Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

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COVID-19 and influenza: main differences between clinical symptoms

Oral and General Health ◽

10.22141/ogh.2.1.2021.227062 ◽

2021 ◽

Vol 2 (1) ◽

pp. 25-32

Author(s):

V.O. Boyko

Keyword(s):

Quality Of Life ◽

Differential Diagnosis ◽

Exponential Growth ◽

Clinical Symptoms ◽

Clinical Course ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Neurological Manifestations ◽

Asymptomatic Carriage

This review analyzes the clinical symptoms, differential diagnosis of COVID-19 and influenza to facilitate clinical diagnosis of both diseases. The development of the COVID-19 epidemic occurred with an exponential growth of the incidence due to the high contagiousness of the virus, asymptomatic carriage. The situation was aggravated by the contagiousness of the patient in the last 2–3 days of the incubation period (before clinical manifestations), which made it difficult to isolate patients and contacts in a timely. The spectrum of damage to the organs and systems is constantly expanding with a more detailed study of the clinical course of COVID-19. Sometimes, the manifestations of COVID-19 persist even during the period of convalescence, which cause a decrease in the performance and quality of life of patients. The article discusses neurological manifestations, gastrointestinal symptoms and features of pneumonia in COVID-19. The clinical features of influenza and the main differences in the clinical course from COVID-19 are also demonstrated.

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CLINIC AND COMPLICATIONS OF COVID-19 CORONAVIRUS DISEASE WITH PATHOGENESIS ELEMENTS

International Medical Journal ◽

10.37436/2308-5274-2020-3-14 ◽

2020 ◽

pp. 72-79

Author(s):

I. V. Аndrusovich

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Tract ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Clinical Symptoms ◽

Clinical Course ◽

Clinical Manifestations ◽

Second Phase ◽

Upper Respiratory Tract

The longer the COVID−19 coronavirus pandemic lasts, the more information about its clinical manifestations is accumulated. The incubation period of COVID−19 ranges from 2 to 14 days, rarely up to 3 weeks, but in a significant number of cases an infection is not accompanied with the appearance of clinical symptoms. Currently, the following variants of the clinical course of COVID−19 can be identified as follows: viral load; subclinical; slight; uncomplicated with damage to only the upper respiratory tract; mild pneumonia, severe pneumonia, acute respiratory distress syndrome, etc. The clinical course of COVID−19 depends on the severity, the criteria of which are the intoxication manifestation, the degree of fever and the dominant syndrome. Mild / moderate forms are manifested by frequent increase in body temperature up to 38 ° C, respiratory symptoms, headache, myalgias, palpitations and general malaise. Patients stop distinguishing smells and feel the taste of food. Approximately from the 7th to the 9th days of the disease there are problems with breathing, which indicates the impairment of the lower respiratory tract and the beginning of the second phase of the disease, and its course is regarded as severe. Severe forms of the disease can also be manifested by impaired coordination of movements, slurred speech. In 1 to 4 % of patients there is developed the psychosis in the form of hallucinations. In the elderly, COVID−19 may be accompanied by delirium, lowering blood pressure. The risks of adverse disease are associated with somatic diseases: cardiovascular and nervous systems, respiratory tract, hormonal disorders, etc. Otitis, sinusitis, sepsis, bronchopulmonary infection, thrombosis, myocarditis etc. can be the complications of COVID−19. Computer tomography is an instrumental test that demonstrates the damage of lungs with coronavirus and allows to assess its severity. Key words: coronavirus infection, COVID−19, clinical variants, severity, pneumonia, acute respiratory distress syndrome.

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Clinical Characteristics and CT Manifestations of 143 Patients With 2019 Novel Coronavirus Disease (COVID-19) in Taizhou City, Zhejiang, China

10.21203/rs.3.rs-32895/v1 ◽

2020 ◽

Author(s):

Yani Kuang ◽

Susu He ◽

Shuangxiang Lin ◽

Rui Zhu ◽

Rongzhen Zhou ◽

...

Keyword(s):

Clinical Symptoms ◽

Protein A ◽

Clinical Manifestations ◽

Imaging Features ◽

First Case ◽

Severe Group ◽

Laboratory Examinations ◽

The Difference ◽

Severity Of The Disease ◽

Novel Coronavirus

Abstract Background: In December 2019, the first case of pneumonia associated with the SARS-CoV-2 was found in Wuhan and rapidly spread throughout China, so data are needed on the affected patients. The purpose of our study was to find the clinical manifestations and CT features of COVID-19.Methods: All patients with COVID-19 in Taizhou city were retrospectively included and divided into non-severe group and severe group according to the severity of the disease. The clinical manifestations, laboratory examinations and imaging features of COVID-19 patients were analyzed, and the differences between the two groups were compared.Results: A total of 143 laboratory-confirmed cases were included in the study, including 110 non-severe patients and 33 severe patients. The median age of patients was 47 (range 4–86 years). Fever (73.4%) and cough (63.6%) were the most common initial clinical symptoms. Between two groups of cases, the results of aspartate transaminase, creatine kinase and lactate dehydrogenase, serum albumin, CR, glomerular filtration rate, amyloid protein A, fibrinogen, calcitonin level and oxygen partial pressure, IL – 10, absolute value of CD3, CD4, CD8 were different, and the difference was statistically significant (P < 0.05). Therefore, these quantitative indicators can be used to help assess the severity. On admission, the CT showed that the lesions were mostly distributed in the periphery of the lung or subpleural (135 cases (98%)), and most of lesions presented as patchy (81%), mixed density (63%) shadow. Consolidation (68% vs 41%), bronchial inflation signs (59% vs 41%), and bronchiectasis (71% vs 39%) were more common in the severe group.Conclusions: Most of the cases of COVID-19 in Taizhou have mild symptoms and no death. In addition to clinical symptoms, some laboratory tests (such as absolute values of CD4 and CD8) and CT findings can be used to assess the severity of the disease.

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CLINICAL AND LABORATORY CHARACTERISTICS OF SARS-COV-2 INFECTION IN CHILDREN AND ADOLESCENTS

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2021/39/2020231 ◽

2021 ◽

Vol 39 ◽

Author(s):

Marlos Melo Martins ◽

Arnaldo Prata-Barbosa ◽

Maria Clara de Magalhães-Barbosa ◽

Antonio José Ledo Alves da Cunha

Keyword(s):

Latin American ◽

Inflammatory Responses ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Current Evidence ◽

Cochrane Library ◽

Childhood And Adolescence ◽

Inflammatory Reactions ◽

One Year ◽

Novel Coronavirus

ABSTRACT Objective: To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence. Data source: This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent. Data synthesis: Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection. Conclusions: Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.

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Clinical features of adenocarcinoma of the cervix

Bukovinian Medical Herald ◽

10.24061/2413-0737.xviii.4.72.2014.186 ◽

2014 ◽

Vol 18 (4 (72)) ◽

Author(s):

N. V. Zelinska ◽

O. P. Peresunko

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Clinical Course ◽

Anatomical Structure ◽

Histological Structure

The analysis of the clinical course of adenocarcinoma of the cervix in stages I-IV of 50 patients has been carried out. We have studied clinical symptoms, the nature of comorbidity, the features of anatomical structure, varieties of histological structure and disadvantages in the detection of tumors.

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COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Journal of Clinical Medicine ◽

10.3390/jcm9051420 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1420 ◽

Cited By ~ 14

Author(s):

Michał Kukla ◽

Karolina Skonieczna-Żydecka ◽

Katarzyna Kotfis ◽

Dominika Maciejewska ◽

Igor Łoniewski ◽

...

Keyword(s):

Systematic Review ◽

Liver Injury ◽

Clinical Course ◽

Meta Analysis ◽

Gastrointestinal Symptoms ◽

Intensive Care Treatment ◽

The Novel ◽

Massive Necrosis ◽

Novel Coronavirus ◽

Elevated Transaminases

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

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A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias

Clinical Infectious Diseases ◽

10.1093/cid/ciaa247 ◽

2020 ◽

Vol 71 (15) ◽

pp. 756-761 ◽

Cited By ~ 95

Author(s):

Dahai Zhao ◽

Feifei Yao ◽

Lijie Wang ◽

Ling Zheng ◽

Yongjun Gao ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Severe Pneumonia ◽

Ground Glass Opacity ◽

Chest Ct ◽

Rt Pcr ◽

Bilateral Involvement ◽

Radiological Features ◽

History Of ◽

Novel Coronavirus

Abstract Background A novel coronavirus (COVID-19) has raised world concern since it emerged in Wuhan, China in December 2019. The infection may result in severe pneumonia with clusters of illness onsets. Its impacts on public health make it paramount to clarify the clinical features with other pneumonias. Methods Nineteen COVID-19 and 15 other patients with pneumonia (non-COVID-19) in areas outside of Hubei were involved in this study. Both COVID-19 and non-COVID-19 patients were confirmed to be infected using throat swabs and/or sputa with/without COVID-2019 by real-time RT-PCR. We analyzed the demographic, epidemiological, clinical, and radiological features from those patients, and compared the differences between COVID-19 and non-COVID-19. Results All patients had a history of exposure to confirmed cases of COVID-19 or travel to Hubei before illness. The median (IQR) duration was 8 (6–11) and 5 (4–11) days from exposure to onset in COVID-19 and non-COVID-19 cases, respectively. The clinical symptoms were similar between COVID-19 and non-COVID-19. The most common symptoms were fever and cough. Fifteen (78.95%) COVID-19 but 4 (26.67%) non-COVID-19 patients had bilateral involvement while 17 COVID-19 patients (89.47%) but 1 non-COVID-19 patient (6.67%) had multiple mottling and ground-glass opacity on chest CT images. Compared with non-COVID-19, COVID-19 presents remarkably more abnormal laboratory tests, including AST, ALT, γ-GT, LDH, and α-HBDH. Conclusions The COVID-19 infection has onsets similar to other pneumonias. CT scan may be a reliable test for screening COVID-19 cases. Liver function damage is more frequent in COVID-19 than non-COVID-19 patients. LDH and α-HBDH may be considerable markers for evaluation of COVID-19.

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Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9040941 ◽

2020 ◽

Vol 9 (4) ◽

pp. 941 ◽

Cited By ~ 136

Author(s):

Israel Júnior Borges do Nascimento ◽

Nensi Cacic ◽

Hebatullah Mohamed Abdulazeem ◽

Thilo Caspar von Groote ◽

Umesh Jayarajah ◽

...

Keyword(s):

Scoping Review ◽

Clinical Symptoms ◽

Meta Analysis ◽

Laboratory Data ◽

Gastrointestinal Symptoms ◽

Common Disease ◽

Imaging Data ◽

Laboratory Findings ◽

Number Of Patients ◽

Novel Coronavirus

A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%–99%; n = 4410), cough (61%, 95% CI 39%–81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%–55%; n = 3778), dyspnea (26%, 95% CI 12%–41%; n = 3700), headache in 12% (95% CI 4%–23%, n = 3598 patients), sore throat in 10% (95% CI 5%–17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%–17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83–1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54–45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%–1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

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Role of natural drugs in severe acute respiratory syndrome coronavirus 2: potential beneficial effects in prevention or prior treatment in elderly and cancer patients

Geriatric Care ◽

10.4081/gc.2020.9016 ◽

2020 ◽

Vol 6 (2) ◽

Author(s):

Eugenio Boccalone ◽

Veronica Maria Lanni ◽

Valerio Massimo Magro

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Clinical Symptoms ◽

Gastrointestinal Symptoms ◽

Converting Enzyme ◽

Acute Respiratory Disease ◽

Angiotensin Converting Enzyme 2 ◽

Beneficial Effects ◽

Entire World ◽

Natural Drugs

In 2019, a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), aroused the attention of the entire world. It causes an acute respiratory disease, by involving the same receptor, i.e. the angiotensin-converting enzyme 2, as that for severe acute respiratory syndrome coronavirus (SARS-CoV), mainly spreads through the respiratory tract. The clinical symptoms in patients with of SARS-CoV-2 include fever, cough, dyspnea, fatigue and in a small percentage of patients also gastrointestinal symptoms have been reported...

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Gastrointestinal symptoms in the course of COVID-19

Postępy Higieny i Medycyny Doświadczalnej ◽

10.5604/01.3001.0014.5459 ◽

2020 ◽

Vol 74 ◽

pp. 498-503

Author(s):

Grzegorz K. Jakubiak ◽

Józefina Ochab-Jakubiak ◽

Grzegorz Cieślar ◽

Agata Stanek

Keyword(s):

Intestinal Inflammation ◽

Gastrointestinal Symptoms ◽

Unknown Etiology ◽

Wuhan City ◽

Angiotensin Converting Enzyme 2 ◽

Current State ◽

Novel Coronavirus ◽

Loss Of Appetite ◽

First Time

COVID-19 is an infectious disease caused by novel coronavirus SARS-CoV-2, a betacoronavirus comprised of single-stranded ribonucleic acid (RNA), the first time reported in December 2019 as pneumonia with unknown etiology in Wuhan City in China. It is a very important current problem for public health worldwide. A typical clinical course includes dyspnoea, dry cough and fever. In the presented paper we conducted the literature review and described the most important facts within the current state of knowledge about symptomatology and pathophysiology of gastrointestinal dysfunction in the course of COVID-19. Data about prevalence of gastrointestinal symptoms in the course of COVID-19 show wide divergence in the cited literature. Generally, the most common reported digestive symptoms were loss of appetite, nausea and vomiting. Liver injury in the course of COVID-19 is also an important and not well understood problem. The virus has high affinity to cells containing angiotensin- -converting enzyme 2 (ACE2) protein. Digestive symptoms of COVID-19 may be associated with ACE2 expression in epithelial cells in upper oesophagus, ileum and colon. Previous scientific reports have elucidated the role of ACE2 in modulating intestinal inflammation and diarrhoea.

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