Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children

Mabena, Fikile C; Baillie, Vicky; Hale, Martin; Thwala, Bukiwe Nana; Mthembu, Nonhlanhla; Els, Toyah; Serafin, Natali; Plessis, Jeanine du; Swart, Peter J.; Velaphi, Sithembiso; Petersen, Karen; Wadula, Jeannette; Govender, Nelesh P.; Verwey, Charl; Moore, David P.; Moosa, F; Nakwa, Firdose; Maroane, Basetsana V; Okudo, Grace; Mabaso, T.; Dangor, Ziyaad; Nunes, Marta C; Madhi, Shabir A.

doi:10.1097/inf.0000000000003227

Cited by 9 publications

(20 citation statements)

References 25 publications

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“…The greater frequency of fibrin platelet thrombi in the COVID+ decedents when compared to COVID- decedents suggests that this is one of the manifestations of this infection and that it is systemic in nature, being found in the pulmonary vasculature, portal vein, hepatic vein and hepatic arterioles. Similar systemic fibrin platelet thrombi have also been found in other series of both adult and paediatric decedents [ 34 , 35 ]. On the other hand, the Polak et al classification, by not including the exudative phase, misses those COVID+ deaths in the early phase of illness that have only intra-alveolar exudation of fluid, protein and hyaline membrane formation.…”

Section: Discussionsupporting

confidence: 83%

Clinical characteristics and histopathology of COVID-19 related deaths in South African adults

et al. 2022

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Comparisons of histopathological features and microbiological findings between decedents with respiratory symptoms due to SARS-CoV-2 infection or other causes, in settings with high prevalence of HIV and Mycobacterium tuberculosis (MTB) infections have not been reported. Deaths associated with a positive ante-mortem SARS-CoV-2 PCR test and/or respiratory disease symptoms at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa from 15th April to 2nd November 2020, during the first wave of the South African COVID-19 epidemic, were investigated. Deceased adult patients had post-mortem minimally-invasive tissue sampling (MITS) performed to investigate for SARS-CoV-2 infection and molecular detection of putative pathogens on blood and lung samples, and histopathology examination of lung, liver and heart tissue. During the study period MITS were done in patients displaying symptoms of respiratory disease including 75 COVID-19-related deaths (COVID+) and 42 non-COVID-19-related deaths (COVID-). The prevalence of HIV-infection was lower in COVID+ (27%) than in the COVID- (64%), MTB detection was also less common among COVID+ (3% vs 13%). Lung histopathology findings showed differences between COVID+ and COVID- in the severity of the morphological appearance of Type-II pneumocytes, alveolar injury and repair initiated by SARS-CoV-2 infection. In the liver necrotising granulomatous inflammation was more common among COVID+. No differences were found in heart analyses. The prevalence of bacterial co-infections was higher in COVID+. Most indicators of respiratory distress syndrome were undifferentiated between COVID+ and COVID- except for Type-II pneumocytes. HIV or MTB infection does not appear in these data to have a meaningful correspondence with COVID-related deaths.

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Section: Discussionsupporting

confidence: 83%

Clinical characteristics and histopathology of COVID-19 related deaths in South African adults

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“…This review was undertaken before COVID-19 pneumonia data in children was reported. However, subsequently, a South African study conducted during the peak of the first wave of the COVID-19 outbreak identified histopathology lung findings in 11 cases in which COVID-19 was considered to have contributed to the child’s death [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review

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Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria – 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection ( Streptococcus pneumoniae , Staphylococcus aureus ) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.

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“…Post-mortem histopathological findings (13 days after the SARS-CoV-2 positive result), obtained by targeted minimal invasive tissue sampling, revealed hyaline membrane, type II pneumocyte proliferation, interstitial inflammation, markedly reactive bronchial cells, and intravascular thrombi, which could be consistent with COVID-19. The immediate cause of death was assigned to be attributed to A. baumannii nosocomial sepsis with the antecedent cause related to nosocomial SARS-CoV-2 and acute respiratory distress syndrome due to SARS-CoV-2 ( 32 ).…”

Section: Resultsmentioning

confidence: 99%

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

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IntroductionThe provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.MethodsContact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24–72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.ResultsTwelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from Acinetobacter baumannii sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.ConclusionWe report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks.

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Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children

Cited by 9 publications

References 25 publications

Clinical characteristics and histopathology of COVID-19 related deaths in South African adults

Clinical characteristics and histopathology of COVID-19 related deaths in South African adults

Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

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