Croup as a Manifestation of SARS-CoV-2 Omicron Variant Infection in Young Children

Choi, Youn Young; Kim, You Sun; Lee, Seong Yong; Sim, Jiwoo; Choe, Young June; Han, Mi Seon

doi:10.3346/jkms.2022.37.e140

Cited by 22 publications

(28 citation statements)

References 22 publications

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“…But no patients required invasive ventilation or died. 9 18 In three retrospective studies, the COVID-19 variant and the omicron subtype were not identified. 9 17 18 However, in our cases, a COVID-19 variant analysis was performed, and omicron sublineage BA.2 variants (Stealth omicron) were identified.…”

Section: Discussionmentioning

confidence: 99%

“… 9 18 In three retrospective studies, the COVID-19 variant and the omicron subtype were not identified. 9 17 18 However, in our cases, a COVID-19 variant analysis was performed, and omicron sublineage BA.2 variants (Stealth omicron) were identified. Lyngse et al 10 found that BA.2 was substantially more transmissible than BA.1.…”

Section: Discussionmentioning

confidence: 99%

“… 12 14 Three retrospective analyses of COVID-19-associated croup have demonstrated that the incidence of croup significantly increased during periods where the omicron variant was circulating. 9 17 18 …”

Section: Discussionmentioning

confidence: 99%

“…Brewster et al 9 reported that the observed rates of hospitalization and re-dosing of croup treatments in COVID-19-associated croup might be due to more severe manifestations than croup caused by other viruses. Also, Tunç et al 17 and Choi et al 18 found that croup patients were more likely to receive NRE during the omicron variant surge, which suggests that the early symptoms of croup with omicron are more severe than they were during the Delta variant surge. But no patients required invasive ventilation or died.…”

Section: Discussionmentioning

confidence: 99%

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Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients

et al. 2022

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Croup is a common upper airway infection characterized by a barking cough, stridor, and hoarseness. It is usually caused by viral infection. A small number of croup caused by coronavirus disease 2019 (COVID-19) has been reported in children before the omicron variant surge. Previously reported cases indicated that croup caused by COVID-19 can be treated in the same manner as those with other viral causes. We describe two cases (9-month-old girl and 11-month-old boy) of previously healthy infants who presented with a barking cough and chest retraction and required endotracheal intubation and cardiopulmonary resuscitation. Despite receiving dexamethasone and nebulized racemic epinephrine (NRE) treatment for croup in the emergency department, these patients still developed acute respiratory failure. Reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal samples revealed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron BA.2 variant (Stealth omicron) and no other common respiratory viral pathogens. Both patients were treated with mechanical ventilation, dexamethasone, and NRE in the pediatric intensive care unit. The duration of intubation was 112 hours and 80 hours, respectively. Both patients were discharged without complications. To the best of our knowledge, this is the first report of life-threatening croup produced by the omicron BA.2 variant and confirmed by RT-PCR. We suggest that this SARS-CoV-2 variant may cause severe croup that may not improve with conventional treatment, even in children without underlying diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients

et al. 2022

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“…13,14 Likewise, increasing cases of croup, an acute laryngotracheobronchitis characterized by barking cough, were noted in South Korea, during the Omicron surge. 15 What is more, the endocytic entry which Omicron prefer over angiotensin-converting enzyme 2 (ACE2) dependent pathway, could also explain the higher number of pediatric cases since children have a lower number of ACE receptors. 16,17 An experimental study compared the replication competence of wild type, pre-Delta variants (D614G, Alpha and Beta), Delta, and Omicron in human bronchi and lungs.…”

mentioning

confidence: 99%

Age-varying susceptibility to the Omicron variant (B.1.1.529) of SARS-CoV-2

Chun¹,

Kim

Jeong

2022

Preprint

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The Omicron variant (B.1.1.529) is estimated to be more transmissible than previous strains of SARS-CoV-2 especially among children, potentially resulting in croup which is characteristic disease in children. However, there have been no reports confirming the relative susceptibility of different age groups to SARS-CoV-2. In this study, we estimated the age-specific susceptibility during the 5th (Omicron driven), 4th (Delta driven), and 3rd (pre-Delta) waves in South Korea, using the age-structured compartmental model. Even after adjusting for contact pattern, vaccination status, and waning of vaccine effectiveness, the susceptibility among age group 0–19 years was approximately 5 times higher during the 5th wave (Omicron driven) than that during the 3rd wave (pre-Delta), and 3 times higher than that during the 4th wave (Delta driven). Here, we found that children are indeed more susceptible to the Omicron variant compared with the previous strains of SARS-CoV-2.

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Machine learning versus multivariate logistic regression for predicting severe COVID‐19 in hospitalized children with Omicron variant infection

Liu,

Xing,

Peng

et al. 2024

Journal of Medical Virology

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With the emergence of the Omicron variant, the number of pediatric Coronavirus Disease 2019 (COVID‐19) cases requiring hospitalization and developing severe or critical illness has significantly increased. Machine learning and multivariate logistic regression analysis were used to predict risk factors and develop prognostic models for severe COVID‐19 in hospitalized children with the Omicron variant in this study. Of the 544 hospitalized children including 243 and 301 in the mild and severe groups, respectively. Fever (92.3%) was the most common symptom, followed by cough (79.4%), convulsions (36.8%), and vomiting (23.2%). The multivariate logistic regression analysis showed that age (1–3 years old, odds ratio (OR): 3.193, 95% confidence interval (CI): 1.778–5.733], comorbidity (OR: 1.993, 95% CI:1.154–3.443), cough (OR: 0.409, 95% CI:0.236–0.709), and baseline neutrophil‐to‐lymphocyte ratio (OR: 1.108, 95% CI: 1.023–1.200), lactate dehydrogenase (OR: 1.993, 95% CI: 1.154–3.443), blood urea nitrogen (OR: 1.002, 95% CI: 1.000–1.003) and total bilirubin (OR: 1.178, 95% CI: 1.005–3.381) were independent risk factors for severe COVID‐19. The area under the curve (AUC) of the prediction models constructed by multivariate logistic regression analysis and machine learning (RandomForest + TomekLinks) were 0.7770 and 0.8590, respectively. The top 10 most important variables of random forest variables were selected to build a prediction model, with an AUC of 0.8210. Compared with multivariate logistic regression, machine learning models could more accurately predict severe COVID‐19 in children with Omicron variant infection.

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Croup as a Manifestation of SARS-CoV-2 Omicron Variant Infection in Young Children

Cited by 22 publications

References 22 publications

Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients

Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients

Age-varying susceptibility to the Omicron variant (B.1.1.529) of SARS-CoV-2

Machine learning versus multivariate logistic regression for predicting severe COVID‐19 in hospitalized children with Omicron variant infection

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