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Chen LM, Li JB, Wu R. Predictors of COVID-19 severity in autoimmune disease patients: A retrospective study during full epidemic decontrol in China. Heart Lung 2024; 68:272-278. [PMID: 39142089 DOI: 10.1016/j.hrtlng.2024.08.009] [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: 04/23/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Early identification of risk factors for adverse COVID-19 progression in patients with autoimmune diseases is crucial for patient management, but data on the Chinese population are scarce. OBJECTIVES The purpose of this study was to identify predictors of severe COVID-19 in patients using blood cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and other inflammatory markers. METHODS A retrospective study of 855 patients (746 females; median age 49 years) with autoimmune diseases and concurrent COVID-19 was conducted from December 2022 to February 2023 at the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University. Disease severity was assessed according to the 8th edition of the National Health Commission of the People's Republic of China's COVID-19 Diagnosis and Treatment Guidelines. The clinical classification criteria group mild and moderate cases as nonsevere cases and severe and critical cases as severe cases. A multivariate logistic regression model was established to evaluate the relationships between COVID-19 severity and demographic characteristics, comorbidities, medication use, and laboratory findings. RESULTS The PLR, NLR, and SII were significantly greater in the severe COVID-19 group than in the nonsevere group (all P < 0.05). In addition to classical independent clinical risk factors, increases in the PLR (OR: 1.004, 95 % CI: 1.001∼1.007, p = 0.001), NLR (OR: 1.180, 95 % CI: 1.041∼1.337, p = 0.010), and SII (OR: 0.999, 95 % CI: 0.998∼1.000, p = 0.005) were identified as risk factors for severe COVID-19 in patients with autoimmune diseases. After adjusting for clinical risk factors, the PLR (AUC: 0.592 vs. 0.865; P < 0.05), NLR (AUC: 0.670 vs. 0.866; P < 0.05), and SII (AUC: 0.616 vs. 0.864; P < 0.05) demonstrated higher predictive values. CONCLUSION Early prediction of severe COVID-19 in patients with autoimmune diseases can be achieved using the NLR, PLR, and SII.
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Affiliation(s)
- Li-Ming Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No 17 Yongwaizheng Street, Donghu District, Nanchang City, Jiangxi Province, 330006, China
| | - Jian-Bin Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No 17 Yongwaizheng Street, Donghu District, Nanchang City, Jiangxi Province, 330006, China
| | - Rui Wu
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No 17 Yongwaizheng Street, Donghu District, Nanchang City, Jiangxi Province, 330006, China.
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Reyes-Pagcatipunan MG, Isada PMD, Delos Reyes CA. Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital. ACTA MEDICA PHILIPPINA 2024; 58:14-26. [PMID: 38882922 PMCID: PMC11168954 DOI: 10.47895/amp.v58i7.7717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deaths during the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designated COVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases.Antibiotics were given to 71.7% of patients at the outset. As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at 2.2%. Conclusion Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illness or comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.
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Affiliation(s)
- Marimel G Reyes-Pagcatipunan
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- National Clinical Trials and Translation Center, University of the Philippines Manila
| | | | - Carmina A Delos Reyes
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
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Duan C, Liu L, Wang T, Wang G, Jiang Z, Li H, Zhang G, Ye L, Li C, Cao Y. Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review. BMC Med 2024; 22:116. [PMID: 38481207 PMCID: PMC10938697 DOI: 10.1186/s12916-024-03334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus. METHODS In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures. RESULTS We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression. CONCLUSIONS The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Guanru Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Honglin Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China.
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Walsh P, Hankins A, Bang H. Point-of-care lung ultrasound predicts hyperferritinemia and hospitalization, but not elevated troponin in SARS-CoV-2 viral pneumonitis in children. Sci Rep 2024; 14:5899. [PMID: 38467670 PMCID: PMC10928070 DOI: 10.1038/s41598-024-55590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
SARS-CoV-2 often causes viral pneumonitis, hyperferritinemia, elevations in D-dimer, lactate dehydrogenase (LDH), transaminases, troponin, CRP, and other inflammatory markers. Lung ultrasound is increasingly used to diagnose and stratify viral pneumonitis severity. We retrospectively reviewed 427 visits in patients aged 14 days to 21 years who had had a point-of-care lung ultrasound in our pediatric emergency department from 30/November/2019 to 14/August/2021. Lung ultrasounds were categorized using a 6-point ordinal scale. Lung ultrasound abnormalities predicted increased hospitalization with a threshold effect. Increasingly abnormal laboratory values were associated with decreased discharge from the ED and increased admission to the ward and ICU. Among patients SARS-CoV-2 positive patients ferritin, LDH, and transaminases, but not CRP or troponin were significantly associated with abnormalities on lung ultrasound and also with threshold effects. This effect was not demonstrated in SARS-CoV-2 negative patients. D-Dimer, CRP, and troponin were sometimes elevated even when the lung ultrasound was normal.
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Affiliation(s)
- Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, USA.
| | - Andrea Hankins
- Sutter Institute for Medical Research, 2801 L Street, Sacramento, CA, USA
- Sutter Health Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, 1 Shields Ave, Davis, CA, USA
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Özata MC, Dikici Ü, Özdemir Ö. COVID-19 frequency and clinical course in children with asthma. World J Virol 2023; 12:272-285. [PMID: 38187499 PMCID: PMC10768388 DOI: 10.5501/wjv.v12.i5.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. AIM To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. METHODS The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. RESULTS As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. CONCLUSION According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.
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Affiliation(s)
| | - Ümmügülsüm Dikici
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
| | - Öner Özdemir
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
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Fisler G, Brandt T, Ostovar GA, Taylor MD, Shah S. Procalcitonin Levels in Identifying Bacterial Infections in Children with and without COVID-19. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:287-291. [PMID: 38633859 PMCID: PMC10986730 DOI: 10.36519/idcm.2023.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
Objective Elevated procalcitonin levels have been associated with bacterial infection in children. Observational studies reported high procalcitonin values in COVID-19. Data on bacterial coinfections in pediatric COVID-19 is sparse; small studies suggest a low coinfection rate. In this study, we aimed to quantify the positive predictive value (PPV) of procalcitonin in identifying bacterial infection in children with and without COVID-19. Materials and Methods A retrospective chart review was performed for 215 children <21 years admitted to our tertiary children's hospital between February 1, 2013, and July 15, 2020, who had procalcitonin levels measured within 48 hours of admission. Confirmed bacterial infection was defined as positive blood, urine, or cerebrospinal fluid (CSF) culture, positive endotracheal culture with evidence of leukocytosis on Gram stain, or pneumonia by chest radiograph. Suspected bacterial infection was defined as confirmed bacterial infection or administration of antibiotics for >48 hours. Results Of the 215 patients, 73 were admitted for COVID-19 (66% multisystem inflammatory syndrome in children [MIS-C], 34% acute COVID-19). The PPV of an elevated procalcitonin level >1.0 ng/mL in identifying suspected bacterial infections for those with MIS-C was 6.3% (95% CI=0-15), in acute COVID-19 was 29% (95% CI=0-62%), and in the non-COVID-19 cohort was 75% (95% CI=62-88%). For identification of confirmed bacterial infection, PPV of an elevated procalcitonin level was 0% in MIS-C, 14% (95% CI=0-40%) in acute COVID-19, and 55% (95% CI=40-69%) in the non-COVID-19 cohort. Conclusion We found a low PPV of elevated procalcitonin level above 1 ng/mL in identifying either culture-confirmed or presumed bacterial infection in children hospitalized with COVID-19-related illness.
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Affiliation(s)
- Grace Fisler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Timothy Brandt
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, The Children's Hospital at Montefiore, New York, USA
| | - G. Amin Ostovar
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Matthew D. Taylor
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Sareen Shah
- Division of Pediatric Critical Care Medicine, Department of Pediatrics Cedars-Sinai Medical Center, Los Angeles, USA
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Balas WM, Śliwczyński A, Olszewski P, Gołębiak I, Sybilski AJ. Comparative Analysis of Symptomatology in Hospitalized Children with RSV, COVID-19, and Influenza Infections. Med Sci Monit 2023; 29:e941229. [PMID: 37950434 PMCID: PMC10647936 DOI: 10.12659/msm.941229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The clinical course of respiratory syncytial virus (RSV), SARS-CoV-2, and influenza infections comprises many non-specific symptoms, which makes diagnosis difficult. The aim of this study was to retrospectively analyze the symptomatology of these infections in children and to search for correlations between them. MATERIAL AND METHODS A total of 121 children with a positive RSV (n=61), influenza (n=31), or SARS-CoV-2 (n=29) antigen test were enrolled in this retrospective analysis. Children were aged up to 71 months (median, 8 months). The collected data were collated by performing statistical analysis using the chi-square test and comparing the results using OR (odds ratio) and 95%CI (confidence interval). RESULTS There was a higher risk of fever in children with influenza than in those with RSV. Patients infected with RSV had a higher risk of nasal blockage than those with SARS-CoV-2. Dyspnea was more common in RSV infection than in influenza. Severe, sleep-awakening cough was more frequent in children with RSV than in those with COVID-19. Influenza was more prevalent in children aged >24 months than in those aged 7-24 months. RSV-infected children had a higher risk of numerous auscultatory changes compared to those with SARS-CoV-2. In the case of RSV infection, symptoms requiring hospitalization occurred later than in SARS-CoV-2 infection. CONCLUSIONS Children aged >24 months were at higher risk of contracting influenza. Numerous auscultatory changes, nasal blockage, and dyspnea were more common in children with RSV. There was a higher risk of dyspnea in children with RSV. Fever was more frequent in children with influenza. However, none of the symptoms clearly indicated the etiology of the infection.
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Affiliation(s)
- Weronika M. Balas
- Department of Paediatrics and Neonatology with Allergology Center, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Andrzej Śliwczyński
- Health Public Department, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
| | | | | | - Adam J. Sybilski
- Department of Paediatrics and Neonatology with Allergology Center, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
- Second Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
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8
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Hantoosh S. COVID-19 infections among Iraqi school students: Severity, types, and symptoms. J Med Life 2023; 16:1552-1560. [PMID: 38313185 PMCID: PMC10835548 DOI: 10.25122/jml-2023-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 02/06/2024] Open
Abstract
The prevalence of COVID-19 infections among school students has become a significant and ongoing concern. This study aimed to assess the severity and types of COVID-19 cases and associated symptoms among school students in Iraq. A comprehensive study was conducted by the Public Health Directorate of AL-Muthanna Governorate from November 29, 2020, to February 12, 2021, utilizing RT-PCR-based COVID-19 surveys. The survey included 9,357 students (4,261 male and 5,096 female) and 83 schools. The retrospective analysis of the survey records indicated that male and female students had a mean age of 9.2±1.16 years with notably higher rates of asymptomatic infections than older students. Male students showed lower odds of asymptomatic infection but higher odds of symptomatic and pre-symptomatic infections compared to their female peers, particularly among elementary students. Fever, abdominal pain, diarrhea, loss of taste and smell, shortness of breath, and muscle pain were significantly associated with COVID-19 infection. Sneezing was significantly associated with a lack of infection. Home nursing by parents and self-care practices have proven to be highly effective in controlling COVID-19 infection among children. These findings highlight the need for age- and gender-specific considerations in COVID-19 prevention and management strategies in schools.
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Affiliation(s)
- Saad Hantoosh
- Department of Science, Open Educational College, Ministry of Education, Samawa, Iraq
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Alshalani A, Alotaibi BA, Aldali JA, AlSudais H, Almuqrin AM, Alshehri NA, Alamar NB, Alhejji MA. Paediatric COVID-19 Outcomes: Haematology Parameters, Mortality Rates, and Hospitalization Duration. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1615. [PMID: 37892279 PMCID: PMC10605890 DOI: 10.3390/children10101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 pandemic has strained healthcare systems around the globe, necessitating extensive research into the variables that affect patient outcomes. This study examines the relationships between key haematology parameters, duration of hospital stay (LOS), and mortality rates in COVID-19 cases in paediatric patients. Researchers analyse relationships between independent variables (COVID-19 status, age, sex) and dependent variables (mortality, LOS, coagulation parameters, WBC count, RBC parameters) using multivariate regression models. Although the R-square values (0.6-3.7%) indicate limited explanatory power, coefficients with statistical significance establish the impact of independent variables on outcomes. Age emerges as a crucial predictor of mortality; the mortality rate decreases by 1.768% per age group. Both COVID-19 status and age have an inverse relationship with length of stay, emphasising the milder hospitalisation of children. Platelet counts decline with age and male gender, potentially revealing the influence of COVID-19 on haematological markers. There are significant correlations between COVID-19 status, age, gender and coagulation measures. Lower prothrombin time and D-dimer concentrations in elder COVID-19 patients are indicative of distinct coagulation profiles. WBC and RBC parameters exhibit correlations with variables: COVID-19-positive patients have lower WBC counts, whereas male COVID-19-positive patients have higher RBC counts. In addition, correlations exist between independent variables and the red cell distribution width, mean corpuscular volume, and mean corpuscular haemoglobin. However, there is no correlation between mean corpuscular haemoglobin concentration and outcomes, indicating complex interactions between haematological markers and outcomes. In essence, this study underlines the importance of age in COVID-19 mortality, provides novel insights into platelet counts, and emphasises the complexity of the relationships between haematological parameters and disease outcomes.
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Affiliation(s)
- Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia (A.M.A.)
| | - Badi A. Alotaibi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia
| | - Jehad A. Aldali
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Hamood AlSudais
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia (A.M.A.)
| | - Abdulaziz M. Almuqrin
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia (A.M.A.)
| | - Nasser A. Alshehri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Nasser B. Alamar
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Mogtba A. Alhejji
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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Yan L, Wu J, Fan X, Liu J, Zhang L, Hu J, Li X, Su Y, Zhang F, Xu X, Chen X, Yang H. Analysis of risk factors and short-term prognostic factors of arrhythmia in patients infected with mild/moderate SARS-CoV-2 Omicron variant. Front Med (Lausanne) 2023; 10:1186200. [PMID: 37575983 PMCID: PMC10413106 DOI: 10.3389/fmed.2023.1186200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background Complications, including arrhythmia, following severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection continue to be of concern. Omicron is the mainstream SARS-CoV-2 mutant circulating in mainland China. At present, there are few epidemiological studies concerning the relationship between arrhythmia and Omicron variant infection in mainland China. Objectives To investigate the risk factors of arrhythmia in patients infected with the SARS-CoV-2 Omicron variant and the factors influencing prognosis. Methods Data from 192 Omicron infected patients with symptoms of arrhythmia (AH group) and 100 Omicron infected patients without arrhythmia (Control group) were collected. Patients in the AH group were divided into the good and poor prognosis groups, according to the follow-up results 4-6 weeks after infection. The general and clinical data between the AH and Control groups, and between the good and poor prognosis groups were compared. The variables with differences between the groups were included in the multivariate logistic regression analysis, and the quantitative variables were analyzed by receiver operating characteristic curve to obtain their cut-off values. Results Compared with the control group, the body mass index (BMI), proportion of patients with a history of arrhythmia, proportion of antibiotics taken, heart rate, moderate disease severity, white blood cell (WBC) count, and the aspartate aminotransferase, creatine kinase (CK), CK isoenzyme (CK-MB), myoglobin (Mb), high-sensitive troponin I (hs-cTnI), lymphocyte ratio and high sensitivity C-reactive protein (hs-CRP) levels in the AH group were significantly higher (p < 0.05). In addition, obesity (BMI ≥24 kg/m2), fast heart rate (≥100 times/min), moderate disease severity, and WBC, CK-MB and hs-cTnI levels were independent risk factors of arrhythmia for patients with Omicron infection (p < 0.05), and hs-CRP was a protective factor (p < 0.05). Compared with the good prognosis group, the age, proportion of patients with a history of arrhythmia, heart rate, proportion of moderate disease severity, and hs-CRP, CK, Mb and hs-cTnI levels were significantly higher in the poor prognosis group, while the proportion of vaccination was lower in the poor prognosis group (p < 0.05). Advanced age (≥65 years old), proportion of history of arrhythmia, moderate disease severity, vaccination, and hs-CRP, Mb and cTnI levels were independent factors for poor prognosis of patients with arrhythmia (p < 0.05). Conclusion The factors that affect arrhythmia and the prognosis of patients infected with Omicron include obesity, high heart rate, severity of the disease, age. history of arrhythmia, WBC, hs-CRP, and myocardial injury indexes, which could be used to evaluate and prevent arrhythmia complications in patients in the future.
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Affiliation(s)
- Lijie Yan
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jintao Wu
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xianwei Fan
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jingjing Liu
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Leiming Zhang
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Juan Hu
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuejie Li
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yandong Su
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Futao Zhang
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Xizheng Xu
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Xiaosheng Chen
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haitao Yang
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Fuwai Central China Hospital of Zhengzhou University, Zhengzhou, Henan, China
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[Clinical characteristics of neonates infected with the Omicron variant of SARS-CoV-2: a multicenter cross-sectional survey]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:678-684. [PMID: 37529948 PMCID: PMC10414171 DOI: 10.7499/j.issn.1008-8830.2302049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS A cross-sectional survey was conducted on 542 hospitalized neonates with confirmed coronavirus disease 2019 (COVID-19) in 27 hospitals in Shenzhen from December 7, 2022, to January 12, 2023 (during the Omicron variant epidemic period). The neonates were divided into two groups: asymptomatic infection and symptomatic infection. The clinical characteristics, results of laboratory examination, chest X-ray findings, and outcome were compared between the two groups. RESULTS Among the 542 neonates, there were 285 males and 257 females. Among them, 515 (95.0%) were full-term infants, and 27 (5.0%) were preterm infants. The asymptomatic infection group had 60 cases, and the symptomatic infection group had 482 cases. Among them, 336 cases (69.7%) were mild, 125 cases (25.9%) were moderate, 15 cases (3.1%) were severe, and 6 cases (1.2%) were critical. Fever was the most common symptom (434 cases, 90.0%), followed by cough and/or spitting (183 cases, 38.0%), nasal congestion and/or runny nose (131 cases, 27.2%), shortness of breath (36 cases, 7.5%), and feeding intolerance (30 cases, 6.2%). Among the 325 cases who underwent chest X-ray examination, 136 cases (41.8%) had patchy or consolidative shadows in the lungs, 2 cases (0.6%) had pneumothorax, 2 cases (0.6%) had decreased lung transparency, and 185 cases (57.0%) showed no abnormality. Among the 396 cases (73.1%) who received treatment, 341 cases (86.1%) received symptomatic treatment, 137 cases (34.6%) received antibiotic treatment, 4 cases (1.0%) received immunoglobulin treatment, and 23 cases (5.8%) received respiratory support treatment. All 542 neonates were discharged from the hospital after their clinical symptoms were relieved, and the median hospital stay was 5 days. The white blood cell count, neutrophil count, hemoglobin, and procalcitonin were lower in the symptomatic infection group than those in the asymptomatic infection group (P<0.05), while the platelet count and blood glucose levels were higher in the symptomatic infection group than those in the asymptomatic infection group (P<0.05). The proportions of neonates with decreased neutrophil count, increased platelet count, and decreased hemoglobin concentration were higher in the symptomatic infection group than those in the asymptomatic group (P<0.05). CONCLUSIONS Most neonates with COVID-19 caused by the Omicron variant of SARS-CoV-2 are mild, with fever as the predominant symptom. Symptomatic neonates with COVID-19 are often accompanied by decreased neutrophil count, increased platelet count, and decreased hemoglobin level. Symptomatic treatment is the main treatment, and the prognosis is good.
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Damps M, Byrska-Maciejasz E, Kowalska M, Rosada-Kurasińska J, Rybojad B, Sordyl J, Zielińska M, Bartkowska-Śniatkowska A. COVID-19 in Pediatric Intensive Care Units in Poland, PAPITCO-19 Study (Polish Analysis of PICU Trends during COVID-19). J Clin Med 2023; 12:3983. [PMID: 37373677 DOI: 10.3390/jcm12123983] [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: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Children suffering from COVID-19 constitute about 10% of the entire population infected with the virus. In most of them, we observe asymptomatic or mild courses; however, about 1% of affected children require a stay in a paediatric intensive care unit (PICU) due to the course of the disease becoming severely life-threatening. The risk of respiratory failure, as with adults, is associated with the coexistence of concomitant diseases. The aim of our study was to analyse patients admitted to PICUs due to the severe course of their SARS-CoV-2 infection. We studied epidemiological and laboratory parameters, as well as the endpoint (survival or death). METHODS A retrospective multi-centre study, the analysis covered all children with a confirmed diagnosis of SARS-CoV-2 virus infection who were admitted to PICUs in the period from November 2020 to August 2021. We studied epidemiological and laboratory parameters, as well as the endpoint (survival or death). RESULTS The study analysed 45 patients (0.075% of all children hospitalised in Poland due to COVID-19 at that time). Mortality calculated in the entire study group was 40% (n = 18). Statistically significant differences between the compared groups (survived and died) concerned the parameters of the respiratory system. Lung Injury Score and the Paediatric Sequential Organ Failure Assessment were used. A significant correlation between disease severity and the patient's prognosis was shown by the liver function parameter AST (p = 0.028). During the analysis of patients requiring mechanical ventilation and assuming survival as the primary outcome, a significantly higher oxygen index on the first day of hospitalisation, lower pSOFA scores and lower AST levels (p: 0.007; 0.043; 0.020; 0.005; 0.039, respectively) were found. CONCLUSIONS As with adults, children with comorbidities are most frequently at risk of severe SARS-CoV-2 infection. Increasing symptoms of respiratory failure, the need for mechanical ventilation and persistently high values of aspartate aminotransferase are indicators of poor prognosis.
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Affiliation(s)
- Maria Damps
- Department of Anaesthesiology and Intensive Care, Upper Silesian Child Health Centre, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Elżbieta Byrska-Maciejasz
- Department of Anaesthesiology and Intensive Therapy, University Children's Hospital of Krakow, 30-663 Krakow, Poland
| | - Małgorzata Kowalska
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-514 Katowice, Poland
| | - Jowita Rosada-Kurasińska
- Department of Paediatric Anaesthesiology and Intensive Care, Poznań University of Medical Sciences, 60-806 Poznan, Poland
| | - Beata Rybojad
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Lublin; 20-035 Lublin, Poland
| | - Joanna Sordyl
- Department of Oncology, Hematology, and Chemotherapy, Upper Silesian Child Health Centre, 40-752 Katowice, Poland
| | - Marzena Zielińska
- Department of Anesthesiology and Intensive Care, Wrocław Medical University, 50-556 Wrocław, Poland
- Department of Paediatric Anesthesiology and Intensive Care, University Clinical Hospital in Wrocław, 50-556 Wrocław, Poland
| | - Alicja Bartkowska-Śniatkowska
- Department of Paediatric Anaesthesiology and Intensive Care, Poznań University of Medical Sciences, 60-806 Poznan, Poland
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Totapally BR, Nadiger M, Hassor S, Laufer M, Etinger V, Ramos O, Biehler J, Meyer K, Melnick S. Identification of Multisystem Inflammatory Syndrome in Children Classes and Development of Hyperinflammation Score in Pediatric COVID-19. J Pediatr Intensive Care 2023; 12:137-147. [PMID: 37082465 PMCID: PMC10113008 DOI: 10.1055/s-0041-1730932] [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: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 01/08/2023] Open
Abstract
The aim of this study is to describe characteristics and hospital course of children admitted with COVID-19 to a tertiary care pediatric center in Southeastern United States, and to present the frequency of three classes of multisystem inflammatory syndrome in children (MIS-C) and develop pediatric COVID-19 associated hyperinflammation score (PcHIS). A retrospective cohort study of 68 children was performed. Critical illness was defined as any child requiring respiratory or cardiovascular support or renal replacement therapy. PcHIS was developed by using six variables: fever, hematological dysfunction, coagulopathy, hepatic injury, macrophage activation, and cytokinemia. Centers for Disease Control and Prevention criteria were used to identify MIS-C, and three classes of MIS-C were identified based on the findings of recently published latent class analysis (Class 1: MIS-C without Kawasaki like disease, Class 2: MIS-C with respiratory disease, and Class 3: MIS-C with Kawasaki like disease). The median age was 6.4 years. Fever, respiratory, and gastrointestinal were common presenting symptoms. MIS-C was present in 32 (47%), critical COVID-19 illness in 11 (16%), and 17 (25%) were admitted to the PICU. Children with critical illness were adolescents with elevated body mass index and premorbid conditions. PcHIS score of 3 had a sensitivity of 100% and a specificity of 77% for predicting critical COVID-19 illness. Among MIS-C patients, 15 (47%) were in Class 1, 8 (25%) were in Class 2, and 9 (28%) were in Class 3. We conclude that most children with COVID-19 have mild-to-moderate illness. Critical COVID-19 is mainly seen in obese adolescents with premorbid conditions. Three Classes of MIS-C are identifiable based on clinical features. Validation and clinical implication of inflammation score in pediatric COVID-19 need further investigation.
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Affiliation(s)
- Balagangadhar R. Totapally
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Meghana Nadiger
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Sophia Hassor
- Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Marcelo Laufer
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Infectious Diseases, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Veronica Etinger
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Otto Ramos
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Infectious Diseases, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Jefry Biehler
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Keith Meyer
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Steven Melnick
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Department of Pathology, Nicklaus Children's Hospital, Miami, Florida, United States
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14
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Mohammedsaeed W, Alsehli F, Alfarsi L, Bakhsh A, Alzahrani M, Almarwani M, Alharbi Y. COVID-19 in Pediatric Patients: A Study Based on Biomarker Levels. Cureus 2023; 15:e39408. [PMID: 37378147 PMCID: PMC10291959 DOI: 10.7759/cureus.39408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected people of all ages, but limited data are available on children with mild and severe coronavirus disease 2019 (COVID-19). METHODS Clinical characteristics, inflammation, and other biochemical biomarkers have been described, but information is scarce in asymptomatic and mild cases. Laboratory investigations were performed with pediatric patients (n=70) for liver function and kidney function, along with C-reactive protein (CRP). RESULTS Mild clinical characteristics and symptoms were observed in pediatric patients. Even in moderate cases of COVID-19, elevated levels of biomarkers indicate altered liver and kidney function in children. The levels of liver enzymes, bilirubin, creatinine, and CRP varied significantly between the three classes, particularly between asymptomatic and moderate cases. Liver enzymes, bilirubin, and creatinine levels in moderate COVID-19 pediatric cases were twice as elevated as in asymptomatic cases. Liver enzymes and CRP levels were moderately elevated. CONCLUSION Monitoring blood biomarkers consistently can assist in the accurate identification of infection in young patients as well as in the prevention of its spread and the administration of appropriate treatment.
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Affiliation(s)
- Walaa Mohammedsaeed
- Diabetes and Endocrinology, Clinical Biochemistry, Taibah University, Madinah, SAU
| | | | | | - Ameen Bakhsh
- Laboratory, Maternity and Children Hospital, Madinah, SAU
| | - Mansour Alzahrani
- Laboratory, Poison control and Forensic Chemistry Center, Madinah, SAU
| | | | - Yousef Alharbi
- Laboratory, Maternity and Children Hospital, Madinah, SAU
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Abdulla ZA, Al-Bashir SM, Alzoubi H, Al-Salih NS, Aldamen AA, Abdulazeez AZ. The Role of Immunity in the Pathogenesis of SARS-CoV-2 Infection and in the Protection Generated by COVID-19 Vaccines in Different Age Groups. Pathogens 2023; 12:329. [PMID: 36839601 PMCID: PMC9967364 DOI: 10.3390/pathogens12020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
This study aims to review the available data regarding the central role of immunity in combating SARS-CoV-2 infection and in the generation of protection by vaccination against COVID-19 in different age groups. Physiologically, the immune response and the components involved in it are variable, both functionally and quantitatively, in neonates, infants, children, adolescents, and adults. These immunological differences are mirrored during COVID-19 infection and in the post-vaccination period. The outcome of SARS-CoV-2 infection is greatly dependent on the reaction orchestrated by the immune system. This is clearly obvious in relation to the clinical status of COVID-19 infection, which can be symptomless, mild, moderate, or severe. Even the complications of the disease show a proportional pattern in relation to the immune response. On the contrary, the commonly used anti-COVID-19 vaccines generate protective humoral and cellular immunity. The magnitude of this immunity and the components involved in it are discussed in detail. Furthermore, many of the adverse effects of these vaccines can be explained on the basis of immune reactions against the different components of the vaccines. Regarding the appropriate choice of vaccine for different age groups, many factors have to be considered. This is a cornerstone, particularly in the following age groups: 1 day to 5 years, 6 to 11 years, and 12 to 17 years. Many factors are involved in deciding the route, doses, and schedule of vaccination for children. Another important issue in this dilemma is the hesitancy of families in making the decision about whether to vaccinate their children. Added to these difficulties is the choice by health authorities and governments concerning whether to make children's vaccination compulsory. In this respect, although rare and limited, adverse effects of vaccines in children have been detected, some of which, unfortunately, have been serious or even fatal. However, to achieve comprehensive control over COVID-19 in communities, both children and adults have to be vaccinated, as the former group represents a reservoir for viral transmission. The understanding of the various immunological mechanisms involved in SARS-CoV-2 infection and in the preparation and application of its vaccines has given the sciences a great opportunity to further deepen and expand immunological knowledge. This will hopefully be reflected positively on other diseases through gaining an immunological background that may aid in diagnosis and therapy. Humanity is still in continuous conflict with SARS-CoV-2 infection and will be for a while, but the future is expected to be in favor of the prevention and control of this disease.
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Affiliation(s)
| | - Sharaf M. Al-Bashir
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Hiba Alzoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Noor S. Al-Salih
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Ala A. Aldamen
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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Beltran DM, Villamil Osorio M, Fonseca SLG, Restrepo-Gualteros SM, Garcia MJR, Rodriguez-Martinez CE. Predictors of severity in severe respiratory infection in children with COVID-19 respiratory infection in a developing country. J Med Virol 2023; 95:e28453. [PMID: 36594415 DOI: 10.1002/jmv.28453] [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: 07/21/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
On March 11, 2020, the WHO declared the COVID-19 pandemic. This name was given to the disease caused by the SARS-CoV 2 virus at its outbreak in December 2019 in Wuhan, Hubei, China. In Colombia, a significant number of cases have been confirmed. The aim of this study was to evaluate children with respiratory symptoms caused by SARS-CoV2 infection, identifying independent predictors of risk of having a severe illness, thus leading to an early approach and intervention in our patients, especially in children with comorbidities. An analytical cross-sectional study was conducted between April 1, 2020 and March 31, 2021 at a fourth-level referral institution in Bogotá on patients under 18 years of age with respiratory symptoms and a COVID-19 diagnosis confirmed in the laboratory. An explanatory binary logistic regression model was performed with an outcome variable of admission to the intensive care unit. A total of 385 children were included in the study, with ages between 9 months and 17 years of age; 50.1% were male, and the ICR was 9.75 years. 41.6% had some comorbidity, 13.5% were admitted to the pediatric ICU, and 3.6% of the total number of patients died. The predictor variables were: use of antibiotics in the first 24 h, neurological comorbidity, and consolidation shown in the chest X-ray. This explains 38.7% of the variability of the variable. In this cohort of patients with COVID-19-associated respiratory symptoms, we identified predictors of severity, so we consider that these patients require a risk approach that allows timely and adequate care.
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Affiliation(s)
| | | | | | | | | | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogotá, Colombia
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17
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Gabr AES, Abdelhameed AM, Mohammad SA, Fouda EM, Maher SA, Fathallah SK, Alkaphoury MGAM. Chest CT features of coronavirus disease 2019 (COVID-19) in pediatric patients and its correlation with the clinical condition. EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [PMCID: PMC9809511 DOI: 10.1186/s43055-022-00948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Background
All pediatric health organizations are concerned about the impact of coronavirus disease on children, especially on those with other comorbidities; fortunately, pediatric cases appear to be less severe than in adults (De Luca et al. in Pediatr Respir Rev 5:9–14, 2020). The purpose of this study is to characterize chest CT findings of children with and without comorbidities who had confirmed coronavirus disease (COVID-19) and to investigate the relation between chest CT findings and the clinical severity of COVID-19 pneumonia and their laboratory findings.
Results
The study was conducted on 36 patients, 72.2% of whom had associated comorbidities. Twenty-three patients (63.88%) had abnormal CT findings. Consolidative patches were the most common radiological sign (55.6%) followed by ground glass opacities (50%). The lesions were bilateral (58.3%), having predominantly peripheral distribution (38.9%) with predominant left lower lobe affection (25%). Cases with clinically severe chest conditions had significantly more prevalent consolidative patches (p = 0.026) which show a higher CT density (p = 0.01) and a significantly higher CT severity score (SS) compared to other groups (p = 0.029). The cutoff of severity score 4/20 had 100% sensitivity and 78.12% specificity in the diagnosis of severe cases. There were no statistically significant differences between patients with or without comorbidities regarding CT-SS or any radiological signs.
Conclusions
Consolidation was the most common radiological finding in children with COVID-19 and was more prevalent and denser in severe cases. The CT-SS may be used as a complementary tool for the evaluation of the severity of the chest condition. Chest CT-SS more than 4 can be used as an indicator of severe cases, yet no significant difference in CT-SS between patients with associated comorbidities or not.
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Mayne ES, George JA, Louw S. Assessing Biomarkers in Viral Infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1412:159-173. [PMID: 37378766 DOI: 10.1007/978-3-031-28012-2_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Current biomarkers to assess the risk of complications of both acute and chronic viral infection are suboptimal. Prevalent viral infections like human immunodeficiency virus (HIV), hepatitis B and C virus, herpes viruses, and, more recently, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be associated with significant sequelae including the risk of cardiovascular disease, other end-organ diseases, and malignancies. This review considers some biomarkers which have been investigated in diagnosis and prognosis of key viral infections including inflammatory cytokines, markers of endothelial dysfunction and activation and coagulation, and the role that more conventional diagnostic markers, such as C-reactive protein and procalcitonin, can play in predicting these secondary complications, as markers of severity and to distinguish viral and bacterial infection. Although many of these are still only available in the research setting, these markers show promise for incorporation in diagnostic algorithms which may assist to predict adverse outcomes and to guide therapy.
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Affiliation(s)
- Elizabeth S Mayne
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa.
| | - Jaya A George
- National Health Laboratory Service and Wits Diagnostic Innovation Hub, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Louw
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Colangelo L, Volpe A, Toso E, Magnano M, Matta M, Vignati C, Marchini A, Semperboni L, Stefanini L, Gaita F. Incidence and Clinical Relevance of COVID-19 in a Population of Young Competitive and Elite Football Players: A Retrospective Observational Study. SPORTS MEDICINE - OPEN 2022; 8:54. [PMID: 35426529 PMCID: PMC9012064 DOI: 10.1186/s40798-022-00442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/27/2022] [Indexed: 12/11/2022]
Abstract
Background The COVID-19 pandemic dramatically changed lifestyle worldwide, including sport. A comprehensive evaluation of the prevalence of cardiac involvement in COVID-19 is essential to finalize a safe protocol for resuming elite sport. The aim of this study is to evaluate incidence of cardiac involvement and COVID-19 impact on athletic performance. Materials and methods This retrospective observational study analysed the data collected from consecutive competitive athletes who performed medical-sports examinations at the J Medical Center from March 2020 to March 2021. All athletes periodically performed a molecular test using a nasopharyngeal swab to detect COVID-19 infection. Positive athletes performed laboratory (cardiac troponin T—cTnT) and instrumental (echocardiography, stress test, Holter ECG) investigations following recovery to identify any cardiac involvement. Cardiac magnetic resonance imaging (MRI) was performed in case of abnormal findings at first-level evaluation. Results Among 238 athletes (median age 20 years), 77 contracted COVID-19, mainly males (79%) with a median age of 16 years. Fifty-one athletes (66%) presented mild symptoms, and none required hospitalization. Evaluation for resuming sport was performed after a median of 30 days from the first positive test. Abnormal findings were obtained in 13 cases (5 athletes [6%] with elevated cTnT values; 13 athletes [17%] with arrhythmias on Holter ECG and/or during stress test; 2 athletes [3%] anomalies at echocardiography). Cardiac MRI discovered abnormalities in 9 cases, but none of these was clearly related to COVID-19 and none fulfilled acute myocarditis criteria. No negative impact on athletic performance was observed, and none of the athletes developed persistent COVID-related symptoms. Conclusions Our registry confirms the predominantly self-limiting illness in young athlete population. The incidence of clear COVID-19-related structural myocardial injury was very low, but transient exertional ventricular arrhythmias or pericardial effusion was observed without significant impact on athletic performance. Implemented screening for return to activity is likely reasonable only in moderate-to-severe symptomatic athletes.
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Kyriakoulis KG, Kyriakoulis IG, Trontzas IP, Syrigos N, Kyprianou IA, Fyta E, Kollias A. Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses. Rev Cardiovasc Med 2022; 23:404. [PMID: 39076653 PMCID: PMC11270392 DOI: 10.31083/j.rcm2312404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/05/2022] [Accepted: 10/20/2022] [Indexed: 07/31/2024] Open
Abstract
Background Cardiac injury (CI) is not a rare condition among hospitalized patients with coronavirus disease 2019 (COVID-19). Its prognostic value has been extensively reported through the literature, mainly in the context of observational studies. An impressive number of relevant meta-analyses has been conducted. These meta-analyses present similar and consistent results; yet interesting methodological issues emerge. Methods A systematic literature search was conducted aiming to identify all relevant meta-analyses on (i) the incidence, and (ii) the prognostic value of CI among hospitalized patients with COVID-19. Results Among 118 articles initially retrieved, 73 fulfilled the inclusion criteria and were included in the systematic review. Various criteria were used for CI definition mainly based on elevated cardiac biomarkers levels. The most frequently used biomarker was troponin. 30 meta-analyses reported the pooled incidence of CI in hospitalized patients with COVID-19 that varies from 5% to 37%. 32 meta-analyses reported on the association of CI with COVID-19 infection severity, with only 6 of them failing to show a statistically significant association. Finally, 46 meta-analyses investigated the association of CI with mortality and showed that patients with COVID-19 with CI had increased risk for worse prognosis. Four meta-analyses reported pooled adjusted hazard ratios for death in patients with COVID-19 and CI vs those without CI ranging from 1.5 to 3. Conclusions The impact of CI on the prognosis of hospitalized patients with COVID-19 has gained great interest during the pandemic. Methodological issues such as the inclusion of not peer-reviewed studies, the inclusion of potentially overlapping populations or the inclusion of studies with unadjusted analyses for confounders should be taken into consideration. Despite these limitations, the adverse prognosis of patients with COVID-19 and CI has been consistently demonstrated.
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Affiliation(s)
- Konstantinos G Kyriakoulis
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Ioannis G Kyriakoulis
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Ioannis P Trontzas
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Nikolaos Syrigos
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Ioanna A Kyprianou
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Eleni Fyta
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Anastasios Kollias
- National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
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21
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Timur D, Demirpek U, Demirbaş BC, Türe E, Korkmaz MF, Timur A. Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1758743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection.
Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied.
Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower.
Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered.
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Affiliation(s)
- Demet Timur
- Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Turkey
| | - Ugur Demirpek
- Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Turkey
| | | | - Esra Türe
- Division of Pediatric Emergency Diseases, Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
| | | | - Ahmet Timur
- Bursa City Department of Health, Bursa, Turkey
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22
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Dobrijević D, Antić J, Rakić G, Andrijević L, Katanić J, Pastor K. Could platelet indices have diagnostic properties in children with
COVID
‐19? J Clin Lab Anal 2022; 36:e24749. [DOI: 10.1002/jcla.24749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dejan Dobrijević
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Institute for Child and Youth Health Care of Vojvodina Novi Sad Serbia
| | - Jelena Antić
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Institute for Child and Youth Health Care of Vojvodina Novi Sad Serbia
| | - Goran Rakić
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Institute for Child and Youth Health Care of Vojvodina Novi Sad Serbia
| | | | - Jasmina Katanić
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Institute for Child and Youth Health Care of Vojvodina Novi Sad Serbia
| | - Kristian Pastor
- Faculty of Medicine University of Novi Sad Novi Sad Serbia
- Institute for Child and Youth Health Care of Vojvodina Novi Sad Serbia
- Faculty of Technology University of Novi Sad Novi Sad Serbia
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23
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Siagian SN, Oetama S, Pohan FZ, Mendel B, Lelya O, Sakti DDA, Kurniawati Y. Clinical outcomes of COVID-19 infection in congenital heart disease: A single-center experience in Indonesia. Front Cardiovasc Med 2022; 9:1022183. [DOI: 10.3389/fcvm.2022.1022183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundCongenital heart disease (CHD) patients are thought to be vulnerable to COVID-19 complications. In this study, we would like to assess the outcomes and clinical characteristics in COVID-19 CHD patients.MethodA single-center, observational study was conducted in National Cardiovascular Center Harapan Kita (NCCHK). This study included patients with CHD who were hospitalized for COVID-19. The extracted data were baseline characteristics, clinical findings, supportive examination findings, complications, outcomes, and length of stay of the patients. The data were then analyzed using SPSS 26.0 software.ResultTwenty-six patients with CHD and COVID-19 infection were included in our study. There were 24 resolved cases and 2 deaths, four patients experienced complications such as renal insufficiency (1), sepsis (2), and multiorgan failure (1). The median length of stay was 13 days. The most common symptoms experienced by the patients were breathlessness (65.4%), cough (57.7%), and fever (42.3%).ConclusionWe observed a relatively mild COVID-19 clinical course despite prior research showing that patients with cardiovascular comorbidities, such as CHD, have a higher case-fatality rate. This could be because of the smaller sample size, non-standardized diagnosis, severity, treatment, and age group.
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24
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Wong JJM, Abbas Q, Liauw F, Malisie RF, Gan CS, Abid M, Efar P, Gloriana J, Chuah SL, Sultana R, Thoon KC, Yung CF, Lee JH. Development and validation of a clinical predictive model for severe and critical pediatric COVID-19 infection. PLoS One 2022; 17:e0275761. [PMID: 36301941 PMCID: PMC9612577 DOI: 10.1371/journal.pone.0275761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain the likelihood of developing severe manifestations. METHODS The predictive model was based on an analysis of registry data from COVID-19 positive patients admitted to five tertiary pediatric hospitals across Asia [Singapore, Malaysia, Indonesia (two centers) and Pakistan]. Independent predictors of severe/critical COVID-19 infection were determined using multivariable logistic regression. A training cohort (n = 802, 70%) was used to develop the prediction model which was then validated in a test cohort (n = 345, 30%). The discriminative ability and performance of this model was assessed by calculating the Area Under the Curve (AUC) and 95% confidence interval (CI) from final Receiver Operating Characteristics Curve (ROC). RESULTS A total of 1147 patients were included in this analysis. In the multivariable model, infant age group, presence of comorbidities, fever, vomiting, seizures and higher absolute neutrophil count were associated with an increased risk of developing severe/critical COVID-19 infection. The presence of coryza at presentation, higher hemoglobin and platelet count were associated with a decreased risk of severe/critical COVID-19 infection. The AUC (95%CI) generated for this model from the training and validation cohort were 0.96 (0.94, 0.98) and 0.92 (0.86, 0.97), respectively. CONCLUSION This predictive model using clinical history and commonly used laboratory values was valuable in estimating the risk of developing a severe/critical COVID-19 infection in hospitalized children. Further validation is needed to provide more insights into its utility in clinical practice.
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Affiliation(s)
- Judith Ju Ming Wong
- Department of Pediatric Subspecialties, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
- * E-mail:
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Felix Liauw
- Division of Pediatric Emergency and Intensive Care, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
| | - Ririe Fachrina Malisie
- Child Health Department, Medical Faculty of Universitas Sumatera Utara, Kota Medan, Sumatera Utara, Indonesia
- Murni Teguh Memorial Hospital, Kota Medan, Sumatera Utara, Indonesia
| | - Chin Seng Gan
- Pediatric Intensive Care Unit, Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Abid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Pustika Efar
- Division of Pediatric Emergency and Intensive Care, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
| | - Josephine Gloriana
- Child Health Department, Medical Faculty of Universitas Sumatera Utara, Kota Medan, Sumatera Utara, Indonesia
- Murni Teguh Memorial Hospital, Kota Medan, Sumatera Utara, Indonesia
| | - Soo Lin Chuah
- Pediatric Intensive Care Unit, Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Koh Cheng Thoon
- Department of Pediatrics, Infectious Disease Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Department of Pediatrics, Infectious Disease Service, KK Women’s and Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jan Hau Lee
- Department of Pediatric Subspecialties, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
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25
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Chow EJ, Englund JA. Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Children. Infect Dis Clin North Am 2022; 36:435-479. [PMID: 35636909 PMCID: PMC8806161 DOI: 10.1016/j.idc.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children generally have milder presentations, but severe disease can occur in all ages. MIS-C and persistent post-acute COVID-19 symptoms can be experienced by children with previous infection and emphasize the need for infection prevention. Optimal treatment for COVID-19 is not known, and clinical trials should include children to guide therapy. Vaccines are the best tool at preventing infection and severe outcomes of COVID-19. Children suffered disproportionately during the pandemic not only from SARS-CoV-2 infection but because of disruptions to daily life, access to primary care, and worsening income inequalities.
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Affiliation(s)
- Eric J. Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356423, Seattle, WA 98195, USA,Corresponding author.
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, 4800 Sand Point Way NE - MA7.234, Seattle, WA 98105, USA
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26
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Musolino AM, Ferro V, Supino MC, Boccuzzi E, Scateni S, Sinibaldi S, Cursi L, Schingo PMS, Reale A, Campana A, Raponi M, Villani A, Tomà P. One Year of Lung Ultrasound in Children with SARS-CoV-2 Admitted to a Tertiary Referral Children's Hospital: A Retrospective Study during 2020-2021. CHILDREN (BASEL, SWITZERLAND) 2022; 9:761. [PMID: 35626938 PMCID: PMC9139579 DOI: 10.3390/children9050761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
During the COVID-19 pandemic, the lung ultrasound (LU) turned out to be a pivotal tool to study the lung involvement in the adult population, but the same was not well evaluated in children. We detected the LU patterns through an integrated approach with clinical−laboratory features in children hospitalized for COVID-19 in relation to the temporal trend of the Italian epidemic. We conducted a retrospective study which took place at a pediatric tertiary hospital from 15 March 2020 to 15 March 2021. We compared the characteristics of the initial phase of the first COVID-19 year—in the spring and summer (15 March−30 September 2020)—and those of the second phase—in the autumn and winter (1 October 2020−15 March 2021). Twenty-eight patients were studied both in the first and in the second phase of the first COVID-19 year. The disease severity score (DSS) was significantly greater in the second phase (p = 0.015). In the second phase of the first COVID-19 year, we detected a more significant occurrence of the following LU features than in the first phase: the irregular pleural line (85.71% vs. 60.71%; p = 0.035), the B-lines (89.29% vs. 60%; p = 0.003) and the several but non-coalescent B-lines (89.29% vs. 60%; p = 0.003). The LU score correlated significantly with the DSS, with a moderate relationship (r = 0.51, p < 0.001). The combined clinical, laboratory and ultrasound approaches might be essential in the evaluation of pulmonary involvement in children affected by COVID-19 during different periods of the pandemic.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Valentina Ferro
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Maria Chiara Supino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Elena Boccuzzi
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Simona Scateni
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Serena Sinibaldi
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Antonino Reale
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Andrea Campana
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Alberto Villani
- General Pediatrics Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.M.S.S.); (P.T.)
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27
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Üstündağ Y, G Kazanci E, Koloğlu RF, Çağlak HA, Yildirim F, Y Arikan E, Huysal K. A retrospective study of age-defined hematologic inflammatory markers related to pediatric COVID-19 diagnosis. Int J Lab Hematol 2022; 44:722-728. [PMID: 35437914 PMCID: PMC9111715 DOI: 10.1111/ijlh.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
Background The aim of this study was to examine age‐related differences in hemogram parameters and hematologic inflammatory markers in pediatric patients with COVID‐19. Methods This retrospective study included children aged 2 months to 18 years (n = 208) who have a confirmed diagnosis of COVID‐19 and a control group comprising 117 healthy children between February 2021 and July 2021. The analysis of subgroup hematological values were performed according to the children's age cutoffs. Results The most significant difference between pediatric patients with COVID‐19 and controls were peripheral blood eosinophil counts and eosinophil‐to‐monocyte ratio (EMR) levels on admission. The levels of monocyte‐to‐lymphocyte ratio, aggeregate index of systemic inflammation (neutrophil × platelet × monocyte/lymphocyte), neutrophil‐to‐ lymphocyte × platelet ratio, and systemic inflammation response index (neutrophil × monocyte/ lymphocyte) were higher in patients than in controls. EMR had the highest area under the curve (AUC) value of 0.777, with a cutoff value of 0.26. The sensitivity for EMR was 75% under 2 years of age, and between 78.6–87.5% in the other age groups. Conclusion In children younger than 6 months, the discriminative power of hematological indices is low, while the discriminative power of EMR is high at all ages when age appropriate cutoffs are used. Hematological inflammatory parameters may be particularly practical in pediatric clinics to help identify COVID‐19 infection.
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Affiliation(s)
- Yasemin Üstündağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Elif G Kazanci
- Department of Pediatric Hemato-Oncology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Rahime F Koloğlu
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hatice A Çağlak
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Fatih Yildirim
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Elif Y Arikan
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Abstract
Purpose of Review Due to the rapidly changing landscape of COVID-19, the purpose of this review is to provide a concise and updated summary of pediatric COVID-19 diagnosis and management. Recent Findings The relative proportion of pediatric cases have significantly increased following the emergence of the Omicron variant (from < 2% in the early pandemic to 25% from 1/27 to 2/3/22). While children present with milder symptoms than adults, severe disease can still occur, particularly in children with comorbidities. There is a relative paucity of pediatric data in the management of COVID-19 and the majority of recommendations remain based on adult data. Summary Fever and cough remain the most common clinical presentations, although atypical presentations such as “COVID toes,” anosmia, and croup may be present. Children are at risk for post-infectious complications such as MIS-C and long COVID. Nucleic acid amplification tests through respiratory PCR remain the mainstay of diagnosis. The mainstay of management remains supportive care and prevention through vaccination is highly recommended. In patients at increased risk of progression, interventions such as monoclonal antibody therapy, PO Paxlovid, or IV remdesivir × 3 days should be considered. In patients with severe disease, the use of remdesivir, dexamethasone, and immunomodulatory agents (tocilizumab, baricitinib) is recommended. Children can be at risk for thrombosis from COVID-19 and anticoagulation is recommended in children with markedly elevated D-dimer levels or superimposed clinical risk factors for hospital associated venous thromboembolism.
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COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran). CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:2737719. [PMID: 35340920 PMCID: PMC8942697 DOI: 10.1155/2022/2737719] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
Abstract
Background. The novel coronavirus disease 2019 (COVID-19) started in Wuhan, China, in December 2019. It spread widely around the world and was described as a pandemic by the World Health Organization (WHO). The knowledge regarding the mortality rate and risk factors of COVID-19 among the pediatric population is lacking. In this regard, we aimed to report the clinical and laboratory characteristics of deceased pediatric patients with SARS-CoV-2 infection. Method. This cross-sectional study was conducted in Mofid Children’s Hospital, Tehran, Iran, from February 2020 to April 2021. Recorded documents of 59 pediatric patients (under 18 years old) assumed to have COVID-19 who had died in the COVID-19 ward and COVID-19 intensive care unit (ICU) were retrospectively evaluated. All statistical analyses were performed using SPSS software (v. 26.0, Chicago, IL). A
value of less than 0.05 was considered statistically significant. Results. From 711 COVID-19 definite and suspected patients, 59 children died. Of these deceased pediatric patients, 34 were boys (57.62%) and 25 were girls (42.37%), with a total mean age of 5.6 years. The median length of stay in the hospital was 10 days (range 1–215). 91.52% had underlying comorbidities of which neurological diseases accounted for the largest share. 54 patients were admitted to the ICU and 83.05% of them had intubation during their hospitalization. In addition, the most common reasons for death in our study were related to respiratory and multiorgan failure. Conclusion. According to our knowledge, we are the first team to report such a thorough study in the field of COVID-19 pediatric mortality in Iran. Mortality was observed in all age groups of children, especially in those with previous comorbidities, specifically neurological disease. Abnormally elevated tests of ESR, CRP, LDH, AST, and ALT as well as the presence of proteinuria and hematuria were found in more than 50% of patients in our investigations, and ICU admission between both definite and suspected groups had significant differences, so monitoring and considering these factors may help to control and reduce the progression of the disease to death.
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30
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Folino F, Menis C, Di Pietro GM, Pinzani R, Marchisio P, Bosis S. Incidental occurrence of neutropenia in children hospitalised for COVID-19. Ital J Pediatr 2022; 48:43. [PMID: 35292084 PMCID: PMC8922397 DOI: 10.1186/s13052-022-01234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Investigations on haematological alterations in paediatric COVID-19 have been focused mostly on lymphocytes and clotting profiles. Neutropenia has been occasionally reported and its course and impact on the disease have not been elucidated. The aim of this study was to describe the epidemiology, course, and impact of neutropenia in children with COVID-19 hospitalised in a tertiary care referral paediatric ward. Methods A single-centre retrospective study was conducted. Hospitalised children between 1 month and 18 years with confirmed COVID-19 and neutropenia were included and compared to non neutropenic patients. Complete blood picture with differential blood count, serum biochemistry, clotting profiles were performed; clinical data, length of hospitalisation, and prescription of drugs were collected. Results Twelve out of 95 patients (12.63%) with documented SARS-CoV-2 infection were neutropenic and met the inclusion criteria. The mean age was 161 days (range 38—490 days). The mean duration of symptoms in neutropenic children was 3.82 days, while the mean length of hospitalisation was 7.67 days. These findings were not significantly different in the two study groups. All patients had mild clinical manifestations and were discharged without sequelae. Conclusions We provided the first comprehensive study on neutropenia in mild paediatric COVID-19 infection. Our findings show that the main features of this haematological disorder in COVID-19 are analogous to the well-known transient benign neutropenia associated with other common viral infections. In our setting, neutropenia does not emerge as a potential negative prognostic factor in paediatric COVID-19.
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Affiliation(s)
- Francesco Folino
- University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Camilla Menis
- University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | | | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Mania A, Pokorska-Śpiewak M, Figlerowicz M, Pawłowska M, Mazur-Melewska K, Faltin K, Talarek E, Zawadka K, Dobrzeniecka A, Ciechanowski P, Łasecka-Zadrożna J, Rudnicki J, Hasiec B, Stani M, Frańczak-Chmura P, Zaleska I, Szenborn L, Horecka P, Sulik A, Szczepańska B, Pałyga-Bysiecka I, Kucharek I, Sybilski A, Sobolewska-Pilarczyk M, Dryja U, Majda-Stanisławska E, Niedźwiecka S, Kuchar E, Kalicki B, Gorczyca A, Marczyńska M. Pneumonia, gastrointestinal symptoms, comorbidities, and coinfections as factors related to a lengthier hospital stay in children with COVID-19-analysis of a paediatric part of Polish register SARSTer. Infect Dis (Lond) 2022; 54:196-204. [PMID: 34711132 PMCID: PMC8567279 DOI: 10.1080/23744235.2021.1995628] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although COVID-19 is associated with a mild course in children, a certain proportion requires admission to hospital due to SARS-CoV-2 infection and coexisting diseases. The prospective multicenter study aimed to analyze clinical factors influencing the length of the hospital stay (LoHS) in children with COVID-19. METHODS The study included 1283 children from 14 paediatric infectious diseases departments with diagnosed SARS-CoV-2 infection. Children were assessed in respective centres regarding indications for admission to hospital and clinical condition. History data, clinical findings, laboratory parameters, treatment, and outcome, were collected in the paediatric SARSTer register. The group of children with a hospital stays longer than seven days was compared to the remaining patients. Parameters with a statistically significant difference were included in further logistic regression analysis. RESULTS One thousand one hundred and ten children were admitted to the hospital, 763 children were hospitalized >24 h and 173 children >7 days. 268 children had comorbidities. Two hundred and eleven children had an additional diagnosis with coinfections present in 135 children (11%). Factors increasing the risk of higher LoHS included pneumonia [odds ratio-OR 3.028; 95% confidence interval-CI (1.878-4.884)], gastrointestinal symptoms [OR = 1.556; 95%CI (1.049-2.322)], or rash [OR = 2.318; 95%CI (1.216-4.418)] in initial clinical findings. Comorbidities [OR = 2.433; 95%CI (1.662-3.563)], an additional diagnosis [OR = 2.594; 95%CI (1.679-4.007)] and the necessity of the empirical antibiotic treatment [OR = 2.834; 95%CI (2.834-6.713)] were further factors related to higher LoHS. CONCLUSIONS The clinical course of COVID-19 was mild to moderate in most children. Factors increasing the risk of higher LoHS included pneumonia, gastrointestinal symptoms, comorbidities, an additional diagnosis, and the empirical antibiotic treatment.
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Affiliation(s)
- Anna Mania
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kamil Faltin
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Talarek
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Zawadka
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Dobrzeniecka
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Ciechanowski
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Joanna Łasecka-Zadrożna
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Józef Rudnicki
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Barbara Hasiec
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Martyna Stani
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Paulina Frańczak-Chmura
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Izabela Zaleska
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Leszek Szenborn
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Paulina Horecka
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Bialystok, Poland
| | | | | | - Izabela Kucharek
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Paediatrics and Neonatology with Allergology Center, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Adam Sybilski
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Paediatrics and Neonatology with Allergology Center, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Małgorzata Sobolewska-Pilarczyk
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Urszula Dryja
- Department of Paediatric Infectious Diseases, Medical University of Lodz, Lodz, Poland
| | | | - Sławomira Niedźwiecka
- Department of Paediatric Infectious Diseases, Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, Gdańsk, Poland
| | - Ernest Kuchar
- Department of Paediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Anna Gorczyca
- The Ward of Pediatric Infectious Diseases and Hepatology, The John Paul II Hospital in Krakow, Krakow, Poland
| | - Magdalena Marczyńska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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Essone PN, Adegbite BR, Mbadinga MJM, Mbouna AV, Lotola-Mougeni F, Alabi A, Edoa JR, Lell B, Alabi AS, Adegnika AA, Ramharter M, Siawaya JFD, Grobusch MP, Kremsner PG, Agnandji ST. Creatine kinase-(MB) and hepcidin as candidate biomarkers for early diagnosis of pulmonary tuberculosis: a proof-of-concept study in Lambaréné, Gabon. Infection 2022; 50:897-905. [PMID: 35133607 PMCID: PMC9338130 DOI: 10.1007/s15010-022-01760-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/15/2022] [Indexed: 12/05/2022]
Abstract
Background The present study aimed to evaluate the diagnostic utility of creatine kinase-MB (CK-MB), hepcidin (HEPC), phospholipase A2 group IIA (PLa2G2A), and myosin-binding protein C (MYBPC1) for tuberculosis (TB). These four biomarkers are differentially regulated between quiescent Mycobacterium tuberculosis (Mtb) infected individuals (non-progressors to TB disease) and Mtb-infected TB disease progressors 6 months before the onset of symptoms.
Methods We enrolled samples from patients experiencing moderate-to-severe pulmonary infections diseases including 23 TB cases confirmed by smear microscopy and culture, and 34 TB-negative cases. For each participant, the serum levels of the four biomarkers were measured using ELISA. Results The levels of CK-MB and HEPC were significantly reduced in patients with active TB disease. CK-MB median level was 2045 pg/ml (1455–4000 pg/ml) in active TB cases and 3245 pg/ml (1645–4000 pg/ml) in non-TB pulmonary diseases. Using the receiver operating characteristic curve (ROC) analysis, HEPC and CK-MB had the Area Under the Curve (AUC) of 79% (95% CI 67–91%) and 81% (95% CI 69–93%), respectively. Both markers correlated with TB diagnosis as a single marker. PLa2G2A and MYBPC1 with AUCs of 48% (95% CI 36–65%) and 62% (95% CI 48–76%) did not performed well as single biomarkers. The three markers’model (CK-MB-HEPC-PLa2G2A) had the highest diagnostic accuracy at 82% (95% CI 56–82%) after cross-validation. Conclusion CK-MB and HEPC levels were statistically different between confirmed TB cases and non-TB cases. This study yields promising results for the rapid diagnosis of TB disease using a single marker or three biomarkers model. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01760-8.
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Affiliation(s)
- Paulin N Essone
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany.
- Unité de Recherche et de Diagnostics Spécialisés, Laboratoire National de Santé Publique/Centre Hospitalier Universitaire Mère Enfant Fondation Jeanne EBORI, Libreville, Gabon.
| | - Bayode R Adegbite
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Armel V Mbouna
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Ayodele Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean R Edoa
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Abraham S Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joel F D Siawaya
- Unité de Recherche et de Diagnostics Spécialisés, Laboratoire National de Santé Publique/Centre Hospitalier Universitaire Mère Enfant Fondation Jeanne EBORI, Libreville, Gabon
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany
| | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research Tübingen, Tübingen, Germany.
- The African Society of Clinical Trials and the African Congress for Clinical Trials, Lambaréné, Gabon.
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Liu M, Han Y, Sun J, Wei X, Zhao X, Wang B, Zhang Y, Ma X, Gai Z. Comparison of the Epidemiological and Clinical Characteristics of Hospitalized Children With Pneumonia Caused by SARS-CoV-2, Influenza A, and Human Adenoviruses: A Case-Control Study. Clin Pediatr (Phila) 2022; 61:150-158. [PMID: 34753343 DOI: 10.1177/00099228211058601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. This case-control study aims to investigate the clinical characteristics in pediatric patients with pneumonia infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and human adenoviruses (HAdVs). Methods. Hospitalized pediatric patients with pneumonia infected with SARS-CoV-2 at Wuhan Children's Hospital and pneumonia infected with influenza A, and HAdVs at Qilu Children's Hospital were compared. Clinical manifestations, laboratory examinations, and imaging characteristics were analyzed. Results. The proportions of hyperpyrexia (54.3%, 33.9%), cough (100%, 99.2%), wheezing (45.7%, 53.7%), diarrhea (31.4%, 14.9%), and fever (100%, 75.2%) in patients with influenza A and HAdVs were higher than those of patients with SARS-CoV-2 (9.4%, P < .001; 48.5%, P < .001; 0%, P < .001; 8.8%, P = .002; 41.5%, P < .001; respectively). Laboratory examinations revealed the proportions of leukocytosis (37.1%, 52.9%), abnormal rates of neutrophils (40%, 40.5%), and lymphocytosis (42.9%, 65.3%) in influenza A and HAdV pneumonia groups were significantly higher than coronavirus disease 2019 (COVID-19) group (0%, P < .001; 0%, P < .001; 0%, P < .001; respectively). The proportion of elevated procalcitonin (5.7%, 14%) in patients with influenza A and HAdVs was significantly lower than those in patients with SARS-CoV-2 (64%, P < .001). In chest computed tomography, ground-glass opacities near the pleura were more common in patients with COVID-19 than those in patients with influenza A and HAdVs (32.7% vs 0% vs 0%, P < .001). Conclusion. Fever, cough, and wheezing are more common in the influenza A and HAdVs groups, whereas procalcitonin and computed tomography findings are likely to be pronounced in COVID-19 pneumonia. It provides a variety of methods except polymerase chain reaction for differentiating COVID-19 pneumonia from influenza A and HAdVs pneumonia.
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Affiliation(s)
- Miao Liu
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuling Han
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jing Sun
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoling Wei
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuxia Zhao
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bing Wang
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yun Zhang
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiang Ma
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhongtao Gai
- Department of Respiratory Diseases, Qilu Children's Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Karim SA, Weiss CN, Marrinan JE, Herlihy JM. Inflammation and Cytopenias in a Well-Appearing Infant With SARS-CoV-2. Clin Pediatr (Phila) 2022; 61:116-119. [PMID: 34581199 DOI: 10.1177/00099228211048599] [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: 11/16/2022]
Affiliation(s)
- Sabrina A Karim
- Boston University, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Cary N Weiss
- Boston University, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Jaclyn E Marrinan
- Boston University, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - Julie M Herlihy
- Boston University, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
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Clerico A, Aimo A, Cantinotti M. High-sensitivity cardiac troponins in pediatric population. Clin Chem Lab Med 2022; 60:18-32. [PMID: 34679265 DOI: 10.1515/cclm-2021-0976] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
Apparently healthy children often complain of chest pain, especially after physical exercise. Cardiac biomarker levels are often measured, but the clinical relevance of these assays in children is still debated, even when a cardiac disease is present. Coronary artery disease is exceedingly rare in children, but elevated circulating levels of cardiac troponin I (cTnI) and T (cTnT) in an acute setting may help detect heart failure due to an unknown cardiac disorder, or worsening heart failure, particularly in combination with other biomarkers such as B-type natriuretic peptides. However, the interpretation of biomarkers is often challenging, especially when institutions transition from conventional cTn assays to high-sensitivity (hs-cTn) methods, as well demonstrated in the emergency setting for adult patients. From a clinical perspective, the lack of established reference values in the pediatric age is the main problem limiting the use of hs-cTn methods for the diagnosis and managements of cardiac diseases in infants, children and adolescents. This review aims to discuss the possibility to use hs-cTnI and hs-cTnT to detect cardiac disease and to explore age-related differences in biomarker levels in the pediatric age. We start from some analytical and pathophysiological considerations related to hs-cTn assays. Then, after a systematic literature search, we discuss the current evidence and possible limitations of hs-cTn assay as indicators of cardiac disease in the most frequently cardiac disease in pediatric setting.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
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36
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Ramoğlu MG, Karagözlü S, Bayram Ö, Bakhtiyarzada J, Aydın A, Vatansever G, Özdemir H, Tekin D, Uçar T, Çiftçi E, Tutar E. The role and efficacy of routine high-sensitivity troponin T screening in paediatric COVID-19. Cardiol Young 2022; 32:1-5. [PMID: 34986921 DOI: 10.1017/s1047951121005199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the efficacy and role of high-sensitivity troponin T in children with a confirmed SARS-CoV-2 infection and also the correlation of troponin T levels with symptoms, and echocardiographic findings were analysed. METHODS Two hundred and fourteen patients with a confirmed SARS-CoV-2 infection between the dates of 28 March and 15 August 12020 were enrolled in this retrospective single-centre study. Patients with comorbidities and diagnosed as multisystem inflammatory syndrome in children were excluded. Demographic data, clinical and laboratory parameters were evaluated. The patients were classified and compared according to the troponin positivity. The correlation of troponin T with symptoms and echocardiographic findings was analysed. RESULTS The most common symptoms in the whole study group were fever (53.3%) and cough (24.8%). Troponin T levels were elevated in 15 (7%) patients. The most common symptom in patients with troponin positivity was also fever (73.3%). Troponin T positivity was significantly higher in patients under the age of 12 months and troponin T levels were negatively correlated with age. C-reactive protein levels were elevated in 77 (36%) of the patients in the whole group and 7 (46.7%) of 15 patients with troponin positivity. C-reactive protein levels were similar between groups. CONCLUSION Routine troponin screening does not yield much information in previously healthy paediatric COVID-19 patients without any sign of myocardial dysfunction. Elevated troponin levels may be observed but it is mostly a sign of myocardial injury without detectable myocardial dysfunction in this group of patients.
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Affiliation(s)
- Mehmet G Ramoğlu
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Selen Karagözlü
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Özlem Bayram
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Jeyhun Bakhtiyarzada
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Alperen Aydın
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Department of Pediatric Emergency Medicine, Ankara University, School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Medicine, Ankara University, School of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
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Leeman R, Shoag J, Borchetta M, Mitchell C, Davis JA, Corrales-Medina FF. Clinical Implications of Hematologic and Hemostatic Abnormalities in Children With COVID-19. J Pediatr Hematol Oncol 2022; 44:e282-e286. [PMID: 33930009 DOI: 10.1097/mph.0000000000002176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Leukopenia, thrombocytopenia, elevated D-dimer, and prolonged prothrombin time are considered poor prognostic factors in adults with acute Coronavirus Disease 2019. The prognostic significance of these abnormalities among pediatric patients remains underreported in the literature. This retrospective cohort study evaluates the prognostic implications of hematologic and hemostatic derangements in patients younger than 22-years-of-age who were admitted to a tertiary-care referral institution for management of acute Coronavirus Disease 2019 infection. Leukopenia and thrombocytopenia were identified as independent prognostic factors of disease severity. Although the majority of children, with available results, had elevated D-dimer or prolonged prothrombin time upon initial presentation, these markers were not found to be associated with the development of severe clinical complications.
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Affiliation(s)
- Rachel Leeman
- Holtz Children's Hospital, Jackson Memorial Medical Center
| | - Jamie Shoag
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
| | - Michael Borchetta
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Miami-Miller School of Medicine
| | - Charles Mitchell
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Miami-Miller School of Medicine
| | - Joanna A Davis
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
- University of Miami-Hemophilia Treatment Center, Miami, FL
| | - Fernando F Corrales-Medina
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
- University of Miami-Hemophilia Treatment Center, Miami, FL
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38
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Nicastro E, Ebel NH, Kehar M, Czubkowski P, Ng VL, Michaels MG, Lobritto SJ, Martinez M, Indolfi G. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper. J Pediatr Gastroenterol Nutr 2022; 74:159-170. [PMID: 34694269 PMCID: PMC8673661 DOI: 10.1097/mpg.0000000000003339] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
ABSTRACT Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, Toronto, ON, Canada
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Steven J. Lobritto
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Mercedes Martinez
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Giuseppe Indolfi
- Meyer Children's University Hospital, Department NEUROFARBA, University of Florence, Firenze, Italy
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Slower Recovery with Early Lopinavir/Ritonavir use in Pediatric COVID-19 Patients: A Retrospective Observational Study. Paediatr Drugs 2022; 24:269-280. [PMID: 35428969 PMCID: PMC9012665 DOI: 10.1007/s40272-022-00500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There was initially insufficient understanding regarding suitable pharmacological treatment for pediatric Coronavirus Disease 2019 (COVID-19) patients. Lopinavir-ritonavir (LPV/r) was originally used for the treatment of Human Immunodeficiency Virus-1 (HIV-1) infection. It was also used in patients with severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) with positive results. Nonetheless, results from recent randomized controlled trials and observational studies on COVID-19 patients were unfavorable. We sought to evaluate the clinical outcomes associated with early treatment with LPV/r for pediatric COVID-19 patients. STUDY DESIGN A total of 933 COVID-19 patients aged ≤ 18 years were admitted between 21 January 2020 and 31 January 2021 in Hong Kong. Exposure was receiving LPV/r within the first two days of admission. Time to clinical improvement, hospital discharge, seroconversion and hyperinflammatory syndrome, cumulative costs, and hospital length of stay were assessed. Multivariable Cox proportional hazard and linear models were performed to estimate hazard ratios (HR) and their 95% confidence intervals (CI) of time-to-event and continuous outcomes, respectively. RESULTS LPV/r users were associated with longer time to clinical improvement (HR 0.51, 95% CI 0.38-0.70; p < 0.001), hospital discharge (HR 0.51, 95% CI 0.38-0.70; p < 0.001) and seroconversion (HR 0.59, 95% CI 0.43-0.80; p < 0.001) when compared with controls. LPV/r users were also associated with prolonged hospital length of stay (6.99 days, 95% CI 6.23-7.76; p < 0.001) and higher costs at 30 days (US$11,709 vs US$8270; p < 0.001) as opposed to controls. CONCLUSION Early treatment with LPV/r for pediatric COVID-19 patients was associated with longer time to clinical improvement. Our study advocates the recommendation against LPV/r use for pediatric patients across age groups.
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López-Medina E, Camacho-Moreno G, Brizuela ME, Dávalos DM, Torres JP, Ulloa-Gutierrez R, López P, Debbag R, Pérez P, Patiño J, Norero X, Mariño C, Luengas MA, Ensinck G, Daza C, Luciani K, Quintana Kuhner P, Rodriguez M, Rodríguez-Auad JP, Estrada-Villarroel A, Carnevale M, Mantese OC, Berezin EN, Castillo JI, Mascareñas A, Jimenez-Zambrano A, Dueñas L, Melgar M, Galvez N, Cantor E, Asturias EJ. Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America. Front Pediatr 2022; 10:868297. [PMID: 35498776 PMCID: PMC9048675 DOI: 10.3389/fped.2022.868297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. OBJECTIVE To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. METHOD Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. RESULTS A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. CONCLUSIONS In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia.,Clínica Imbanaco, Grupo Quirón Salud, Cali, Colombia
| | - German Camacho-Moreno
- Pediatric Infectious Disease Unit, Fundación HOMI Hospital Pediátrico de la Misericordia and Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martin E Brizuela
- Infectious Diseases Division, Hospital Zonal General de Agudos "Dr. Isidoro Iriarte", Buenos Aires, Argentina
| | - Diana M Dávalos
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Juan Pablo Torres
- Department of Pediatrics, Facultas de Medicina, Hospital Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Pio López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia
| | - Roberto Debbag
- Department of Infectious Diseases and Epidemiology, Hospital de Pediatría, Buenos Aires, Argentina
| | - Paola Pérez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Jaime Patiño
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Ximena Norero
- Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panama
| | | | | | - Gabriela Ensinck
- Servicio de Infectología, Hospital de Niños Víctor J. Vilela de Rosario, Rosario, Argentina
| | - Carlos Daza
- Hospital Materno Infantil José Domingo de Obaldía, Chiriquí, Panama
| | - Kathia Luciani
- Department of Infectious Diseases, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panama
| | | | - Mónica Rodriguez
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | | | - Mayli Carnevale
- Hospital Universitario Pediatria Agustin Zubillaga, Barquisimeto, Venezuela
| | | | - Eitan N Berezin
- Department of Pediatrics, Santa Casa de São Paulo Medical School, São Paulo, Brazil
| | | | - Abiel Mascareñas
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Nancy Galvez
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Erika Cantor
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Institute of Statistics, Universidad de Valparaíso, Valparaíso, Chile
| | - Edwin J Asturias
- Colorado School of Public Health, Center for Global Health, Aurora, CO, United States.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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Onimoe G, Alvarado J, Boakye A. Hematologic manifestations of coronavirus disease 2019 in children: Case-series report and a review. Front Pediatr 2022; 10:935236. [PMID: 36052361 PMCID: PMC9424539 DOI: 10.3389/fped.2022.935236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022] Open
Abstract
On 11 March 2020, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) was declared as a pandemic by the World Health Organization (WHO). As the COVID-19 pandemic has ravaged worldwide, children have not been unaffected. Information gleaned from adult experience with the disease has aided in disease detection and treatment strategies in children. Numerous cases have been described in adult literature about hematologic manifestations of COVID-19. This case series aims to report several hematologic presentations in patients with COVID-19 and multisystem inflammatory syndrome in children (MIS-C, an immune-mediated reaction leading to severe COVID-19 illness) with and without a primary hematologic disorder.
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Affiliation(s)
- Grace Onimoe
- The MetroHealth System, Cleveland, OH, United States.,Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Juan Alvarado
- The MetroHealth System, Cleveland, OH, United States.,Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Anita Boakye
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
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Akbeyaz B, Karaaslan A, Çetin C, Köle M, AltaŞ Z, Akın Y. Hematological profile of COVID-19 infected children before and after the spread of the Omicron variant in Istanbul. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.364004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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43
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Incidence and Outcome of Coinfections with SARS-CoV-2 and Rhinovirus. Viruses 2021; 13:v13122528. [PMID: 34960797 PMCID: PMC8709236 DOI: 10.3390/v13122528] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background: We aimed to compare the clinical severity in patients who were coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and rhinovirus or monoinfected with a single one of these viruses. Methods: The study period ranged from 1 March 2020 to 28 February 2021 (one year). SARS-CoV-2 and other respiratory viruses were identified by real-time reverse-transcription-PCR as part of the routine work at Marseille University hospitals. Bacterial and fungal infections were detected by standard methods. Clinical data were retrospectively collected from medical files. This study was approved by the ethical committee of our institute. Results: A total of 6034/15,157 (40%) tested patients were positive for at least one respiratory virus. Ninety-three (4.3%) SARS-CoV-2-infected patients were coinfected with another respiratory virus, with rhinovirus being the most frequent (62/93, 67%). Patients coinfected with SARS-CoV-2 and rhinovirus were significantly more likely to report a cough than those with SARS-CoV-2 monoinfection (62% vs. 31%; p = 0.0008). In addition, they were also significantly more likely to report dyspnea than patients with rhinovirus monoinfection (45% vs. 36%; p = 0.02). They were also more likely to be transferred to an intensive care unit and to die than patients with rhinovirus monoinfection (16% vs. 5% and 7% vs. 2%, respectively) but these differences were not statistically significant. Conclusions: A close surveillance and investigation of the co-incidence and interactions of SARS-CoV-2 and other respiratory viruses is needed. The possible higher risk of increased clinical severity in SARS-CoV-2-positive patients coinfected with rhinovirus warrants further large scale studies.
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Cytokine-induced liver injury in coronavirus disease-2019 (COVID-19): untangling the knots. Eur J Gastroenterol Hepatol 2021; 33:e42-e49. [PMID: 33405427 DOI: 10.1097/meg.0000000000002034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver dysfunction manifesting as elevated aminotransferase levels has been a common feature of coronavirus disease-2019 (COVID-19) infection. The mechanism of liver injury in COVID-19 infection is unclear. However, it has been hypothesized to be a result of direct cytopathic effects of the virus, immune dysfunction and cytokine storm-related multiorgan damage, hypoxia-reperfusion injury and idiosyncratic drug-induced liver injury due to medications used in the management of COVID-19. The favored hypothesis regarding the pathophysiology of liver injury in the setting of COVID-19 is cytokine storm, an aberrant and unabated inflammatory response leading to hyperproduction of cytokines. In the current review, we have summarized the potential pathophysiologic mechanisms of cytokine-induced liver injury based on the reported literature.
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45
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Clinical Picture and Risk Factors of Severe Respiratory Symptoms in COVID-19 in Children. Viruses 2021; 13:v13122366. [PMID: 34960635 PMCID: PMC8703640 DOI: 10.3390/v13122366] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Children with COVID-19 develop moderate symptoms in most cases. Thus, a proportion of children requires hospital admission. The study aimed to assess the history, clinical and laboratory parameters in children with COVID-19 concerning the severity of respiratory symptoms. The study included 332 children (median age 57 months) with COVID-19. History data, clinical findings, laboratory parameters, treatment, and outcome, were evaluated. Children were compared in the groups that varied in the severity of symptoms of respiratory tract involvement. Children who required oxygen therapy represented 8.73%, and intensive care 1.5% of the whole cohort. Comorbidities were present in 126 patients (37.95%). Factors increasing the risk of oxygen therapy included comorbidities (odds ratio (OR) = 92.39; 95% confidence interval (95% CI) = (4.19; 2036.90); p < 0.00001), dyspnea (OR = 45.81; 95% CI (4.05; 518.21); p < 0.00001), auscultation abnormalities (OR = 34.33; 95% CI (2.59; 454.64); p < 0.00001). Lactate dehydrogenase (LDH) > 280 IU/L and creatinine kinase > 192 IU/L were parameters with a good area under the curve (0.804-LDH) and a positive predictive value (42.9%-CK). The clinical course of COVID-19 was mild to moderate in most patients. Children with comorbidities, dyspnea, or abnormalities on auscultation are at risk of oxygen therapy. Laboratory parameters potentially useful in patients evaluated for the severe course are LDH > 200 IU/L and CK > 192 IU/L.
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Nooh HA, Abdellateif MS, Refaat L, Kandeel EZ, Bayoumi A, Samra M, Khafagy M. The role of inflammatory indices in the outcome of COVID-19 cancer patients. Med Oncol 2021; 39:6. [PMID: 34748094 PMCID: PMC8573297 DOI: 10.1007/s12032-021-01605-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 02/08/2023]
Abstract
To assess the prognostic role of different inflammatory indices on the outcome of cancer patients with COVID-19. Sixty-two adults and 22 pediatric cancer patients with COVID-19 infection were assessed for the prognostic value of certain inflammatory indices including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), derived NLR (dNLR), systemic inflammation index (SII), mean platelet volume to platelet ratio (MPR), C-reactive protein to lymphocyte ratio (CRP/L), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil to lymphocyte, platelet ratio (NLPR). Data were correlated to patients' outcome regarding ICU admission, and incidence of mortality. Increased CRP/L ratio in adult COVID-19 cancer patients was significantly associated with inferior survival [152 (19-2253) in non-survivors, compared to 27.4 (0.8-681) in survivors (P = 0.033)]. It achieved a sensitivity (60%) and a specificity (90.2%) at a cut-off 152, while it achieved a sensitivity of 60% and specificity 95.1% at a cut-off 252 (AUC 0.795, P = 0.033). When combining both CRP/L and NLPR for the prediction of poor outcome in adult cancer patients with COVID19, the sensitivity increased to 80% and the specificity was 70.7% (AUC 0.805, P = 0.027). Increased incidence of ICU admission in pediatric cancer patients associated significantly with the severity of covid19 infection, decreased mean corpuscular hemoglobin (MCH) < 28.3, increased red cell distribution width (RDW) > 16, lymphopenia < 1.04, pseudo Pelger-Huet appearance, and PLR < 196.4 (P = 0.004, P = 0.040, P = 0.029, P = 0. 0.039, P = 0.050, and P = 0.040; respectively). The mean corpuscular volume (MCV), MCH, and RDW could be useful prognostic markers for poor outcome in COVID-19 pediatric cancer patients (P < 0.05 for all). Increased both CRP/L and NLPR associated significantly with poor survival in adult COVID-19 cancer patients, while PLR associated significantly with ICU admission in pediatric COVID-19 cancer patients.
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Affiliation(s)
- Hend A Nooh
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mona S Abdellateif
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt. .,Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Lobna Refaat
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman Z Kandeel
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Bayoumi
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Samra
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Medhat Khafagy
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Shah K, Upadhyaya M, Kandre Y, Pandya A, Saraf V, Saxena D, Mavalankar D. Epidemiological, clinical and biomarker profile of pediatric patients infected with COVID-19. QJM 2021; 114:476-495. [PMID: 34293142 PMCID: PMC8420635 DOI: 10.1093/qjmed/hcab206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population. METHODS For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis. RESULTS Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality. CONCLUSION Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.
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Affiliation(s)
- Komal Shah
- Assistant Professor, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
- Dr. Komal Shah (*Corresponding Author) Assistant Professor, Indian Institute of Public Health – Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Gandhinagar-Chiloda Road, Gandhinagar – 382042, Mob: 9924264500,
| | - Mudita Upadhyaya
- Independent Researcher, 9138 Harbor Hills Drive, Houston Texas, 77054, USA
| | - Yogini Kandre
- Programe Associate, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
| | - Apurvakumar Pandya
- Economic Evaluation Specialist, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Vishakh Saraf
- MPH Student, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Deepak Saxena
- Professor, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Dileep Mavalankar
- Director, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
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Tzoulis P. Prevalence, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021474. [PMID: 34738553 PMCID: PMC8689294 DOI: 10.23750/abm.v92i5.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
Hyponatraemia is frequently encountered in adults with coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. This review aims to describe for the first time the prevalence, aetiology, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19, taking into account all relevant studies published in PubMed and Cochrane Library studies until 26th September 2021. Literature search did not detect any studies evaluating the prevalence and prognostic value of sodium disorders in paediatric patients with COVID-19. A broader literature review showed a high prevalence of hyponatraemia in children with bacterial pneumonia, while some studies have reported that hyponatraemia is relatively common in Multisystem Inflammatory Syndrome in Children (MIS-C). In adults with COVID-19, an inverse association between sodium and interleukin-6 levels has been found, indicating that hyponatraemia could be used as a surrogate marker for the risk of cytokine storm and may facilitate the identification of patients who could benefit from immunomodulatory agents. Studies are urgently needed to evaluate the frequency and prognostic impact of electrolyte abnormalities in children with COVID-19. In the meantime, clinicians are urged to consider hyponatraemia in children with COVID-19 as a potential red flag, investigate the cause and administer fluids and other therapies accordingly.
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Persaud Y, Shamoun M, Chitlur M, Des Rosier KJ, Taub JW. Childhood B-Cell Acute Lymphoblastic Leukemia Following SARS CoV-2 Infection: A Potential Second "Hit" in Leukemogenesis. J Pediatr Hematol Oncol 2021; 43:e1241-e1243. [PMID: 33369996 DOI: 10.1097/mph.0000000000002037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has become the worst pandemic in modern history. The lack of prior immunity to the virus has resulted in a high mortality rate, though children have fared better than adults, overall. We present a case of a child who developed B-cell acute lymphoblastic leukemia 1 week following a symptomatic COVID-19 infection. It is possible that this viral infection provided the "second hit" posited to occur in pediatric leukemogenesis as proposed by Dr Greaves, with his initial viral exposure occurring several weeks earlier.
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Affiliation(s)
- Yogindra Persaud
- Division of Hematology/Oncology, Children's Hospital of Michigan
| | - Mark Shamoun
- Division of Hematology/Oncology, Children's Hospital of Michigan
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI
| | - Meera Chitlur
- Division of Hematology/Oncology, Children's Hospital of Michigan
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI
| | | | - Jeffrey W Taub
- Division of Hematology/Oncology, Children's Hospital of Michigan
- Department of Pediatrics, Wayne State University School of Medicine, Detroit
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI
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Palladino M. Complete blood count alterations in COVID-19 patients: A narrative review. Biochem Med (Zagreb) 2021; 31:030501. [PMID: 34658642 PMCID: PMC8495616 DOI: 10.11613/bm.2021.030501] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic represents a scientific and social crisis. One of the main unmet needs for coronavirus disease 2019 is its unpredictable clinical course, which can rapidly change in an irreversible outcome. COVID-19 patients can be classified into mild, moderate, and severe. Several haematological parameters, such as platelets, white blood cell total count, lymphocytes, neutrophils, (together with neutrophil-lymphocyte and platelet-lymphocyte ratio), and haemoglobin were described to be associated with COVID-19 infection and severity. The purpose of these review is to describe the current state of the art about complete blood count alterations during COVID-19 infection, and to summarize the crucial role of some haematological parameters during the course of the disease. Decreased platelet, lymphocyte, haemoglobin, eosinophil, and basophil count, increased neutrophil count and neutrophil-lymphocyte and platelet-lymphocyte ratio have been associated with COVID-19 infection and a worse clinical outcome. Our study adds some novelty about the identification of effective biomarkers of progressive disease, and might be helpful for diagnosis, prevention of complications, and effective therapy.
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