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Kulkarni D, Ismail NF, Zhu F, Wang X, del Carmen Morales G, Srivastava A, Allen KE, Spinardi J, Rahman AE, Kyaw MH, Nair H. Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis. J Glob Health 2024; 14:05003. [PMID: 38419461 PMCID: PMC10902805 DOI: 10.7189/jogh.14.05003] [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] [Indexed: 03/02/2024] Open
Abstract
Methods We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection. Results We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths. Conclusions Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19. Registration PROSPERO: CRD42022327680.
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Affiliation(s)
- Durga Kulkarni
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Nabihah Farhana Ismail
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia
| | - Fuyu Zhu
- Schol of Public Health, Nanjing Medical University, China
| | - Xin Wang
- Schol of Public Health, Nanjing Medical University, China
| | | | | | | | | | - Ahmed Ehsanur Rahman
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- International Centre for Diarrhoeal Diseases Research, Bangladesh
| | | | - Harish Nair
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Schol of Public Health, Nanjing Medical University, China
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Asseri AA, Al-Qahtani SM, Algathradi MA, Alzaydani IA, Al-Jarie AA, Al-Benhassan IA, AlHelali IA, Alassiri MS, Alrmelawi AA, Ali AS. Clinical, laboratory, and chest radiographic characteristics of COVID-19 associated severe pediatric pneumonia. A retrospective study. Saudi Med J 2022; 43:1390-1396. [PMID: 36517065 PMCID: PMC9994509 DOI: 10.15537/smj.2022.43.12.20220420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/13/2022] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To evaluate the demographics, clinical presentation, laboratory data, chest radiographs, and outcomes of pediatric patients with critical coronavirus disease 2019 (COVID-19). METHODS This retrospective study included 34 children who were diagnosed with severe COVID-19 pneumonia between August 2020 and July 2021. Severe pneumonia was defined as fever, respiratory distress (tachypnea, chest retractions, and hypoxia [oxygen saturation <90% in room air]), and obvious infiltrations on chest radiography. RESULTS Ages of the patients ranged from newborns to 12 years old, with a median of 24 months (interquartile range: 12-72 months). Preschool-aged children were the most common age group (44%). Levels of inflammatory markers (C-reactive protein, ferritin, and procalcitonin) were elevated in most patients. A total of 13 patients developed severe acute respiratory distress syndrome (ARDS), while 4 developed multiorgan failure. Despite receiving supportive therapy, 2 (5.9%) patients died due to severe septic shock and multiorgan failure. One deceased patient was born prematurely at 30 weeks, while the other had chronic granulomatous disease. CONCLUSION This study described a single-center cohort of pediatric patients with severe COVID-19 pneumonia. In this cohort, children with cardiopulmonary comorbidities and ARDS had a high mortality and long-term morbidity, as observed in other pediatric studies.
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Affiliation(s)
- Ali A. Asseri
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Saleh M. Al-Qahtani
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Mohammed A. Algathradi
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Ibrahim A. Alzaydani
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Ahmed A. Al-Jarie
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Ibrahim A. Al-Benhassan
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Ibrahim A. AlHelali
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Mona S. Alassiri
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Ali A. Alrmelawi
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
| | - Abdelwahid S. Ali
- From the Department of Child Health (Asseri, Al-Qahtani); from the Department of Radiology (Algathradi); from the Department of Microbiology and Clinical Parasitology (Ali), College of Medicine, King Khalid University, from the Department of Pediatrics (Alzaydani, Al-Jarie, Alassiri); from the Department of Pediatric Critical Care Unit (Al-Benhassan, AlHelali); and from the Department of Microbiology (Alrmelawi), Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.
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Dandachi I, Aljabr W. Prognosis of COVID-19 in the middle eastern population, knowns and unknowns. Front Microbiol 2022; 13:974205. [PMID: 36118201 PMCID: PMC9471247 DOI: 10.3389/fmicb.2022.974205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.
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Asseri AA, Al-Murayeh R, Abudiah AM, Elgebally EI, Aljaser AM. A case report of pediatric systemic lupus erythematosus with diffuse alveolar hemorrhage following COVID-19 infection: Causation, association, or chance? Medicine (Baltimore) 2022; 101:e30071. [PMID: 35984167 PMCID: PMC9387659 DOI: 10.1097/md.0000000000030071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Diffuse alveolar hemorrhage (DAH) is a rare manifestation of childhood systemic lupus erythematosus (SLE) that can be life-threatening. Several reports have linked previous or concurrent coronavirus disease (COVID-19) infections with a high prevalence of autoimmune and autoinflammatory disorders. PATIENT CONCERNS We report a case of a 13-year-old female who presented with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection. DIAGNOSES The patient was diagnosed with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection. INTERVENTIONS AND OUTCOMES The patient was treated with intravenous methylprednisolone pulse, broad-spectrum antibiotics, and supportive measures. In addition, she received 6 sessions of plasma exchange and maintenance methylprednisolone therapy (2 mg/kg/day). The patient then improved and was discharged on prednisolone, hydroxychloroquine, and azathioprine. LESSONS We suggest plasmapheresis be considered a treatment for SLE-associated DAH in the context of active disease when conventional treatment has failed to induce a rapid response. In addition, further studies are needed to assess the role of COVID-19 as an autoimmune disease trigger, particularly for SLE.
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Affiliation(s)
- Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
- *Correspondence: Ali Alsuheel Asseri, Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia (e-mail: )
| | | | - Abdoh M. Abudiah
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi Arabia
| | - Elsayed I. Elgebally
- Department of Pediatrics, Saudi German Hospital, Aseer, Saudi Arabia
- Department of Pediatrics, Menoufia University, Shebeen Al-Kom, Egypt
| | - Abdullah M. Aljaser
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi Arabia
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Al-Qahtani SM, Shati AA, Alqahtani YA, Ali AS. Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review. Front Pediatr 2022; 10:923125. [PMID: 35783317 PMCID: PMC9249085 DOI: 10.3389/fped.2022.923125] [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: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.
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Affiliation(s)
- Saleh M Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayed A Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Youssef A Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdelwahid Saeed Ali
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Asseri AA. Pediatric Asthma Exacerbation in Children with Suspected and Confirmed Coronavirus Disease 2019 (COVID-19): An Observational Study from Saudi Arabia. J Asthma Allergy 2021; 14:1139-1146. [PMID: 34594113 PMCID: PMC8476942 DOI: 10.2147/jaa.s326860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Most asthma exacerbations are caused by viral respiratory infections such as rhinovirus, coronaviruses, influenza viruses, and many others. While there have been data about the impact of COVID-19 on adult asthma, much remains unknown about the impact of COVID-19 on childhood asthma. Methods This retrospective cohort study included all pediatric patients aged 2 to 12 years who were admitted to Abha Maternity and Children Hospital for acute asthma exacerbation between June 1, 2020, and May 31, 2021, and underwent testing for SARS-CoV-2 using nasopharyngeal real-time polymerase chain reaction. Results Sixty children hospitalized with the diagnosis of asthma were included in the study. Out of these patients, 10 (16.7%) were diagnosed with COVID-19. The enrolled patients were between 2 and 12 years, with a median age of five years (interquartile range, 3.8), and 58% were males (35/60). Cough, shortness of breath, and hypoxia were the most common presenting symptoms and signs. Severe asthma was more prevalent among positive COVID-19 compared with negative COVID-19 patients (60 vs 20%; P= 0.016). In addition, chronic asthma for more than five years was more prevalent among positive COVID-19 than negative COVID-19 patients (60 vs 40%, P= 0.305). Fifty-five percent of the enrolled patients had eosinophilic asthma using a 300cells/μL threshold. None of the children required invasive respiratory support (ventilation through an endotracheal tube or tracheostomy), but 12 patients (21.7%) required respiratory support via high-flow nasal cannula. The total days of hospitalization in either PICU or pediatric general ward did not differ between the two groups. All patients were discharged, and there were no reports of serious morbidity or mortality. Conclusion Eosinophilic asthma was the most prevalent asthma phenotype in the study group. Furthermore, there was no difference in the presenting symptoms of an asthma flare-up, laboratory indicators, and hospitalization outcomes (critical care admission and hospital stay) between asthmatics with and without a COVID-19 diagnosis.
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Affiliation(s)
- Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
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