Comparison of acute pneumonia caused by SARS-COV-2 and other respiratory viruses in children: a retrospective multi-center cohort study during COVID-19 outbreak

Abstract

Background Until January 18, 2021, coronavirus disease-2019 (COVID-19) has infected more than 93 million individuals and has caused a certain degree of panic. Viral pneumonia caused by common viruses such as respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses have been more common in children. However, the incidence of COVID-19 in children was significantly lower than that in adults. The purpose of this study was to describe the clinical manifestations, treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak. Methods Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study. A total of 64 children with COVID-19 were defined as the COVID-19 cohort, of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort. Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort. The epidemiologic, clinical, and laboratory findings were compared by Kolmogorov-Smirnov test, t-test, Mann-Whitney U test and Contingency table method. Drug usage, immunotherapy, blood transfusion, and need for oxygen support were collected as the treatment indexes. Mortality, intensive care needs and symptomatic duration were collected as the outcome indicators. Results Compared with the viral pneumonia cohort, children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19 (53/64 vs. 23/284), were of older median age (6.3 vs. 3.2 years), and had a higher proportion of ground-glass opacity (GGO) on computed tomography (18/40 vs. 0/38, P < 0.001). Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases (1/40 vs. 38/284, P = 0.048), and lower cases with high fever (3/40 vs. 167/284, P < 0.001), requiring intensive care (1/40 vs. 32/284, P < 0.047) and with shorter symptomatic duration (median 5 vs. 8 d, P < 0.001). The proportion of cases with evaluated inflammatory indicators, biochemical indicators related to organ or tissue damage, D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort (P < 0.05). No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs (lopinavir-ritonavir, ribavirin, and arbidol) as compared with duration in 39 children without antiviral therapy [median 10 vs. 9 d, P = 0.885]. Conclusion The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia. Lopinavir-ritonavir, ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19. During the COVID-19 outbreak, attention also must be given to children with infection by other pathogens infection.

Coronavirus Disease 2019 in Children

“…Therefore, even in the presence of an initially negative SARS-CoV-2 molecular testing, a high level of suspicion of COVID-19 should be maintained if other causes of bronchiolitis are unidentifiable. Symptoms and severity of COVID-19 lower airways infection in children seem no more severe than those in children with other viral infections (178). Despite this, it was recommended to check SARS-CoV-2 positive children for other viral pathogens, namely influenza A virus and metapneumovirus, as the identification of co-infections may lead to modify the diagnostic and therapeutic protocols (179).…”

The Association between Kidney Function and the Severity of COVID-19 in Children

“…Gastrointestinal symptoms (7.5% and 17.5%) were also present but did not express any symptoms. Symptoms and severity of COVID-19 pneumonia in children are the same as for other viral pneumonias [22], [23].…”

“…In advanced cases, crazy paving appearance and fragmented consolidation are observed [25]. The ground-glass appearance observed especially in chest CT is thought to be caused by alveolar edema, exudation, and bleeding secondary to inflammation [23], [24]. Chest X-ray imaging is mostly preferred for the diagnosis of pneumonia in children.…”

“…The most common findings in chest X-ray was a unilateral increase in density and the lower zones were the most affected area [25]. Ground-glass opacity (GGO) was the most common radiographic presentation of children with COVID-19 pneumonia, while the proportion of cases with consolidation was lower in the cohort as compared to the viral pneumonia cohort [23]. Other radiographic presentations of COVID-19 pneumonia included tiny nodules, consolidation combined with GGO, cable shadow, light shadow, streak shadow, and hydrothorax.…”

Children and Adults in a Household Cohort Study Have Robust Longitudinal Immune Responses Following SARS-CoV-2 Infection or Exposure

“…Children also have lower transmission rates compared to adults, in part because asymptomatic COVID-19 is less infectious than symptomatic disease (3), and because they are less likely to be the primary index case in a household (4)(5)(6). This is in contrast to the higher prevalence and severity observed in children for most other respiratory viruses (1,7,8).…”