tetano
Editor, Senior Moderator
Front Pediatr
. 2021 Jan 28;9:629040.
doi: 10.3389/fped.2021.629040. eCollection 2021.
Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic
Angelo Mazza[SUP] 1 [/SUP], Angelo Di Giorgio[SUP] 2 [/SUP], Laura Martelli[SUP] 3 [/SUP], Ciretta Pelliccia[SUP] 4 [/SUP], Moira Alessandra Pinotti[SUP] 4 [/SUP], Vera Quadri[SUP] 5 [/SUP], Lucio Verdoni[SUP] 6 [/SUP], Alice Decio[SUP] 7 [/SUP], Maurizio Ruggeri[SUP] 8 [/SUP], Lorenzo D'Antiga[SUP] 8 [/SUP]
Affiliations
Abstract
Background: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted to our unit shortly after the first outbreak. Methods: we retrospectively reviewed the notes of all pediatric patients diagnosed with COVID-19. We enrolled patients with positive swabs or serology and classified them based on the pattern and the timing of presentation after the first outbreak. This setting was considered a reliable reflection of the consequences of unmitigated SARS-CoV-2 circulation. Results: We diagnosed 35 patients over a 3-month period and we identified six patterns presenting in two temporal phases: Early phase, Group 1 (median of 20 days from epidemic start, IQR: 15-27): neonatal sepsis (n.7), pneumonia (n.5), flu-like symptoms (n.2). Late phase, Group 2 (59:51-66 days, p < 0.001): MIS-C (n.18), neurological manifestations (n.3). Group 1 differed from Group 2 for younger age (1 vs. 8 years, p = 0.02), lower C-reactive protein (0.9 vs. 16.6 mg/dl, p = 0.008), procalcitonin (0.16 vs. 7.9 ng/ml, p = 0.008) and neutrophil count (3,765 vs. 6,780/μl, p = 0.006), higher rate of positive swabs (14/14 vs. 9/21, p < 0.001), higher lymphocyte count (3,000 vs. 930/μl, p = 0.006) and platelet count (323,000 vs. 210,000/μl, p = 0.009). Conclusions: Following an outbreak of unmitigated SARS-CoV-2 diffusion, infected children may present with clinical patterns suggesting two temporal clusters, the first characterized by markers of direct viral injury, the second suggesting an immune-mediated disease.
Keywords: COVID-19; SARS–CoV−2; children; clinical manifestation; immunity.
. 2021 Jan 28;9:629040.
doi: 10.3389/fped.2021.629040. eCollection 2021.
Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic
Angelo Mazza[SUP] 1 [/SUP], Angelo Di Giorgio[SUP] 2 [/SUP], Laura Martelli[SUP] 3 [/SUP], Ciretta Pelliccia[SUP] 4 [/SUP], Moira Alessandra Pinotti[SUP] 4 [/SUP], Vera Quadri[SUP] 5 [/SUP], Lucio Verdoni[SUP] 6 [/SUP], Alice Decio[SUP] 7 [/SUP], Maurizio Ruggeri[SUP] 8 [/SUP], Lorenzo D'Antiga[SUP] 8 [/SUP]
Affiliations
- PMID: 33585374
- PMCID: PMC7877486
- DOI: 10.3389/fped.2021.629040
Abstract
Background: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted to our unit shortly after the first outbreak. Methods: we retrospectively reviewed the notes of all pediatric patients diagnosed with COVID-19. We enrolled patients with positive swabs or serology and classified them based on the pattern and the timing of presentation after the first outbreak. This setting was considered a reliable reflection of the consequences of unmitigated SARS-CoV-2 circulation. Results: We diagnosed 35 patients over a 3-month period and we identified six patterns presenting in two temporal phases: Early phase, Group 1 (median of 20 days from epidemic start, IQR: 15-27): neonatal sepsis (n.7), pneumonia (n.5), flu-like symptoms (n.2). Late phase, Group 2 (59:51-66 days, p < 0.001): MIS-C (n.18), neurological manifestations (n.3). Group 1 differed from Group 2 for younger age (1 vs. 8 years, p = 0.02), lower C-reactive protein (0.9 vs. 16.6 mg/dl, p = 0.008), procalcitonin (0.16 vs. 7.9 ng/ml, p = 0.008) and neutrophil count (3,765 vs. 6,780/μl, p = 0.006), higher rate of positive swabs (14/14 vs. 9/21, p < 0.001), higher lymphocyte count (3,000 vs. 930/μl, p = 0.006) and platelet count (323,000 vs. 210,000/μl, p = 0.009). Conclusions: Following an outbreak of unmitigated SARS-CoV-2 diffusion, infected children may present with clinical patterns suggesting two temporal clusters, the first characterized by markers of direct viral injury, the second suggesting an immune-mediated disease.
Keywords: COVID-19; SARS–CoV−2; children; clinical manifestation; immunity.