The Wide Spectrum of COVID-19 Clinical Presentation in Children
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Clinical Characteristics at COVID-19 Onset
3.2. Treatments and Evolution
3.2.1. Infants (<2 Years Old, n = 14)
3.2.2. Children (2–10 Years Old, n = 2)
3.2.3. Teenagers (>10 Years Old, n = 7)
4. Discussion
4.1. COVID-19 Severity is Inversely Correlated with Age
4.2. Pediatric Inflammatory Multisystem Syndrome Linked to SARS-CoV-2 Infection
4.3. In Infants, COVID-19 Seems to Lead to a Mild Respiratory Disease
4.4. Immune and Epithelial Response to SARS-CoV-2 in Children
4.5. Probable Adult-to-Children Transmission of the Virus
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Clinical Characteristics | Total n = 23 | <2 Years Old n = 14 (61%) | 2–10 Years Old n = 2 (9%) | >10 Years Old n = 7 (30%) |
---|---|---|---|---|
Age: years; mean [range] | 4.9 [0.1; 17.6] | 0.4 [0.1; 1.2] | 5.2 [4.5; 6.0] | 14.0 [11.4; 17.6] |
Gender: boys, n (%) | 13 (57%) | 9 (64%) | 1 (50%) | 3 (43%) |
Ancestry, n (%) | ||||
Asia | 1 (4%) | 1 (7%) | 0 (0%) | 0 (0%) |
Europe | 8 (35%) | 5 (36%) | 1 (50%) | 2 (29%) |
Middle East and Maghreb | 4 (17%) | 3 (21%) | 0 (0%) | 1 (14%) |
Sub-Saharan Africa/Caribbean | 10 (43%) | 5 (36%) | 1 (50%) | 4 (57%) |
Comorbidities, n (%) | 12 (52%) | 5 (36%) | 1 (50%) | 6 (86%) |
Asthma | 3 (13%) | 2 (14%) | 0 (0%) | 1 (14%) |
Sickle cell disease | 3 (13%) | 1 (7%) | 0 (0%) | 2 (29%) |
Overweight/obesity | 3 (13%) | 0 (0%) | 1 (50%) | 2 (29%) |
Other | 4 (17%) | 1 (7%) immune deficiency 1 (7%) premature birth | 1 (14%) myoclonic-astatic epilepsy 1 (14%) Bronchiectasis 1 (14 %) COPD | |
Exposure to SARS-CoV-2, n (%) | ||||
Family cluster | 20 (87%) | 14 (100%) | 1 (50%) | 5 (71%) |
Other exposure | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Unknown | 3 (13%) | 0 (0%) | 1 (50%) | 2 (29%) |
Initial symptoms, n (%) | 21 (91%) | 13 (93%) | 1 (50%) | 7 (100%) |
Fever | 18 (78%) | 11 (79%) | 1 (50%) | 6 (86%) |
Fatigue/deterioration of general status | 12 (52%) | 8 (57%) | 1 (50%) | 3 (43%) |
Cough | 11 (48%) | 7 (50%) | 0 (0%) | 4 (57%) |
Pharyngitis (sore throat) | 4 (17%) | 1 (7%) | 1 (50%) | 2 (29%) |
Dyspnea | 5 (22%) | 2 (14%) | 0 (0%) | 3 (43%) |
Wheezing | 4 (17%) | 2 (14%) | 0 (0%) | 2 (29%) |
Acute rhinitis | 11 (48%) | 9 (64%) | 1 (50%) | 1 (14%) |
Acute anosmia/ageusia | 1 (4%) | 0 (0%) | 0 (0%) | 1 (14%) |
Myalgia/arthralgia | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Nausea or vomiting | 3 (13%) | 0 (0%) | 1 (50%) | 2 (29%) |
Diarrhea | 4 (17%) | 1 (7%) | 1 (50%) | 2 (29%) |
Abdominal pain | 5 (22%) | 0 (0%) | 2 (100%) | 3 (43%) |
Abnormal cry | 4 (17%) | 4 (29%) moaning | 0 (0%) | 0 (0%) |
Abnormal skin color | 6 (26%) | 4 (29%) mottled skin | 1 (50%) diffuse rash | 1 (14%) thoracic rash |
Neurological signs | 5 (22%) | 3 (21%) hypotonia | 1 (50%) drowsiness | 1 (14%) drowsiness |
Initial vital signs, median [range] | ||||
Temperature (°C) | 37.9 [36.6; 39.9] | 38.0 [36.6; 38.7] | 36.7 [36.6; 36.7] | 38.1 [36.9; 39.9] |
Respiratory rate (/min) | 40 [15; 60] | 46 [24; 60] | 18 [18; 18] | 30 [15; 60] |
Oxygen saturation (%) | 98 [85; 100] | 99 [96; 100] | 99.5 [99; 100] | 97 [85; 99] |
Cardiac rate (/min) | 144 [64; 195] | 161 [126; 195] | 113.5 [106; 121] | 123 [64; 155] |
Blood Tests at Admission | Total n = 23 Median [Range] | <2 Years Old n = 14 Median [Range] | 2–10 Years Old n = 2 Median [Range] | >10 Years Old n = 7 Median [Range] | ||||
---|---|---|---|---|---|---|---|---|
WBC (×109/L) | 9.5 | [4.1–26.1] | 9 | [4.1–22.3] | 16.3 | [12.8–19.8] | 11.8 | [4.1–26.1] |
Lymphocytes (×109/L) | 3.4 | [0.4–7.2] | 4.3 | [1.0–7.2] | 2.7 | [1.5–4] | 2.4 | [0.4–3.5] |
Neutrophils (×109/L) | 4.2 | [0.8–22.2] | 2.2 | [0.8–5.6] | 12.1 | [7.3–16.8] | 6.8 | [2.2–22.2] |
Hemoglobin (g/dL) | 10.8 | [7.5–15] | 10.7 | [8.5–14.7] | 10.3 | [8.2–12.4] | 12.4 | [7.5–15] |
Platelets (×109/L) | 275.5 | [122–492] | 349 | [123–492] | 294 | [210–378] | 182 | [122.0–474] |
CRP (mg/L) | 4 | [0–329.7] | 3.3 | [0–32] | 91.8 | [0.0–183.5] | 66 | [0–329.7] |
Procalcitonin (µg/L) | 0.2 | [0–242.4] | 0.2 | [0.1–14] | 242.4 | [242.4–242.4] | 2.6 | [0–63.5] |
AST (IU/L) | 44 | [18.0–99] | 45 | [18.0–67] | 61 | [23–99] | 33 | [20–77] |
ALT (IU/L) | 18 | [7–59] | 36 | [7.0–59] | 15.5 | [10–21] | 12 | [7–46] |
CPK (IU/L) | 170 | [0–1024] | 224 | [224–224] | N/A | 116 | [0–1024] |
Evolution | Total n = 21 | <2 Years Old n = 13 | 2–10 Years Old n = 1 | >10 Years Old n = 7 |
---|---|---|---|---|
Symptoms prior to hospitalization | ||||
Duration (days): median [range] | 3 [0–13] | 1 [0–10] | 6 | 3 [0–13] |
Overall hospitalization | ||||
Duration (days): median [range] | 6 [1–21] | 3 [1–7] | 12 | 6 [2–21] |
ICU, n (%) | 5 (24%) | 0 | 1 (100%) | 4 (57%) |
Oxygen therapy, n (%) | 4 (19%) | 0 | 0 | 4 (57%) |
Duration (days): median [range] | 1.5 [1–3] | – | – | 1.5 [1–3] |
Non-invasive ventilation, n (%) | 2 (10%) | 0 | 0 | 2 (29%) |
Duration (days): median [range] | 5 [4–6] | – | – | 5 [4–6] |
Mechanical ventilation, n (%) | 2 (10%) | 0 | 1 (100%) | 1 (14%) |
Duration (days): median [range] | 4 [3–5] | – | 3 | 5 |
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Nathan, N.; Prevost, B.; Sileo, C.; Richard, N.; Berdah, L.; Thouvenin, G.; Aubertin, G.; Lecarpentier, T.; Schnuriger, A.; Jegard, J.; et al. The Wide Spectrum of COVID-19 Clinical Presentation in Children. J. Clin. Med. 2020, 9, 2950. https://doi.org/10.3390/jcm9092950
Nathan N, Prevost B, Sileo C, Richard N, Berdah L, Thouvenin G, Aubertin G, Lecarpentier T, Schnuriger A, Jegard J, et al. The Wide Spectrum of COVID-19 Clinical Presentation in Children. Journal of Clinical Medicine. 2020; 9(9):2950. https://doi.org/10.3390/jcm9092950
Chicago/Turabian StyleNathan, Nadia, Blandine Prevost, Chiara Sileo, Nicolas Richard, Laura Berdah, Guillaume Thouvenin, Guillaume Aubertin, Thibault Lecarpentier, Aurélie Schnuriger, Julien Jegard, and et al. 2020. "The Wide Spectrum of COVID-19 Clinical Presentation in Children" Journal of Clinical Medicine 9, no. 9: 2950. https://doi.org/10.3390/jcm9092950