Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread around the world. However, approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported. We retrospectively analyzed the clinical data of 97 children with probable COVID-19. A total of 13 (13.4%) patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing, and 41 (42.3%) patients were found to be infected with other pathogens. Notably, no pathogen was detected in 43 (44.3%) patients. Among all patients, 25 (25.8%) had familial cluster exposure history, and 52 (53.6%) had one or more coexisting conditions. Fifteen (15.5%) patients were admitted or transferred to the PICU. In the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG against SARS-CoV-2, respectively. In 22 patients with suspected COVID-19, 1 (4.5%) was positive for IgG but negative for IgM. The most frequently detected pathogen was Mycoplasma pneumonia (29, 29.9%). One patient with confirmed COVID-19 died. Our results strongly indicated that the detection of asymptomatic COVID-19 or coexisting conditions must be strengthened in pediatric patients. These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted. A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.

Keywords

coronavirus disease 2019 / pediatrics / emergency / retrospective investigation / severe acute respiratory syndrome coronavirus 2

References

[1] Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med 2020; 14(2): 126–135

[2] Xu J, Chen Y, Chen H, Cao B. 2019 novel coronavirus outbreak: a quiz or final exam? Front Med 2020; 14(2): 225–228

[3] Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020: 92(6):568–576 doi: 10.1002/jmv.25748 PMID:32134116

[4] Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 2020; 55(3): 105924

[5] Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, Chen S. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med 2020; 14(2): 229–231

[6] Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Zhang W, Wang Y, Bao S, Li Y, Wu C, Liu H, Liu D, Shao J, Peng X, Yang Y, Liu Z, Xiang Y, Zhang F, Silva RM, Pinkerton KE, Shen K, Xiao H, Xu S, Wong GWK; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382(17): 1663–1665

[7] Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, Zheng Y, Xu B, Xie Z, Lin L, Shang Y, Lu X, Shu S, Bai Y, Deng J, Lu M, Ye L, Wang X, Wang Y, Gao L, China National Clinical Research Center for Respiratory Diseases; National Center for Children’s Health, Beijing, China; Group of Respirology, Chinese Pediatric Society, Chinese Medical Association; Chinese Medical Doctor Association Committee on Respirology Pediatrics; China Medicine Education Association Committee on Pediatrics; Chinese Research Hospital Association Committee on Pediatrics; Chinese Non-government Medical Institutions Association Committee on Pediatrics; China Association of Traditional Chinese Medicine, Committee on Children’s Health and Medicine Research; China News of Drug Information Association, Committee on Children’s Safety Medication; Global Pediatric Pulmonology Alliance. Diagnosis, treatment and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr 2020; 16(3): 223–231doi:10.1007/s12519-020-00343-7

[8] Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, Spitters C, Ericson K, Wilkerson S, Tural A, Diaz G, Cohn A, Fox L, Patel A, Gerber SI, Kim L, Tong S, Lu X, Lindstrom S, Pallansch MA, Weldon WC, Biggs HM, Uyeki TM, Pillai SK, Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382(10): 929–936

[9] Society of Pediatrics, Chinese Medical Association; Editorial Board, Chinese Journal of Pediatrics. Recommendations for the diagnosis, prevention and control of the 2019 novel coronavirus infection on children (first interim edition). Chin J Pediatr (Zhonghua Er Ke Za Zhi) 2020; 58(3): 169–174 (in Chinese)

[10] Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun WM, Wang YP. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol 2020; 92(6): 577–583

[11] Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020; 323(13): 1313–1314

[12] Zhang YH, Lin DJ, Xiao MF, Wang JC, Wei Y, Lei ZX, Zeng ZQ, Li L, Li HA, Xiang W. 2019-novel coronavirus infection in a three-month-old baby. Chin J Pediatr (Zhonghua Er Ke Za Zhi) 2020; 58(3): 182–184 (in Chinese)

[13] Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: transmission dynamics and clinical characteristics. J Formos Med Assoc 2020; 119(3): 670–673 PMID: 32139299

[14] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061–1069

[15] Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020; 71(15): 762–768

[16] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497–506

[17] Zeng LK, Tao XW, Yuan WH, Wang J, Liu X, Liu ZS. First case of neonate infected with novel coronavirus pneumonia in China. Chin J Pediatr (Zhonghua Er Ke Za Zhi) 2020; [Epub ahead of print] (in Chinese) doi: 10.3760/cma.j.issn.0578-1310.2020.0009

[18] Chen F, Liu ZS, Zhang FR, Xiong RH, Chen Y, Cheng XF, Wang WY, Ren J. First case of severe childhood novel coronavirus pneumonia in China. Chin J Pediatr (Zhonghua Er Ke Za Zhi) 2020; 58(3): 179–183 (in Chinese)

[19] Memish ZA, Al-Tawfiq JA, Assiri A, AlRabiah FA, Al Hajjar S, Albarrak A, Flemban H, Alhakeem RF, Makhdoom HQ, Alsubaie S, Al-Rabeeah AA. Middle East respiratory syndrome coronavirus disease in children. Pediatr Infect Dis J 2014; 33(9): 904–906

[20] Bitnun A, Allen U, Heurter H, King SM, Opavsky MA, Ford-Jones EL, Matlow A, Kitai I, Tellier R, Richardson S, Manson D, Babyn P, Read S, Other Members of the Hospital for Sick Children SARS Investigation Team. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics 2003; 112(4): e261

[21] Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323(13): 1239

[22] Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect 2020; 53(3): 371–372 PMID: 32147409

[23] Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell 2020; 181(2): 281–292.e6 PMID: 32155444

[24] Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203(2): 631–637

[25] Jia H. Pulmonary angiotensin-converting enzyme 2 (ACE2) and inflammatory lung disease. Shock 2016; 46(3): 239–248

[26] Cai X, Ma Y, Li S, Chen Y, Rong Z, Li W. Clinical characteristics of 5 COVID-19 cases with non-respiratory symptoms as the first manifestation in children. Front Pediatr 2020; 8: 258

[27] Chan JF, Yip CC, To KK, Tang TH, Wong SC, Leung KH, Fung AY, Ng AC, Zou Z, Tsoi HW, Choi GK, Tam AR, Cheng VC, Chan KH, Tsang OT, Yuen KY. Improved molecular diagnosis of COVID-19 by the novel, highly sensitive and specific COVID-19-RdRp/Hel real-time reverse transcription-polymerase chain reaction assay validated in vitro and with clinical specimens. J Clin Microbiol 2020; 58(5): e00310–20 PMID: 32132196

[28] Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, Feng Y, Zhu C. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta 2020; 505: 172–175

[29] Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, Wang YY, Xiao GF, Yan B, Shi ZL, Zhou P. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect 2020; 9(1): 386–389

RIGHTS & PERMISSIONS

Higher Education Press