tetano
Editor, Senior Moderator
Pediatr Infect Dis J
. 2021 Sep 1;40(9):e323-e332.
doi: 10.1097/INF.0000000000003227.
Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children
Fikile C Mabena[SUP] 1 2 [/SUP], Vicky L Baillie[SUP] 1 3 [/SUP], Martin J Hale[SUP] 1 4 [/SUP], Bukiwe N Thwala[SUP] 1 3 [/SUP], Nonhlanhla Mthembu[SUP] 1 3 [/SUP], Toyah Els[SUP] 1 3 [/SUP], Natali Serafin[SUP] 1 3 [/SUP], Jeanine du Plessis[SUP] 1 3 [/SUP], Peter Swart[SUP] 4 [/SUP], Sithembiso C Velaphi[SUP] 2 [/SUP], Karen L Petersen[SUP] 2 [/SUP], Jeannette Wadula[SUP] 5 [/SUP], Nelesh P Govender[SUP] 6 [/SUP], Charl Verwey[SUP] 1 2 [/SUP], David P Moore[SUP] 1 2 [/SUP], Fatima Y Moosa[SUP] 2 [/SUP], Firdose L Nakwa[SUP] 2 [/SUP], Basetsana V Maroane[SUP] 2 [/SUP], Grace Okudo[SUP] 2 [/SUP], Theodore M Mabaso[SUP] 2 [/SUP], Ziyaad Dangor[SUP] 1 2 [/SUP], Marta C Nunes[SUP] 1 3 [/SUP], Shabir A Madhi[SUP] 1 7 [/SUP]
Affiliations
Abstract
Background: Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.
Methods: Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.
Results: SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.
Conclusions: COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.
. 2021 Sep 1;40(9):e323-e332.
doi: 10.1097/INF.0000000000003227.
Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children
Fikile C Mabena[SUP] 1 2 [/SUP], Vicky L Baillie[SUP] 1 3 [/SUP], Martin J Hale[SUP] 1 4 [/SUP], Bukiwe N Thwala[SUP] 1 3 [/SUP], Nonhlanhla Mthembu[SUP] 1 3 [/SUP], Toyah Els[SUP] 1 3 [/SUP], Natali Serafin[SUP] 1 3 [/SUP], Jeanine du Plessis[SUP] 1 3 [/SUP], Peter Swart[SUP] 4 [/SUP], Sithembiso C Velaphi[SUP] 2 [/SUP], Karen L Petersen[SUP] 2 [/SUP], Jeannette Wadula[SUP] 5 [/SUP], Nelesh P Govender[SUP] 6 [/SUP], Charl Verwey[SUP] 1 2 [/SUP], David P Moore[SUP] 1 2 [/SUP], Fatima Y Moosa[SUP] 2 [/SUP], Firdose L Nakwa[SUP] 2 [/SUP], Basetsana V Maroane[SUP] 2 [/SUP], Grace Okudo[SUP] 2 [/SUP], Theodore M Mabaso[SUP] 2 [/SUP], Ziyaad Dangor[SUP] 1 2 [/SUP], Marta C Nunes[SUP] 1 3 [/SUP], Shabir A Madhi[SUP] 1 7 [/SUP]
Affiliations
- PMID: 34397776
- DOI: 10.1097/INF.0000000000003227
Abstract
Background: Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.
Methods: Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.
Results: SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.
Conclusions: COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.