Salient Conclusive Remarks on Epidemiology and Clinical Manifestations of Pediatric COVID-19: Narrative Review

T Lymphocyte Subset Counts and Interferon-Gamma Production in Adults and Children with COVID-19: A Narrative Review

Adults and children exhibit a broad range of clinical outcomes from SARS-CoV-2 infection, with minimal to mild symptoms, especially in the pediatric age. However, some children present with a severe hyperinflammatory post-infectious complication named multisystem inflammatory syndrome in children (MIS-C), mainly affecting previously healthy subjects. Understanding these differences is still an ongoing challenge, that can lead to new therapeutic strategies and avoid unfavorable outcomes. In this review, we discuss the different roles of T lymphocyte subsets and interferon-γ (IFN-γ) in the immune responses of adults and children. Lymphopenia can influence these responses and represent a good predictor for the outcome, as reported by most authors. The increased IFN-γ response exhibited by children could be the starting point for the activation of a broad response that leads to MIS-C, with a significantly higher risk than in adults, although a single IFN signature has not been identified. Multicenter studies with large cohorts in both age groups are still needed to study SARS-CoV-2 pathogenesis with new tools and to understand how is possible to better modulate immune responses.

Clinical, laboratory, and chest radiographic characteristics of COVID-19 associated severe pediatric pneumonia. A retrospective study

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.

A case report of pediatric systemic lupus erythematosus with diffuse alveolar hemorrhage following COVID-19 infection: Causation, association, or chance?

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.

Seroprevalence of SARS-CoV-2 among Children Visiting a Tertiary Hospital during the Prevaccination Period, Southwest Region, Saudi Arabia

Background: In the early days of the COVID-19 pandemic, tests to ascertain whether individuals were infected with SARS-CoV-2 were often unavailable. One method to deal with this issue is to test for SARS-CoV-2 antibodies. This study sought to determine the seroprevalence of SARS-CoV-2 in children in Saudi Arabia before vaccines were available to them. Methods: This study was conducted among children who visited the tertiary Maternity and Children Hospital in Abha city, Saudi Arabia. Serum samples were screened for SARS-CoV-2-specific IgG, IgM, and IgA antibodies using ELISA. The crude and adjusted seroprevalence values among the studied children were calculated. Results: Among the 413 children studied, the ages of enrolled patients ranged from newborn to 12 years, with a median age of three years. We identified 127 (30.7%) seropositive children. IgG was exclusively positive in 43 (10.4%); IgM was exclusively positive in 8 (1.9%), and IgA was exclusively positive in 15 (3.6%) children. Conclusions: This study is the first to estimate the seroprevalence of SARS-CoV-2 among the pediatric population seeking medical care in southwestern Saudi Arabia. The findings shed light on the dynamics of virus transmission in the community and provide a good reference for future studies. Future research should examine factors related to SARS-CoV-2 infection and seroprevalence among pediatric populations.

Pediatric Asthma Exacerbation in Children with Suspected and Confirmed Coronavirus Disease 2019 (COVID-19): An Observational Study from Saudi Arabia

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.

Distinctive clinical and laboratory features of COVID-19 and H1N1 influenza infections among hospitalized pediatric patients

BACKGROUND

It had been documented in many studies that pediatric coronavirus disease 2019 (COVID-19) is characterized by low infectivity rates, low mortalities, and benign disease course. On the other hand, influenza type A viruses are recognized to cause severe and fatal infections in children populations worldwide. This study is aimed to compare the clinical and laboratory characteristics of COVID-19 and H1N1 influenza infections.

METHODS

A retrospective study comprising 107 children hospitalized at Abha Maternity and Children Hospital, Southern region of Saudi Arabia, with laboratory-confirmed COVID-19 and H1N1 influenza infections was carried out. A complete follow-up for all patients from the hospital admission until discharge or death was made. The clinical data and laboratory parameters for these patients were collected from the medical records of the hospital.

RESULTS

Out of the total enrolled patients, 73 (68.2%) were diagnosed with COVID-19, and 34 (31.8%) were diagnosed with H1N1 influenza. The median age is 12 months for COVID-19 patients and 36 months for influenza patients. A relatively higher number of patients with influenza had a fever and respiratory symptoms than COVID-19 patients. In contrast, gastrointestinal symptoms were observed in a higher number of COVID-19 patients than in influenza patients. A statistically significant increase in white cell counts is noted in COVID-19 but not in influenza patients (P < 0.05). There are no obvious variations in the mean period of duration of hospitalization between COVID-19 and influenza patients. However, the total intensive care unit length of stay was longer for influenza compared to COVID-19 patients.

CONCLUSIONS

A considerable number of children infected with COVID-19 and H1N1 influenza were noted and reported in this study. There were no significant variations in the severity of the symptomatology and laboratory findings between the two groups of patients. Significant differences between these patients in some hospitalization factors and diagnosis upon admission also were not observed. However, more severe clinical manifestations and serious consequences were observed among pediatric patients hospitalized with influenza infections than among those with COVID-19.

Clinical Characteristics and Laboratory Abnormalities of Hospitalized and Critically Ill Children with Coronavirus Disease 2019: A Retrospective Study from Saudi Arabia

BACKGROUND

COVID-19 was reported in several studies characterized by milder clinical course, benign disease, and peculiar epidemiologic patterns among pediatric patients compared to adults' disease. However, other studies indicated that critical cases also exist and are associated with preexisting cardiopulmonary comorbidities and concurrent multisystem inflammatory syndrome in children.

METHODS

The study period was six months, May-October 2020. Data on demographics, clinical manifestations, laboratory abnormalities were extracted from the patients' hospital records. During the study period, 644 pediatric patients attended the hospital. They were all screened for SARS-CoV-2 using RT-PCR. Only the confirmed positive patients were included in the subsequent study analysis. They were hospitalized either in the general pediatric wards (GPW) or pediatric intensive care unit (PICU).

RESULTS

Out of the total patients screened, 79 (12.3%) children were confirmed to have COVID-19 infection. All the confirmed COVID-19 patients were either admitted to the general pediatric wards (58; 73.4%) or PICU (21; 26.6%). The admission diagnoses for these children were acute gastroenteritis (22.85%), acute pneumonia (19%), clinical sepsis (17.7%), and multisystem inflammatory syndrome in children (10.1%). A significantly higher percentage of the PICU admitted patients showed shortness of breath (SOB) (P= 0.016). Respiratory insufficiencies, prematurity, and congenital heart diseases are the most reported comorbid conditions among the admitted children. The oxygen saturation was significantly lower among PICU patients than those in GPW (P=0.001). The total hospital stays differ significantly between the two groups, which were ten days for the PICU group compared to 4.5 days for the GPW group with a statistical significance noted (P= 0.001).

CONCLUSION

Despite the observable variations in the clinical and laboratory findings among the hospitalized pediatric COVID-19 patients, no serious consequences among all patients were observed. The history of SOB and the initial oxygen saturation level were significantly associated with PICU admissions.

COVID-19 in Children: Respiratory Involvement and Some Differences With the Adults

The coronavirus disease 2019 (COVID-19) represents a health problem with multidimensional impacts and heterogeneous respiratory involvement in children, probably due to the interaction between different and complex mechanisms that could explain its variable degrees of severity. Although the majority of reports reveal that children develop less severe cases, the number of patients is increasing with more morbidity. Most serious respiratory manifestations are acute respiratory distress syndrome (ARDS) and pneumonia. By understanding the key aspects that can be used to differentiate between pediatric and adult respiratory compromise by COVID-19, we can improve our knowledge, and thus decrease the negative impact of the disease in the pediatric population. In this mini review, we summarize some of the mechanisms and findings that distinguish between adult and pediatric COVID-19 and respiratory involvement, taking into account some issues related to the physiopathology, diagnosis, clinical and paraclinical presentation, severity, treatment, and control of the disease.