptomatic. The disease course is also milder. Continued research to understand its effect on children is important to help us manage the disease in these vulnerable populations in a timely fashion.
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Affiliation(s)
- Jennifer F Ha
- Department of Paediatrics Otolaryngology-Head & Neck Surgery, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, Western Australia, Australia
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65
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Zhou B, Yuan Y, Wang S, Zhang Z, Yang M, Deng X, Niu W. Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients. Pediatr Res 2021; 90:347-352. [PMID: 33753892 PMCID: PMC7984508 DOI: 10.1038/s41390-021-01429-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND We prepared a meta-analysis on case reports in children with COVID-19, aiming to identify potential risk factors for severe illness and to develop a prediction model for risk assessment. METHODS Literature retrieval, case report selection, and data extraction were independently completed by two authors. STATA software (version 14.1) and R programming environment (v4.0.2) were used for data handling. RESULTS This meta-analysis was conducted based on 52 case reports, including 203 children (96 boys) with COVID-19. By severity, 26 (12.94%), 160 (79.60%), and 15 (7.46%) children were diagnosed as asymptomatic, mild/moderate, and severe cases, respectively. After adjusting for age and sex, 11 factors were found to be significantly associated with the risk of severe illness relative to asymptomatic or mild/moderate illness, especially for dyspnea/tachypnea (odds ratio, 95% confidence interval, P: 6.61, 4.12-9.09, <0.001) and abnormal chest X-ray (3.33, 1.84-4.82, <0.001). A nomogram modeling age, comorbidity, cough, dyspnea or tachypnea, CRP, and LDH was developed, and prediction performance was good as reflected by the C-index. CONCLUSIONS Our findings provide systematic evidence for the contribution of comorbidity, cough, dyspnea or tachypnea, CRP, and LDH, both individually and jointly, to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19. IMPACT We have identified potential risk factors for severe illness in children with COVID-19. We have developed a prediction model to facilitate risk assessment in children with COVID-19. We found the contribution of five risk factors to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19.
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Affiliation(s)
- Bo Zhou
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Yuan
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Shunan Wang
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Min Yang
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Xiangling Deng
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
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Collin J, Queen R, Zerti D, Dorgau B, Georgiou M, Djidrovski I, Hussain R, Coxhead JM, Joseph A, Rooney P, Lisgo S, Figueiredo F, Armstrong L, Lako M. Co-expression of SARS-CoV-2 entry genes in the superficial adult human conjunctival, limbal and corneal epithelium suggests an additional route of entry via the ocular surface. Ocul Surf 2021; 19:190-200. [PMID: 32502616 PMCID: PMC7267807 DOI: 10.1016/j.jtos.2020.05.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The high infection rate of SARS-CoV-2 necessitates the need for multiple studies identifying the molecular mechanisms that facilitate the viral entry and propagation. Currently the potential extra-respiratory transmission routes of SARS-CoV-2 remain unclear. METHODS Using single-cell RNA Seq and ATAC-Seq datasets and immunohistochemical analysis, we investigated SARS-CoV-2 tropism in the embryonic, fetal and adult human ocular surface. RESULTS The co-expression of ACE2 receptor and entry protease TMPRSS2 was detected in the human adult conjunctival, limbal and corneal epithelium, but not in the embryonic and fetal ocular surface up to 21 post conception weeks. These expression patterns were corroborated by the single cell ATAC-Seq data, which revealed a permissive chromatin in ACE2 and TMPRSS2 loci in the adult conjunctival, limbal and corneal epithelium. Co-expression of ACE2 and TMPRSS2 was strongly detected in the superficial limbal, corneal and conjunctival epithelium, implicating these as target entry cells for SARS-CoV-2 in the ocular surface. Strikingly, we also identified the key pro-inflammatory signals TNF, NFKβ and IFNG as upstream regulators of the transcriptional profile of ACE2+TMPRSS2+ cells in the superficial conjunctival epithelium, suggesting that SARS-CoV-2 may utilise inflammatory driven upregulation of ACE2 and TMPRSS2 expression to enhance infection in ocular surface. CONCLUSIONS Together our data indicate that the human ocular surface epithelium provides an additional entry portal for SARS-CoV-2, which may exploit inflammatory driven upregulation of ACE2 and TMPRSS2 entry factors to enhance infection.
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Affiliation(s)
- Joseph Collin
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Rachel Queen
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Darin Zerti
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK; Microscopy Centre and Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Birthe Dorgau
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Maria Georgiou
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Ivo Djidrovski
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Rafiqul Hussain
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Jonathan M Coxhead
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Agatha Joseph
- NHS Blood and Transplant Tissue and Eye Services, Liverpool, UK
| | - Paul Rooney
- NHS Blood and Transplant Tissue and Eye Services, Liverpool, UK
| | - Steven Lisgo
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Francisco Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary and Newcastle University, Newcastle, UK
| | - Lyle Armstrong
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Majlinda Lako
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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Janowski A. Epilogue. BIOCHEMICAL AND MOLECULAR BASIS OF PEDIATRIC DISEASE 2021. [PMCID: PMC8119281 DOI: 10.1016/b978-0-12-817962-8.00052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bloise S, Marcellino A, Testa A, Dilillo A, Mallardo S, Isoldi S, Martucci V, Sanseviero MT, Del Giudice E, Iorfida D, Ventriglia F, Lubrano R. Serum IgG levels in children 6 months after SARS-CoV-2 infection and comparison with adults. Eur J Pediatr 2021; 180:3335-3342. [PMID: 34023936 PMCID: PMC8140562 DOI: 10.1007/s00431-021-04124-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
Since the outbreak of SARS-CoV-2 among the population has occurred quite recently, there is a lack of evidence on the long-term duration of antibody response, especially in children. It is therefore crucial to clarify this aspect, considering its implications in the development of successful surveillance strategies, therapies, and vaccinations. The aim of this study was to assess the antibody response in a children group after SARS-CoV-2 infection, and to compare it with that of their parents affected by SARS-CoV-2 infection. We enrolled 12 children and their parents, both groups being affected by COVID-19 in April 2020. In the children's group, we collected real-time RT-PCR cycle threshold (Ct) values and gene characterization of first nasal-throat swab at the time of diagnosis (T0); 30 days after the diagnosis (T30), we performed blood tests to detect anti-SARS-CoV-2 IgM and IgG. Finally, 180 days after the diagnosis (T180), we measured anti-SARS-CoV-2 IgG in both children and parents. In children, antibody levels declined significantly at 180 days (T180) after first measurement (T30). There were no significant differences in IgG level related to age, sex, and clinical manifestations. We found a significant correlation between IgG titers at T30 and Ct value of gene N. Children showed a lower level of antibodies against SARS-CoV-2 at T180 compared to their parents.Conclusion: Antibody responses in children waned 180 days after SARS-CoV-2 infection, and at the same time, their parents showed a different antibody response to the virus. These results highlight that serological tests should be used with caution in surveillance strategies among the general population. What is known: • Currently is not known how long antibody response will be maintained or if it protects from reinfection. • Recent reports in adults suggest that antibodies to SARS-CoV-2 declined several months after infection, but data are missing in pediatric age. What is new: • We showed that antibody responses to SARS-CoV-2 wane several months after infection also in children with quantitative differences in antibody levels between children and adults. • In this context, serological tests should be used with caution in surveillance strategies.
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Affiliation(s)
- Silvia Bloise
- Dipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy.
| | - Alessia Marcellino
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Alessia Testa
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Anna Dilillo
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Saverio Mallardo
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Sara Isoldi
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Vanessa Martucci
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Maria Teresa Sanseviero
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Emanuela Del Giudice
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Donatella Iorfida
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Flavia Ventriglia
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Riccardo Lubrano
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
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Temel H, Gündüz M, Arslan H, Ünal F, Atağ E, Cömert M, Doğan MS, Erkesim R, Okur M, Öktem S, Tosun Aİ. Evaluation of the Clinical Features of 81 Patients with COVID-19: An Unpredictable Disease in Children. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1721511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objective Data on the prognosis of clinical features of pediatric patients affected by the coronavirus disease 2019 (COVID-19) pandemic is insufficient. This study aimed to examine the clinical, laboratory, and radiology findings of pediatric patients diagnosed with COVID-19.
Methods A total of 81 pediatric patients with a confirmed diagnosis of COVID-19 who were admitted to the pediatric clinics of our tertiary care hospital in Istanbul between March 22 and May 1, 2020, were included in the study.
Results Of the patients, 40 (49.6%) were boys and 41 (50.6%) were girls. The mean age of the patients was 9.3 ± 5.5 years (range: 1 month–16 years). The most common symptoms were cough (28.4%) and fever (25.9%). A total of 26 patients (32.1%) had pharyngeal erythema. There was no significant difference between age groups in terms of symptoms, findings, clinical picture, history of contact, and clinical course (p > 0.001 for each). Abnormal findings were observed in seven (8.6%) patients on chest X-ray, and in four patients (4.9%) on thorax computed tomography. Only three of the patients were hospitalized and all of them discharged with healing.
Conclusion The present study is the most comprehensive study on children diagnosed with COVID-19 in our country, which showed that the COVID-19 picture was mild in pediatric patients, but the signs and symptoms in children were not specific to the disease. Our findings also showed that the rate of asymptomatic infection in children was high and that it was difficult to recognize COVID-19 in children.
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Affiliation(s)
- Hayrettin Temel
- Department of Pediatrics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Gündüz
- Department of Pediatrics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hüseyin Arslan
- Department of Pediatric Chest Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Füsun Ünal
- Department of Pediatric Chest Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Emine Atağ
- Department of Pediatric Chest Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Cömert
- Department of Pediatrics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Sait Doğan
- Department of Pediatric Radiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Remzi Erkesim
- Department of Pediatrics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mesut Okur
- Department of Pediatrics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sedat Öktem
- Department of Pediatric Chest Diseases, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ayşe İstanbullu Tosun
- Department of Medical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Parisi GF, Indolfi C, Decimo F, Leonardi S, Miraglia del Giudice M. COVID-19 Pneumonia in Children: From Etiology to Management. Front Pediatr 2020; 8:616622. [PMID: 33381482 PMCID: PMC7767924 DOI: 10.3389/fped.2020.616622] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is less serious in children than in adults. However, respiratory management dominates the clinical picture of hospitalized COVID-19 even in children. In some case series, deterioration of the clinical picture wherein dyspnea, cyanosis, and the onset of acute respiratory distress syndrome (ARDS) emerged ~8-10 days after the onset of SARS-CoV-2 infection, which could rapidly progress to multiple organ failure and death. This review aimed to evaluate the characteristics of COVID-19 pneumonia in pediatric populations, beginning from its etiology and pathological mechanisms and closing with its clinical management.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Quaranta L, Rovida F, Riva I, Bruttini C, Brambilla I, Baldanti F, De Angelis G, Marseglia GL. Identification of SARS-CoV-2 RNA in the conjunctival swab of an Italian pediatric patient affected with COVID-19: A case report. Eur J Ophthalmol 2020; 32:1120672120977822. [PMID: 33267605 PMCID: PMC8935152 DOI: 10.1177/1120672120977822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/10/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION To report a case of identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in ocular specimen in a pediatric patient affected with Coronavirus disease 2019 (COVID-19) with no signs of ocular involvement. CASE DESCRIPTION A 11-year old male patient with confirmed COVID-19 infection was hospitalized at the Pediatric Clinic Clinic of the IRCCS Foundation and Hospital San Matteo, Pavia, Italy. Three days after hospital admission, because of the patient complaining very mild ocular symptoms, an ophthalmological evaluation was performed. No signs related to conjunctivitis or keratitis were found but a conjunctival swab was collected as well, based on patient's medical history. The specific SARS-CoV-2 reverse transcription PCR (RT-PCR) was performed, unearthing the presence of viral RNA from the swab. On day 25 from hospitalization, the conjunctival swab was repeated, giving negative result. CONCLUSIONS This is the first report of the identification of SARS-CoV-2 RNA in ocular specimen in a pediatric patient without signs of ocular involvement. However, despite the transmission through tears is theoretically possible, it is still unclear whether this could be considered as an important route for the spread of SARS-CoV-2.
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Affiliation(s)
- Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Rovida
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Carlo Bruttini
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Brambilla
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giovanni De Angelis
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Ing RJ, Chatterjee D, Twite MD. Resuscitating Children with COVID-19: What the Pediatric Anesthesiologist Needs to Know. J Cardiothorac Vasc Anesth 2020; 34:3182-3185. [PMID: 32624434 PMCID: PMC7296315 DOI: 10.1053/j.jvca.2020.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Mark D Twite
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings. Pathology 2020; 52:801-808. [PMID: 32888706 PMCID: PMC7437539 DOI: 10.1016/j.pathol.2020.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
As the SARS-CoV-2 pandemic unfolds across the globe, consistent themes are emerging with regard to aspects of SARS-CoV-2 infection and its associated disease entities in children. Overall, children appear to be less frequently infected by, and affected by, SARS-CoV-2 virus and the clinical disease COVID-19. Large epidemiological studies have revealed children represent less than 2% of the total confirmed COVID-19 cases, of whom the majority experience minimal or mild disease that do not require hospitalisation. Children do not appear to be major drivers of SARS-CoV-2 transmission, with minimal secondary virus transmission demonstrated within families, schools and community settings. There are several postulated theories regarding the relatively low SARS-CoV-2 morbidity and mortality seen in children, which largely relate to differences in immune responses compared to adults, as well as differences in angiotensin converting enzyme 2 distribution that potentially limits viral entry and subsequent inflammation, hypoxia and tissue injury. The recent emergence of a multisystem inflammatory syndrome bearing temporal and serological plausibility for an immune-mediated SARS-CoV-2-related disease entity is currently under investigation. This article summarises the current available data regarding SARS-CoV-2 and the paediatric population, including the spectrum of disease in children, the role of children in virus transmission, and host-virus factors that underpin the unique aspects of SARS-CoV-2 pathogenicity in children.
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Sohag AAM, Hannan MA, Rahman S, Hossain M, Hasan M, Khan MK, Khatun A, Dash R, Uddin MJ. Revisiting potential druggable targets against SARS-CoV-2 and repurposing therapeutics under preclinical study and clinical trials: A comprehensive review. Drug Dev Res 2020; 81:919-941. [PMID: 32632960 PMCID: PMC7361641 DOI: 10.1002/ddr.21709] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is one of the most contagious diseases in human history that has already affected millions of lives worldwide. To date, no vaccines or effective therapeutics have been discovered yet that may successfully treat COVID-19 patients or contain the transmission of the virus. Scientific communities across the globe responded rapidly and have been working relentlessly to develop drugs and vaccines, which may require considerable time. In this uncertainty, repurposing the existing antiviral drugs could be the best strategy to speed up the discovery of effective therapeutics against SARS-CoV-2. Moreover, drug repurposing may leave some vital information on druggable targets that could be capitalized in target-based drug discovery. Information on possible drug targets and the progress on therapeutic and vaccine development also needs to be updated. In this review, we revisited the druggable targets that may hold promise in the development of the anti-SARS-CoV-2 agent. Progresses on the development of potential therapeutics and vaccines that are under the preclinical studies and clinical trials have been highlighted. We anticipate that this review will provide valuable information that would help to accelerate the development of therapeutics and vaccines against SARS-CoV-2 infection.
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Affiliation(s)
- Abdullah Al Mamun Sohag
- Department of Biochemistry and Molecular BiologyBangladesh Agricultural UniversityMymensingh2202Bangladesh
| | - Md Abdul Hannan
- Department of Biochemistry and Molecular BiologyBangladesh Agricultural UniversityMymensingh2202Bangladesh
- Department of AnatomyDongguk University College of MedicineGyeongju38066South Korea
- ABEx Bio‐Research CenterEast Azampur, DhakaBangladesh
| | - Sadaqur Rahman
- Department of Biochemistry and Molecular BiologyShahjalal University of Science and TechnologySylhetBangladesh
| | - Motaher Hossain
- Department of Biological SciencesThe University of AlabamaTuscaloosaAlabamaUSA
| | - Mahmudul Hasan
- Department of Pharmaceuticals and Industrial BiotechnologySylhet Agricultural UniversitySylhetBangladesh
| | - Md Kawsar Khan
- Department of Biochemistry and Molecular BiologyShahjalal University of Science and TechnologySylhetBangladesh
- Department of Biological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Amena Khatun
- Northern International Medical College HospitalDhakaBangladesh
| | - Raju Dash
- Department of AnatomyDongguk University College of MedicineGyeongju38066South Korea
| | - Md Jamal Uddin
- ABEx Bio‐Research CenterEast Azampur, DhakaBangladesh
- Graduate School of Pharmaceutical Sciences, College of PharmacyEwha Womans UniversitySeoulRepublic of Korea
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75
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Murillo-Zamora E, Aguilar-Sollano F, Delgado-Enciso I, Hernandez-Suarez CM. Predictors of laboratory-positive COVID-19 in children and teenagers. Public Health 2020; 189:153-157. [PMID: 33246302 PMCID: PMC7584439 DOI: 10.1016/j.puhe.2020.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the study was to identify factors predicting laboratory-positive coronavirus disease 2019 (COVID-19) in pediatric patients with acute respiratory symptoms. STUDY DESIGN We conducted a cross-sectional analysis of a prospective cohort study. METHODS Data from 1849 individuals were analyzed. COVID-19 was confirmed (reverse transcription-quantitative polymerase chain reaction) in 15.9% of patients, and factors predicting a positive test result were evaluated through prevalence odds ratios and 95% confidence intervals. RESULTS Increasing age, personal history of obesity, and household contact with a case were found to be associated, in the multiple regression model, with increased odds of a positive test result. Young patients residing in areas with higher population sizes, as well as those with severe respiratory symptoms, were less likely to be laboratory confirmed. CONCLUSIONS Early identification and isolation of children and teenagers with suggestive symptoms of COVID-19 is important to limit viral spread. We identified several factors predicting the laboratory test result. Our findings are relevant from a public health policy perspective, particularly after the restart of in-person academic activities.
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Affiliation(s)
- E Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico; Facultad de Medicina, Universidad de Colima, Colima, Colima, Mexico
| | - F Aguilar-Sollano
- Programa de Maestr´ıa en Ciencias Me´dicas, Facultad de Medicina, Universidad de Colima, Colima, Colima, Mexico
| | - I Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Colima, Colima, Mexico; Instituto Estatal de Cancerolog´ıa, Servicios de Salud del Estado de Colima, Colima, Colima, Mexico
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76
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He D, Zhang Q. Additional Concerns Regarding Children With Coronavirus Disease 2019. JAMA Pediatr 2020; 174:1218. [PMID: 33104180 DOI: 10.1001/jamapediatrics.2020.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Danni He
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Qi Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
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77
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Khanna S. The 3C's: COVID-19, Children, and Cardiac Surgery - Do we know enough? Braz J Cardiovasc Surg 2020; 35:1029-1030. [PMID: 33113323 PMCID: PMC7731850 DOI: 10.21470/1678-9741-2020-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Sudhansoo Khanna
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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78
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Ismail MB, Omari SA, Rafei R, Dabboussi F, Hamze M. COVID-19 in children: Could pertussis vaccine play the protective role? Med Hypotheses 2020; 145:110305. [PMID: 33032174 PMCID: PMC7521348 DOI: 10.1016/j.mehy.2020.110305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
While COVID-19 continues to spread across the globe, diligent efforts are made to understand its attributes and dynamics to help develop treatment and prevention measures. The paradox pertaining to children being the least affected by severe illness poses exciting opportunities to investigate potential protective factors. In this paper, we propose that childhood vaccination against pertussis (whooping cough) might play a non-specific protective role against COVID-19 through heterologous adaptive responses in this young population. Pertussis is a vaccine-preventable infectious disease of the respiratory tract and it shares many similarities with COVID-19 including transmission and clinical features. Although pertussis is caused by a bacterium (Bordetella pertussis) while COVID-19 is a viral infection (SARS-CoV-2), previous data showed that cross-reactivity and heterologous adaptive responses can be seen with unrelated agents of highly divergent groups, such as between bacteria and viruses. While we build the arguments of this hypothesis on theoretical and previous empirical evidence, we also outline suggested lines of research from different fields to test its credibility. Besides, we highlight some concerns that may arise when attempting to consider such an approach as a potential public health preventive intervention against COVID-19.
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Affiliation(s)
- Mohamad Bachar Ismail
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Faculty of Sciences, Lebanese University, Tripoli, Lebanon
| | - Sarah Al Omari
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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79
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Barrett JS. Risk assessment of therapeutic agents under consideration to treat COVID-19 in paediatric patients and pregnant women. Br J Clin Pharmacol 2020; 87:3462-3480. [PMID: 33125791 DOI: 10.1111/bcp.14630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023] Open
Abstract
AIM Repurposing strategies to address the COVID-19 pandemic have been accelerated. As both pregnant and paediatric patients are likely to be excluded from most planned investigations, the list of repurposed options and the available data on these drugs and vaccines provide a baseline risk assessment and identify gaps for targeted investigation. METHODS Clinical trials have been searched and reviewed; 23 repurposed drugs and drug combinations and nine candidate vaccines have been assessed regarding the availability of relevant data in paediatrics and pregnant women and to evaluate expected or unanticipated risk. RESULTS Thirteen of the repurposed drugs or drug combinations are indicated for use in paediatrics in some age category albeit for indications other than COVID-19; 10 of these are indicated for use in pregnant women. Even in cases where these drugs are indicated in the populations, source data from which safety and or dosing could be extrapolated for use in COVID-19 is sparse. Vaccine trials are ongoing and generally exclude pregnant women; only in a few instances have paediatric subgroups been planned for enrolment. Data from individual case studies and RWD may suggest that subpopulations of both paediatric patients and pregnant women may be more at risk, particularly those in an increased inflammatory state. CONCLUSION In conjunction with more prospective collaboration, plans are evolving to ensure that we will be better prepared to address similar situations especially in paediatrics and pregnant women where experience is limited and actual practice relies heavily on leveraging data from other populations and indications.
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Affiliation(s)
- Jeffrey S Barrett
- Critical Path Institute, 1730 East River Road, Tucson, Arizona, 85718-5893, USA
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80
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SARS-CoV-2 Pandemic Impact on Pediatric Emergency Rooms: A Multicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238753. [PMID: 33255697 PMCID: PMC7728065 DOI: 10.3390/ijerph17238753] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/15/2022]
Abstract
From 9 March to 3 May 2020, lockdown was declared in Italy due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Our aim was to evaluate how the SARS-CoV-2 pandemic and related preventive strategies affected pediatric emergency rooms (ERs) during this period. We performed a retrospective cohort multicenter study, comparing the lockdown period to the corresponding period in 2019. We examined 15 Italian pediatric ERs in terms of visit rates, specific diagnoses (grouped as air communicable diseases and non-air communicable diseases), and triage categories. During the lockdown period, ER admissions decreased by 81% compared to 2019 (52,364 vs. 10,112). All ER specific diagnoses decreased in 2020 and this reduction was significantly higher for air communicable diseases (25,462 vs. 2934, p < 0.001). Considering the triage category, red codes remained similar (1% vs. 1%), yellow codes increased (11.2% vs. 22.3%), and green codes decreased (80.3% vs. 69.5%). We can speculate that social distancing and simple hygiene measures drastically reduced the spread of air communicable diseases. The increase in yellow codes may have been related to a delay in primary care and, consequently, in ER admissions.
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81
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Porritt RA, Paschold L, Noval Rivas M, Hongying Cheng M, Yonker LM, Chandnani H, Lopez M, Simnica D, Schultheiß C, Santiskulvong C, Van Eyk J, Fasano A, Bahar I, Binder M, Arditi M. Identification of a unique TCR repertoire, consistent with a superantigen selection process in Children with Multi-system Inflammatory Syndrome. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.11.09.372169. [PMID: 33200133 PMCID: PMC7668738 DOI: 10.1101/2020.11.09.372169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C), a hyperinflammatory syndrome associated with SARS-CoV-2 infection, shares many clinical features with toxic shock syndrome, which is triggered by bacterial superantigens. The superantigen specificity for binding different Vβ-chains results in Vβ-skewing, whereby T cells with specific Vβ-chains and diverse antigen specificity are overrepresented in the TCR repertoire. Here, we characterized the TCR repertoire of MIS-C patients and found a profound expansion of TCR Βeta Variable gene (TRBV)11-2. Furthermore, TRBV11-2 skewing was remarkably correlated with MIS-C severity and serum cytokine levels. Further analysis of TRBJ gene usage and CDR3 length distribution of MIS-C expanding TRBV11-2 clones revealed extensive junctional diversity, indicating a superantigen-mediated selection process for TRBV expansion. In silico modelling indicates that polyacidic residues in TCR Vβ11-2 engage in strong interactions with the superantigen-like motif of SARS-CoV-2 spike glycoprotein. Overall, our data indicate that the immune response in MIS-C is consistent with superantigenic activation.
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Affiliation(s)
- Rebecca A Porritt
- Departments of Pediatrics, Division of Infectious Diseases and Immunology, Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Magali Noval Rivas
- Departments of Pediatrics, Division of Infectious Diseases and Immunology, Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mary Hongying Cheng
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lael M Yonker
- Mucosal Immunology and Biology Research Center and Department of Pediatrics, Boston, Massachusetts General Hospital, MA, USA
| | - Harsha Chandnani
- Department of Pediatrics, Loma Linda University Hospital, CA, USA
| | - Merrick Lopez
- Department of Pediatrics, Loma Linda University Hospital, CA, USA
| | - Donjete Simnica
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | | | - Jennifer Van Eyk
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center and Department of Pediatrics, Boston, Massachusetts General Hospital, MA, USA
| | - Ivet Bahar
- Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Moshe Arditi
- Departments of Pediatrics, Division of Infectious Diseases and Immunology, Infectious and Immunologic Diseases Research Center (IIDRC) and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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82
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Boettcher AN, Hammoud DA, Weinberg JB, Agarwal P, Mendiratta-Lala M, Luker GD. Cancer Imaging and Patient Care during the COVID-19 Pandemic. Radiol Imaging Cancer 2020; 2:e200058. [PMID: 33778750 PMCID: PMC7706101 DOI: 10.1148/rycan.2020200058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Patients with cancer have been negatively impacted during the coronavirus disease 2019 (COVID-19) pandemic, as many of these individuals may be immunosuppressed and of older age. Additionally, cancer follow-up or imaging appointments have been delayed in many clinics around the world. Postponement of routine screening exams will result in delays in new cancer diagnoses. Clinics are continuing to monitor and adapt their appointment schedules based on local outbreaks of COVID-19. Studies on COVID-19 in patients with cancer are limited, but consistently indicate that this population is at risk for more severe COVID-19 illness. Data from recent studies also suggest that pediatric patients with cancer have a lower risk of severe COVID-19 illness compared to adults. Certain features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected by lung, brain, and gastrointestinal imaging may confound radiologists' interpretation of cancer diagnosis, staging, and treatment response. Lastly, as clinics begin to re-open for routine appointments, protocols have been put in place to reduce SARS-CoV-2 exposure to patients during their visits. This review details different perspectives on the impact of the COVID-19 pandemic on patients with cancer and on cancer imaging. Keywords: Abdomen/GI, Cardiac, Infection, Nervous-Peripheral.
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Affiliation(s)
- Adeline N. Boettcher
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Dima A. Hammoud
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Jason B. Weinberg
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Prachi Agarwal
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Mishal Mendiratta-Lala
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Gary D. Luker
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
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83
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Sen A. Repurposing prolactin as a promising immunomodulator for the treatment of COVID-19: Are common Antiemetics the wonder drug to fight coronavirus? Med Hypotheses 2020; 144:110208. [PMID: 33254515 PMCID: PMC7444632 DOI: 10.1016/j.mehy.2020.110208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/12/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
Prolactin (PRL), the well-known lactogenic hormone, plays a crucial role in immune function given the fact that long term hypoprolactinemia (serum prolactin level below normal) can even lead to death from opportunistic infection. High blood PRL level is known to provide an immunological advantage in many pathological conditions (with some exceptions like autoimmune diseases) and women, because of their higher blood PRL level, get an advantage in this regard. It has been reported that by controlled enhancement of blood PRL level (within the physiological limit and in some cases a little elevated above the normal to induce mild hyperprolactinemia) using dopamine antagonists such immune-stimulatory advantage can led to survival of the patients in many critical conditions. Here it is hypothesized that through controlled augmentation of blood PRL level using dopamine antagonists like domperidone/metoclopramide, which are commonly used drugs for the treatment of nausea and vomiting, both innate and adaptive immunity can be boosted to evade or tone down COVID-19. The hypothesis is strengthened from the fact that at least seven little-understood salient observations in coronavirus patients can apparently be explained by considering the role of enhanced PRL in line with the proposed hypothesis and hence, clinical trials (both therapeutic and prophylactic) on the role of enhanced PRL on the course and outcome of coronavirus patients should be conducted accordingly.
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Affiliation(s)
- Amarnath Sen
- 40 Jadunath Sarbovouma Lane, Kolkata 700035, India.
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84
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Conway EM, Pryzdial ELG. Is the COVID-19 thrombotic catastrophe complement-connected? J Thromb Haemost 2020; 18:2812-2822. [PMID: 32762081 PMCID: PMC7436532 DOI: 10.1111/jth.15050] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023]
Abstract
In December 2019, the world was introduced to a new betacoronavirus, referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for its propensity to cause rapidly progressive lung damage, resulting in high death rates. As fast as the virus spread, it became evident that the novel coronavirus causes a multisystem disease (COVID-19) that may involve multiple organs and has a high risk of thrombosis associated with striking elevations in pro-inflammatory cytokines, D-dimer, and fibrinogen, but without disseminated intravascular coagulation. Postmortem studies have confirmed the high incidence of venous thromboembolism, but also notably revealed diffuse microvascular thrombi with endothelial swelling, consistent with a thrombotic microangiopathy, and inter-alveolar endothelial deposits of complement activation fragments. The clinicopathologic presentation of COVID-19 thus parallels that of other thrombotic diseases, such as atypical hemolytic uremic syndrome (aHUS), that are caused by dysregulation of the complement system. This raises the specter that many of the thrombotic complications arising from SARS-CoV-2 infections may be triggered and/or exacerbated by excess complement activation. This is of major potential clinical relevance, as currently available anti-complement therapies that are highly effective in protecting against thrombosis in aHUS, could be efficacious in COVID-19. In this review, we provide mounting evidence for complement participating in the pathophysiology underlying the thrombotic diathesis associated with pathogenic coronaviruses, including SARS-CoV-2. Based on current knowledge of complement, coagulation and the virus, we suggest lines of study to identify novel therapeutic targets and the rationale for clinical trials with currently available anti-complement agents for COVID-19.
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Affiliation(s)
- Edward M Conway
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward L G Pryzdial
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Blood Services, Centre for Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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85
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Grimwood K, Lambert SB, Ware RS. Endemic Non-SARS-CoV-2 Human Coronaviruses in a Community-Based Australian Birth Cohort. Pediatrics 2020; 146:peds.2020-009316. [PMID: 32887791 DOI: 10.1542/peds.2020-009316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The coronavirus (CoV) disease 2019 pandemic has drawn attention to the CoV virus family. However, in community settings, there is limited information on these viruses in healthy children. We explored the epidemiology of the 4 endemic (non-severe acute respiratory syndrome CoV 2) human coronaviruses (HCoVs) by species, including acute illness episodes, risk factors, and health care burden in Australian children in the first 2 years of life. METHODS The Observational Research in Childhood Infectious Diseases community-based cohort was a prospective study of acute respiratory illnesses in children from birth until their second birthday. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HCoVs, by real-time polymerase chain reaction assays. RESULTS Overall, 158 children participating in Observational Research in Childhood Infectious Diseases provided 11 126 weekly swabs, of which 168 were HCoV-positive involving 130 incident episodes. HCoV-NL63 and HCoV-OC43 were most commonly detected, accounting for two-thirds of episodes. Whereas 30 children had different HCoVs detected on different occasions, 7 were reinfected with the same species. HCoV incidence in the first 2 years of life was 0.76 episodes per child-year (95% confidence interval [CI] 0.63 to 0.91), being greatest in the second year (1.06; 95% CI 0.84 to 1.33) and during winter (1.32; 95% CI 1.02 to 1.71). Fifty percent of HCoV episodes were symptomatic, and 24.2% led to health care contact. CONCLUSIONS In children, HCoV infections are common, recurrent, and frequently asymptomatic. In future studies, researchers should determine transmission pathways and immune mechanisms.
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Affiliation(s)
- Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; .,Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Southport, Queensland, Australia; and
| | - Stephen B Lambert
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert S Ware
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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86
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Minakshi R, Jan AT, Rahman S, Kim J. A Testimony of the Surgent SARS-CoV-2 in the Immunological Panorama of the Human Host. Front Cell Infect Microbiol 2020; 10:575404. [PMID: 33262955 PMCID: PMC7687052 DOI: 10.3389/fcimb.2020.575404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
The resurgence of SARS in the late December of 2019 due to a novel coronavirus, SARS-CoV-2, has shadowed the world with a pandemic. The physiopathology of this virus is very much in semblance with the previously known SARS-CoV and MERS-CoV. However, the unprecedented transmissibility of SARS-CoV-2 has been puzzling the scientific efforts. Though the virus harbors much of the genetic and architectural features of SARS-CoV, a few differences acquired during its evolutionary selective pressure is helping the SARS-CoV-2 to establish prodigious infection. Making entry into host the cell through already established ACE-2 receptor concerted with the action of TMPRSS2, is considered important for the virus. During the infection cycle of SARS-CoV-2, the innate immunity witnesses maximum dysregulations in its molecular network causing fatalities in aged, comorbid cases. The overt immunopathology manifested due to robust cytokine storm shows ARDS in severe cases of SARS-CoV-2. A delayed IFN activation gives appropriate time to the replicating virus to evade the host antiviral response and cause disruption of the adaptive response as well. We have compiled various aspects of SARS-CoV-2 in relation to its unique structural features and ability to modulate innate as well adaptive response in host, aiming at understanding the dynamism of infection.
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Affiliation(s)
- Rinki Minakshi
- Department of Microbiology, Swami Shraddhanand College, University of Delhi, New Delhi, India
| | - Arif Tasleem Jan
- School of Biosciences and Biotechnology, Baba Ghulam Shah Badshah University, Rajouri, India
| | - Safikur Rahman
- Munshi Singh College, BR Ambedkar Bihar University, Muzaffarpur, India
| | - Jihoe Kim
- Department of Medical Biotechnology, Research Institute of Cell Culture, Yeungnam University, Gyeongsan-si, South Korea
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87
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Beretta A, Cranage M, Zipeto D. Is Cross-Reactive Immunity Triggering COVID-19 Immunopathogenesis? Front Immunol 2020; 11:567710. [PMID: 33178193 PMCID: PMC7594548 DOI: 10.3389/fimmu.2020.567710] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023] Open
Abstract
The serological responses to both SARS-CoV-1 and SARS-CoV-2 virus have some unique characteristics that suggest cross-reactive priming by other human coronaviruses (hCoVs). The early kinetics and magnitude of these responses are, in some cases, associated with worse clinical outcomes in SARS and COVID-19. Cross-reactive hCoV antibody responses have been detected in both SARS and COVID-19 patients. There is also evidence that pre-existing T cell immunity to common cold coronaviruses can prime the response to SARS-CoV-2. Studies in non-human primates show that SARS-CoV-1 S-protein vaccine-induced antibodies are associated with acute lung injury in macaques challenged with SARS-CoV-1. Here we discuss the potential of cross-reactive immunity to drive the immunopathogenesis of COVID-19 and its implications for current efforts to develop immune-based therapies and vaccines.
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Affiliation(s)
| | - Martin Cranage
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Donato Zipeto
- Laboratory of Molecular Biology and Virology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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88
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Elahi S. Neonatal and Children’s Immune System and COVID-19: Biased Immune Tolerance versus Resistance Strategy. THE JOURNAL OF IMMUNOLOGY 2020; 205:1990-1997. [DOI: 10.4049/jimmunol.2000710] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
The recent outbreak of COVID-19 has emerged as a major global health concern. Although susceptible to infection, recent evidence indicates mostly asymptomatic or mild presentation of the disease in infants, children, and adolescents. Similar observations were made for acute respiratory infections caused by other coronaviruses (severe acute respiratory syndrome and Middle East respiratory syndrome). These observations suggest that the immune system behaves differently in children than adults. Recent developments in the field demonstrated fundamental differences in the neonatal immune system as compared with adults, whereby infants respond to microorganisms through biased immune tolerance rather than resistance strategies. Similarly, more frequent/recent vaccinations in children and younger populations may result in trained immunity. Therefore, the physiological abundance of certain immunosuppressive cells, a tightly regulated immune system, and/or exposure to attenuated vaccines may enhance trained immunity to limit excessive immune reaction to COVID-19 in the young.
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Affiliation(s)
- Shokrollah Elahi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G2E1, Canada
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta T6G1Z2, Canada
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G2E1, Canada; and
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta T6G2E1, Canada
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89
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Jensen MP, George M, Gilroy D, Sofat R. Beyond dexamethasone, emerging immuno-thrombotic therapies for COVID-19. Br J Clin Pharmacol 2020; 87:845-857. [PMID: 32881064 DOI: 10.1111/bcp.14540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Host immunity is required to clear SARS-CoV-2, and inability to clear the virus because of host or pathogen factors renders those infected at risk of poor outcomes. Estimates of those who are able to clear the virus with asymptomatic or paucisymptomatic COVID-19 remain unclear, and dependent on widespread testing. However, evidence is emerging that in severe cases, pathological mechanisms of hyperinflammation and coagulopathy ensue, the former supported by results from the RECOVERY trial demonstrating a reduction in mortality with dexamethasone in advanced COVID-19. It remains unclear whether these pathogenic pathways are secondary to a failure to clear the virus because of maladaptive immune responses or if these are sequential COVID-19 defining illnesses. Understanding the pathophysiological mechanisms underpinning these cascades is essential to formulating rationale therapeutic approaches beyond the use of dexamethasone. Here, we review the pathophysiology thought to underlie COVID-19 with clinical correlates and the current therapeutic approaches being investigated.
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Affiliation(s)
| | - Marc George
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK
| | - Derek Gilroy
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK
| | - Reecha Sofat
- Centre for Clinical Pharmacology and Therapeutics, UCL, London, UK.,Institute of Health Informatics, 222 Euston Road, London, UK
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90
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Heudorf U, Steul K, Gottschalk R. Sars-Cov-2 in children - insights and conclusions from the mandatory reporting data in Frankfurt am Main, Germany, March-July 2020. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc24. [PMID: 33214989 PMCID: PMC7656974 DOI: 10.3205/dgkh000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: From the beginning of the corona pandemic until August 19, 2020, more than 21,989,366 cases have been reported worldwide - 228,495 in Germany alone, including 12,648 children aged 0-14. In many countries, the proportion of infected children in the total population is comparatively low; in addition, children often have no or milder symptoms and are less likely to transmit the pathogen to adults than the other way round. Based on the registration data in Frankfurt am Main, Germany, the symptoms of children in comparison with adults and the likely routes of transmission are presented below. Materials and methods: The documentation of the mandatory reports includes personal data (name, date of birth, gender, place of residence), disease characteristics (date of report, date of onset of the disease, symptoms), possible contact persons (family, others) and i.a. possible activity or care in children's community facilities. All reports were viewed, especially with regard to likely transmission routes. Results: From March 1 to July 31, 2020, 1,977 infected people were reported, including 138 children between the ages of 0 and 14 years. Children had fewer and milder symptoms than adults. None of the children experienced severe respiratory symptoms or the need for ventilation. 62% of the children had no symptoms at all (19% adults), 5% of the children were hospitalized (24% adults), and none of the children died (3.8% adults). After excluding a cluster of 34 children from refugee accommodations and 14 children from a parish, 78% of the remaining 90 children had been infected by an adult within the family, and only 4% were likely to have a reverse transmission route. In 5.5% of cases, transmission in a community facility was likely. Discussion: The results of the registration data from Frankfurt am Main, Germany confirm the results published in other countries: Children are less likely to become infected, and if infected, their symptoms are less severe than in adults, and they are apparently not the main drivers of virus transmission. Therefore, scientific medical associations strongly recommend reopening schools.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Katrin Steul
- Public Health Department of the City of Frankfurt am Main, Germany
| | - René Gottschalk
- Public Health Department of the City of Frankfurt am Main, Germany
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91
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Verma S, Lumba R, Dapul HM, Gold-von Simson G, Phoon CK, Lighter JL, Farkas JS, Vinci A, Noor A, Raabe VN, Rhee D, Rigaud M, Mally PV, Randis TM, Dreyer B, Ratner AJ, Manno CS, Chopra A. Characteristics of Hospitalized Children With SARS-CoV-2 in the New York City Metropolitan Area. Hosp Pediatr 2020; 11:71-78. [PMID: 33033078 DOI: 10.1542/hpeds.2020-001917] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the characteristics of hospitalized children with severe acute respiratory syndrome coronavirus 2 in New York City metropolitan area. PATIENTS AND METHODS This was a multicenter, retrospective cohort study at 4 hospitals comprising 82 hospitalized children (0-21 years) who tested positive for severe acute respiratory syndrome coronavirus 2 after symptoms and risk screening between March 1 and May 10, 2020. We subdivided patients on the basis of their admission to acute or critical care units and by age groups. Further subanalyses were performed between patients requiring respiratory support or no respiratory support. RESULTS Twenty-three (28%) patients required critical care. Twenty-nine (35%) patients requiring respiratory support, with 9% needing mechanical ventilation, and 1 required extracorporeal support. All patients survived to discharge. Children with any comorbidity were more likely to require critical care (70% vs 37%, P = .008), with obesity as the most common risk factor for critical care (63% vs 28%, P = .02). Children with asthma were more likely to receive respiratory support (28% vs 8%, P = .02), with no difference in need for critical care (P = .26). Children admitted to critical care had higher rates of renal dysfunction at presentation (43% vs 10%, P = .002). CONCLUSIONS Children with comorbidities (obesity and asthma in particular) were at increased risk for critical care admission and/or need for respiratory support. Children with renal dysfunction at presentation were more likely to require critical care.
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Affiliation(s)
- Sourabh Verma
- Departments of Pediatrics and .,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | | | - Heda M Dapul
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | | | - Colin K Phoon
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | - Jennifer L Lighter
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | - Jonathan S Farkas
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | - Alexandra Vinci
- Department of Pediatrics, Long Island School of Medicine, New York University, New York, New York
| | - Asif Noor
- Department of Pediatrics, Long Island School of Medicine, New York University, New York, New York
| | - Vanessa N Raabe
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York.,Department of Medicine, Vaccine Center, NYU Langone Health, New York, New York; and
| | | | | | - Pradeep V Mally
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | - Tara M Randis
- Departments of Pediatrics and Molecular Medicine, University of South Florida, Tampa, Florida
| | - Benard Dreyer
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
| | - Adam J Ratner
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York.,Microbiology, Grossman School of Medicine, New York University, New York, New York
| | | | - Arun Chopra
- Departments of Pediatrics and.,Department of Pediatrics, Bellevue Hospital Center, New York, New York
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92
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Willows S, Alam SB, Sandhu JK, Kulka M. A Canadian perspective on severe acute respiratory syndrome coronavirus 2 infection and treatment: how prevalent underlying inflammatory disease contributes to pathogenesis. Biochem Cell Biol 2020; 99:173-194. [PMID: 33027600 DOI: 10.1139/bcb-2020-0341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a serious respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a global pandemic. Canada reported its first case of COVID-19 on the 25th January 2020. By March 2020, the virus had spread within Canadian communities reaching the most frail and vulnerable elderly population in long-term care facilities. The majority of cases were reported in the provinces of Quebec, Ontario, Alberta, and British Columbia, and the highest mortality was seen among individuals aged 65 years or older. Canada has the highest prevalence and incidence rates of several chronic inflammatory diseases, such as multiple sclerosis, inflammatory bowel disease, and Parkinson's disease. Many elderly Canadians also live with comorbid medical illnesses, such as hypertension, diabetes, cardiovascular disease, and chronic lung disease, and are more likely to suffer from severe COVID-19 with a poor prognosis. It is becoming increasingly evident that underlying inflammatory disease contributes to the pathogenesis of SARS-CoV-2. Here, we review the mechanisms behind SARS-CoV-2 infection, and the host inflammatory responses that lead to resolution or progression to severe COVID-19 disease. Furthermore, we discuss the landscape of COVID-19 therapeutics that are currently in development in Canada.
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Affiliation(s)
- Steven Willows
- Nanotechnology Research Centre, National Research Council Canada, 11421 Saskatchewan Drive, Edmonton, AB T6G 2A3, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Syed Benazir Alam
- Nanotechnology Research Centre, National Research Council Canada, 11421 Saskatchewan Drive, Edmonton, AB T6G 2A3, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Jagdeep K Sandhu
- Human Health Therapeutics Research Centre, National Research Council Canada, 1200 Montreal Road, Ottawa, ON K1A 0R6, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Marianna Kulka
- Nanotechnology Research Centre, National Research Council Canada, 11421 Saskatchewan Drive, Edmonton, AB T6G 2A3, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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93
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Escosa-García L, Aguilera-Alonso D, Calvo C, Mellado MJ, Baquero-Artigao F. Ten key points about COVID-19 in children: The shadows on the wall. Pediatr Pulmonol 2020; 55:2576-2586. [PMID: 32790245 PMCID: PMC7436376 DOI: 10.1002/ppul.25025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of the new coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), initially described in China, is challenging the health care systems of all countries. Every emerging disease raises many questions with a scarcity of answers since all its characteristics are still being discovered. In the case of SARS-CoV-2, most of the literature comes from adult patients. Children seem to be less affected. Pediatric patients diagnosed with COVID-19 disease usually suffer a mild illness, with a low risk of complications, or mortality. Defining the role of children in the transmission of SARS-CoV-2 is critical as some national infection control decisions involving children, such as school closures or social distancing, will probably impact the dynamics of the virus. To aid in the knowledge of COVID-19 in children, this study presents an expert review of the literature published from 1 January to 28 May 2020, including peer-reviewed and preprint nonpeer-reviewed studies, along with some relevant articles afterward, summarizing ten key points that characterize the disease in children.
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Affiliation(s)
- Luis Escosa-García
- Department of Pediatrics, Infectious, and Tropical Diseases, La Paz Hospital, The Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - David Aguilera-Alonso
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Gregorio Marañón Hospital, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), The Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Cristina Calvo
- Department of Pediatrics, Infectious, and Tropical Diseases, La Paz Hospital, The Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - María José Mellado
- Department of Pediatrics, Infectious, and Tropical Diseases, La Paz Hospital, The Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Fernando Baquero-Artigao
- Department of Pediatrics, Infectious, and Tropical Diseases, La Paz Hospital, The Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain
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94
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Amirfakhryan H. Kawasaki-like disease in children with COVID-19: A hypothesis. Med Hypotheses 2020; 143:110117. [PMID: 32721809 PMCID: PMC7367792 DOI: 10.1016/j.mehy.2020.110117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
With rapid spread of severe acute respiratory syndrome- corona virus-2 (SARS-COV-2) globally, some new aspects of the disease have been reported. Recently, it has been reported the incidence of Kawasaki-like disease among children with COVID-19. Since, children had been known to be less severely affected by the virus in part due to the higher concentration of Angiotensin converting enzyme (ACE)-2 receptor, this presentation has emerged concerns regarding the infection of children with SARS-COV2. ACE2 has anti-inflammatory, anti-fibrotic and anti-proliferative characteristics through converting angiotensin (Ag)-II to Ang (1-7). ACE2 receptor is downregulated by the SARS-COV through the spike protein of SARS-CoV (SARS-S) via a process that is tightly coupled with Tumor necrosis factor (TNF)-α production. TNF-α plays a key role in aneurysmal formation of coronary arteries in Kawasaki disease (KD). Affected children by COVID-19 with genetically-susceptible to KD might have genetically under-expression of ACE2 receptor that might further decrease the expression of ACE2 due to the downregulation of the receptor by the virus in these patients. It appears that TNF- α might be the cause and the consequence of the ACE2 receptor downregulation which results in arterial walls aneurysm. Conclusion: Genetically under-expression of ACE2 receptor in children with genetically-susceptible to KD who are infected with SARS-CoV-2 possibly further downregulates the ACE2 expression by TNF-α and leads to surge of inflammation including TNF-α and progression to Kawasaki-like disease.
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Affiliation(s)
- Hamideh Amirfakhryan
- Preventative Cardiovascular Medicine, Faculty of Health Science, University of South Wales, UK.
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95
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Magoon R. COVID-19 and congenital heart disease: Cardiopulmonary interactions for the worse! Paediatr Anaesth 2020; 30:1160-1161. [PMID: 32997860 PMCID: PMC7536948 DOI: 10.1111/pan.14004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Rohan Magoon
- Department of Cardiac AnaesthesiaAtal Bihari Vajpayee Institute of Medical Sciences (ABVIMS)Dr. Ram Manohar Lohia HospitalNew DelhiIndia
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96
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Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients with hyperinflammation. Proc Natl Acad Sci U S A 2020; 117:25254-25262. [PMID: 32989130 PMCID: PMC7568239 DOI: 10.1073/pnas.2010722117] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is a newly recognized condition in children with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These children and adult patients with severe hyperinflammation present with a constellation of symptoms that strongly resemble toxic shock syndrome, an escalation of the cytotoxic adaptive immune response triggered upon the binding of pathogenic superantigens to T cell receptors (TCRs) and/or major histocompatibility complex class II (MHCII) molecules. Here, using structure-based computational models, we demonstrate that the SARS-CoV-2 spike (S) glycoprotein exhibits a high-affinity motif for binding TCRs, and may form a ternary complex with MHCII. The binding epitope on S harbors a sequence motif unique to SARS-CoV-2 (not present in other SARS-related coronaviruses), which is highly similar in both sequence and structure to the bacterial superantigen staphylococcal enterotoxin B. This interaction between the virus and human T cells could be strengthened by a rare mutation (D839Y/N/E) from a European strain of SARS-CoV-2. Furthermore, the interfacial region includes selected residues from an intercellular adhesion molecule (ICAM)-like motif shared between the SARS viruses from the 2003 and 2019 pandemics. A neurotoxin-like sequence motif on the receptor-binding domain also exhibits a high tendency to bind TCRs. Analysis of the TCR repertoire in adult COVID-19 patients demonstrates that those with severe hyperinflammatory disease exhibit TCR skewing consistent with superantigen activation. These data suggest that SARS-CoV-2 S may act as a superantigen to trigger the development of MIS-C as well as cytokine storm in adult COVID-19 patients, with important implications for the development of therapeutic approaches.
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97
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Children were less frequently infected with SARS-CoV-2 than adults during 2020 COVID-19 pandemic in Warsaw, Poland. Eur J Clin Microbiol Infect Dis 2020; 40:541-547. [PMID: 32986153 PMCID: PMC7520378 DOI: 10.1007/s10096-020-04038-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Abstract
Clinical data suggest that during the current COVID-19 pandemic, children are less prone than adults to SARS-CoV-2 infection. Our purpose was to determine the frequency of SARS-CoV-2 in children vs. adults during the 2020 pandemic in Warsaw, Poland, and to investigate whether RSV and/or influenza A/B infections were associated with SARS-CoV-2 infections. We present results of RT-PCR tests for SARS-CoV-2 performed in Warsaw, Poland. Some of the pediatric subjects were also PCR-tested for RSV, and A and B influenza. We compared the test results from the four groups of symptomatic and asymptomatic subjects: 459 symptomatic pediatric patients (children 0–18 years old), 1774 symptomatic adults, 445 asymptomatic children, and 239 asymptomatic adults. 3.26% (15/459) of symptomatic pediatric patients were positive for SARS-CoV-2 in contrast to 5.58% (99/1774) of symptomatic adults (p = 0.0448). There were no SARS-CoV-2 positive cases in the group of asymptomatic children (0/445) and two positive cases in the group of asymptomatic adults (2/239), i.e., 0.83%. In the group of symptomatic pediatric patients, 17.14% (6/35) (p = 0.0002) were positive for RSV, 8.16% (4/49) were positive for influenza A, and 2.04% (1/49), thus 10.20% (5/49) (p = 0.0176) for influenza A/B. Children were less prone to SARS-CoV-2 infection than the adults during the COVID-19 pandemic in Warsaw. Higher percentage of symptomatic children was infected with RSV or influenza A/B than with SARS-CoV-2. This suggests a necessity for the testing for all these viruses for an early identification and isolation of SARS-CoV-2-positive patients for an ensuing 2020 autumn return of COVID-19.
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98
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Beacon TH, Su RC, Lakowski TM, Delcuve GP, Davie JR. SARS-CoV-2 multifaceted interaction with the human host. Part II: Innate immunity response, immunopathology, and epigenetics. IUBMB Life 2020; 72:2331-2354. [PMID: 32936531 DOI: 10.1002/iub.2379] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
The SARS-CoV-2 makes its way into the cell via the ACE2 receptor and the proteolytic action of TMPRSS2. In response to the SARS-CoV-2 infection, the innate immune response is the first line of defense, triggering multiple signaling pathways to produce interferons, pro-inflammatory cytokines and chemokines, and initiating the adaptive immune response against the virus. Unsurprisingly, the virus has developed strategies to evade detection, which can result in delayed, excessive activation of the innate immune system. The response elicited by the host depends on multiple factors, including health status, age, and sex. An overactive innate immune response can lead to a cytokine storm, inflammation, and vascular disruption, leading to the vast array of symptoms exhibited by COVID-19 patients. What is known about the expression and epigenetic regulation of the ACE2 gene and the various players in the host response are explored in this review.
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Affiliation(s)
- Tasnim H Beacon
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruey-Chyi Su
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, Manitoba, Canada
| | - Ted M Lakowski
- College of Pharmacy, Pharmaceutical Analysis Laboratory, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geneviève P Delcuve
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James R Davie
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
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99
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Jamwal S, Gautam A, Elsworth J, Kumar M, Chawla R, Kumar P. An updated insight into the molecular pathogenesis, secondary complications and potential therapeutics of COVID-19 pandemic. Life Sci 2020; 257:118105. [PMID: 32687917 PMCID: PMC7366108 DOI: 10.1016/j.lfs.2020.118105] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an unprecedented disease caused by highly pathogenic SARS-CoV-2 and characterized by extreme respiratory deterrence, pneumonia and immune damage. The phylogenetic analysis demonstrated the sequence similarity of SARS-CoV-2 with other SARS-like bat viruses. The primary source and intermediate host are not yet confirmed, although transmission from human to human is universally confirmed. The new SARS-CoV-2 virus reaches cells via ACE-2 and subsequently down-regulates ACE-2, leaving angiotensin II unbalanced in affected organs primarily in the lungs, heart, brain, and kidneys. As reported recently, numerous secondary complications i.e., neurological, nephrological, cardiovascular, gastrointestinal, immune, and hepatic complications, are associated with COVID-19 infection along with prominent respiratory disease including pneumonia. Extensive research work on recently discovered SARS-CoV-2 is in the pipeline to clarify pathogenic mechanisms, epidemiological features, and identify new drug targets that will lead to the development of successful strategies for prevention and treatment. There are currently no appropriate scientifically approved vaccines/drugs for COVID-19. Nonetheless, few broad-spectrum antiviral drugs, azithromycin were tested against COVID-19 in clinical trials, and finally, FDA approved emergency use of remdesivir in hospitalized COVID-19 patients. Additionally, administration of convalescent plasma obtained from recovered COVID-19 patients to infected COVID-19 patients reduces the viral burden via immunomodulation. This review analysis therefore concentrates primarily on recent discoveries related to COVID-19 pathogenesis along with a full description of the structure, genome, and secondary complication associated with SARS-CoV-2. Finally, a short and brief clinical update has been provided concerning the development of therapeutic medications and vaccines to counter COVID-19.
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Affiliation(s)
- Sumit Jamwal
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Akash Gautam
- Center for Neural and Cognitive Sciences, University of Hyderabad, Hyderabad 500046, India
| | - John Elsworth
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Mandeep Kumar
- University of Genoa, Department of Pharmacology and Toxicology, Viale Cembrano 4, Genoa, Italy
| | - Rakesh Chawla
- University Institute of Pharmaceutical Sciences & Research, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Puneet Kumar
- Department of Pharmacology, Central University of Punjab, Bathinda 151001, India.
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Nathan N, Prevost B, Sileo C, Richard N, Berdah L, Thouvenin G, Aubertin G, Lecarpentier T, Schnuriger A, Jegard J, Guellec I, Taytard J, Corvol H. The Wide Spectrum of COVID-19 Clinical Presentation in Children. J Clin Med 2020; 9:jcm9092950. [PMID: 32932612 PMCID: PMC7564665 DOI: 10.3390/jcm9092950] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.
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Affiliation(s)
- Nadia Nathan
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Inserm UMR_S933, Childhood Genetic Disorders, 75012 Paris, France
| | - Blandine Prevost
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
| | - Chiara Sileo
- Pediatric Radiology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France;
| | - Nicolas Richard
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Laura Berdah
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Guillaume Thouvenin
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Guillaume Aubertin
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Thibault Lecarpentier
- Pediatric Emergency Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France;
| | - Aurélie Schnuriger
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
- Virology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France
| | - Julien Jegard
- Pediatric and Neonatal Intensive Care Unit, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (J.J.); (I.G.)
| | - Isabelle Guellec
- Pediatric and Neonatal Intensive Care Unit, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (J.J.); (I.G.)
| | - Jessica Taytard
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Inserm UMR_S1158, Experimental and clinical respiratory neurophysiology, 75013 Paris, France
| | - Harriet Corvol
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
- Correspondence:
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