Comparison of the Epidemiological and Clinical Characteristics of Hospitalized Children With Pneumonia Caused by SARS-CoV-2, Influenza A, and Human Adenoviruses: A Case-Control Study

Abstract

Background. This case-control study aims to investigate the clinical characteristics in pediatric patients with pneumonia infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and human adenoviruses (HAdVs). Methods. Hospitalized pediatric patients with pneumonia infected with SARS-CoV-2 at Wuhan Children’s Hospital and pneumonia infected with influenza A, and HAdVs at Qilu Children’s Hospital were compared. Clinical manifestations, laboratory examinations, and imaging characteristics were analyzed. Results. The proportions of hyperpyrexia (54.3%, 33.9%), cough (100%, 99.2%), wheezing (45.7%, 53.7%), diarrhea (31.4%, 14.9%), and fever (100%, 75.2%) in patients with influenza A and HAdVs were higher than those of patients with SARS-CoV-2 (9.4%, P < .001; 48.5%, P < .001; 0%, P < .001; 8.8%, P = .002; 41.5%, P < .001; respectively). Laboratory examinations revealed the proportions of leukocytosis (37.1%, 52.9%), abnormal rates of neutrophils (40%, 40.5%), and lymphocytosis (42.9%, 65.3%) in influenza A and HAdV pneumonia groups were significantly higher than coronavirus disease 2019 (COVID-19) group (0%, P < .001; 0%, P < .001; 0%, P < .001; respectively). The proportion of elevated procalcitonin (5.7%, 14%) in patients with influenza A and HAdVs was significantly lower than those in patients with SARS-CoV-2 (64%, P < .001). In chest computed tomography, ground-glass opacities near the pleura were more common in patients with COVID-19 than those in patients with influenza A and HAdVs (32.7% vs 0% vs 0%, P < .001). Conclusion. Fever, cough, and wheezing are more common in the influenza A and HAdVs groups, whereas procalcitonin and computed tomography findings are likely to be pronounced in COVID-19 pneumonia. It provides a variety of methods except polymerase chain reaction for differentiating COVID-19 pneumonia from influenza A and HAdVs pneumonia.

An Overview of the Signs and Symptoms of Pediatric Patients Hospitalized with COVID-19

“…The frequency of lymphopenia in our study was not high (24.5%), although it was higher than in several other studies (14,16,23). But the increase in liver enzymes in our study was more than in most other studies (14,18).…”

Comparison of laboratory parameters, clinical symptoms and clinical outcomes of COVID-19 and influenza in pediatric patients: A systematic review and meta-analysis

“…Fever: Thirteen studies examined the difference in fever between pediatric COVID-19 and influenza patients[ 9 , 10 , 12 - 15 , 17 , 19 - 24 ]. The pooled OR was 0.23 (95%CI: 0.12 to 0.43; I 2 = 87.5%), indicating that there was a significantly lower risk of having a fever in pediatric COVID-19 patients when compared to pediatric influenza patients ( P < 0.001) (Figure 2A ).…”

“…Cough: Thirteen studies examined the difference in having a cough between pediatric patients with COVID-19 and influenza[ 9 , 10 , 12 - 15 , 17 , 19 - 24 ]. The pooled OR was 0.16 (95%CI: 0.09 to 0.27; I 2 = 86.1%), indicating that the pediatric patients with COVID-19 had an 84% lower risk of having a cough when compared to pediatric influenza patients ( P < 0.001) (Figure 2B ).…”

“…Fatigue: Six studies examined the difference in fatigue between pediatric COVID-19 and influenza patients[ 9 , 15 , 17 , 19 , 20 , 24 ]. The pooled OR was 0.63 (95%CI: 0.41 to 0.96; I 2 = 0%).…”

“…Hemoglobin: Seven studies examined the difference in hemoglobin level between pediatric COVID-19 and influenza patients[ 9 , 10 , 13 , 14 , 16 , 17 , 23 ]. The pooled SMD was 1.22 (95%CI: 0.29 to 2.14; I 2 = 97.7%), indicating that COVID-19 causes significantly higher hemoglobin levels when compared to pediatric influenza patients ( P = 0.01) (Figure 4A ).…”