Comparison of clinical severity and epidemiological spectrum between coronavirus disease 2019 and influenza in children

Abstract

Data on the novel coronavirus disease 2019 (COVID-19) in children are limited, and studies from Europe are scarce. We analyzed the clinical severity and epidemiologic aspects of COVID-19 in consecutive children aged 0–18 years, referred with a suspicion of COVID-19 between February 1, and April 15, 2020. RT-PCR on a nasopharyngeal swab was used to confirm COVID-19. 319 children met the criteria of a suspected case. COVID-19 was diagnosed in 15/319 (4.7%) patients (8 male; mean age 10.5 years). All of them had household contact with an infected relative. Five (33.3%) patients were asymptomatic. In 9/15 (60.0%) children, the course of the disease was mild, and in 1/15 (6.7%), it was moderate, with the following symptoms: fever (46.7%), cough (40%), diarrhea (20%), vomiting (13.3%), rhinitis (6.7%), and shortness of breath (6.7%). In the COVID-19-negative patients, other infections were confirmed, including influenza in 32/319 (10%). The clinical course of COVID-19 and influenza differed significantly based on the clinical presentation. In conclusion, the clinical course of COVID-19 in children is usually mild or asymptomatic. In children suspected of having COVID-19, other infections should not be overlooked. The main risk factor for COVID-19 in children is household contact with an infected relative.

What are the risk factors for admission to the pediatric intensive unit among pediatric patients with COVID-19?

“…In adults with COVID-19, it has been observed that independent risk factors associated with mortality included older age, male sex, high fraction of inspired oxygen, high positive end-expiratory pressure, and history of chronic obstructive pulmonary disease, hypercholesterolemia, and type 2 diabetes [9,10]. Studies that have evaluated which factors could predict severe pediatric COVID-19 have shown that younger age, pre-existing underlying chronic severe comorbidities, male sex and lower respiratory tract infection signs and symptoms at presentation could be considered risk factors for PICU admission [11][12][13]. Among laboratory markers, increased leukocyte count, lymphopenia, and elevated inflammatory markers (C-reactive protein and procalcitonin) were those more frequently associated with PICU admission [11][12][13].…”

“…Studies that have evaluated which factors could predict severe pediatric COVID-19 have shown that younger age, pre-existing underlying chronic severe comorbidities, male sex and lower respiratory tract infection signs and symptoms at presentation could be considered risk factors for PICU admission [11][12][13]. Among laboratory markers, increased leukocyte count, lymphopenia, and elevated inflammatory markers (C-reactive protein and procalcitonin) were those more frequently associated with PICU admission [11][12][13]. Only in some cases were lactate dehydrogenase, pro-B-type natriuretic peptide and troponin studied and found to be increased, suggesting a potential role of these variables as markers of risk.…”

“…Among these is heart involvement [16]. Several findings seem to indicate that, in the first phases of severe COVID-19, signs and symptoms of heart lesions can occur and be useful to select children at risk for complications [13,17,18]. A great number of previously healthy children with MIS-C present with cardiovascular alterations [19][20][21].…”

“…A great number of previously healthy children with MIS-C present with cardiovascular alterations [19][20][21]. Some of them already have signs and symptoms of heart dysfunction in the first phases of disease, and it has been reported that they increase the need for PICU admission, development of potential long-term problems, and risk of death [13,17,18]. Reduced left ventricular systolic function with an ejection fraction < 60%; diastolic dysfunction; and arrhythmias, including ST segment changes, QTc prolongation, and premature atrial or ventricular beat, were the earliest manifestations.…”

“…Reduced left ventricular systolic function with an ejection fraction < 60%; diastolic dysfunction; and arrhythmias, including ST segment changes, QTc prolongation, and premature atrial or ventricular beat, were the earliest manifestations. Moreover, increased troponin levels have been repeatedly reported in children with COVID-19 admitted to the PICU [13,18,19]. Inclusion of heart enzyme serum levels and evaluation of ventricular function among predictive markers could lead to a more effective evaluation of children at risk with proper selection of those to admit to the PICU and with more adequate treatment in case of more severe clinical manifestations.…”