Clinical Features and Temporal Changes of RT-PCR and Chest CT in COVID-19 Pediatric Patients: A Diagnostic Strategy Study

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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Chest CT changes in COVID-19 patients with hypertension comorbidities

10.21203/rs.3.rs-30394/v1 ◽

2020 ◽

Author(s):

Wei Li ◽

Wenjun Yu ◽

Jianwei Liao ◽

Yijie Fang ◽

Lin Yao ◽

...

Keyword(s):

Global Health ◽

Clinical Features ◽

Clinical Data ◽

Clinical Characteristics ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Relationship Of ◽

Pcr Test

Abstract AIMTo summarize the chest CT and clinical features of COVID-19 pneumonia patients with hypertension comorbidities.METHODSThe initial chest CT imaging and clinical data of 15 confirmed COVID-19 patients with hypertension comorbidities treated in our hospital were analyzed retrospectively from January 1, 2019 to February 14, 2020. The chest CT images and clinical data were reviewed and their relationship of the disease was analyzed.RESULTSTotally 15 COVID-19 patients diagnosed with hypertension comorbidities were included. In terms of clinical characteristics, 14/15 (93.3%) of patients had characteristics of clustering onset, and the positive rates of the first RT-PCR test and the initial CT were 80% and 93% respectively. The most frequent CT abnormality observed was ground glass opacity (GGO) (13/15, 86.7%), including patchy/ punctate GGO and large/multiple GGO. Most of the lesions were multiple, and 60% of them involved 4-5 lobes. Most patients present with bilateral CT onset (12,80.0%), and most present with subpleural distribution (10,66.7%). The average CT score is 13.7, and 40% of the patients exceeded 20 points.CONCLUSIONThe common chest CT findings in COVID-19 patients with hypertension comorbidities are GGO, most of which at present with bilateral CT onset and subpleural distribution. CT is indispensable in the diagnosis and evaluation of this global health emergency.

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Can Clinical Symptoms and Laboratory Results Predict CT Abnormality? Initial Findings Using Novel Machine Learning Techniques in Children With COVID-19 Infections

Frontiers in Medicine ◽

10.3389/fmed.2021.699984 ◽

2021 ◽

Vol 8 ◽

Author(s):

Huijing Ma ◽

Qinghao Ye ◽

Weiping Ding ◽

Yinghui Jiang ◽

Minhao Wang ◽

...

Keyword(s):

Machine Learning ◽

Clinical Data ◽

Pediatric Patients ◽

Clinical Symptoms ◽

Chest Ct ◽

Rt Pcr ◽

Health Crisis ◽

Children's Hospital ◽

Laboratory Results ◽

Children’S Hospital

The rapid spread of coronavirus 2019 disease (COVID-19) has manifested a global public health crisis, and chest CT has been proven to be a powerful tool for screening, triage, evaluation and prognosis in COVID-19 patients. However, CT is not only costly but also associated with an increased incidence of cancer, in particular for children. This study will question whether clinical symptoms and laboratory results can predict the CT outcomes for the pediatric patients with positive RT-PCR testing results in order to determine the necessity of CT for such a vulnerable group. Clinical data were collected from 244 consecutive pediatric patients (16 years of age and under) treated at Wuhan Children's Hospital with positive RT-PCR testing, and the chest CT were performed within 3 days of clinical data collection, from January 21 to March 8, 2020. This study was approved by the local ethics committee of Wuhan Children's Hospital. Advanced decision tree based machine learning models were developed for the prediction of CT outcomes. Results have shown that age, lymphocyte, neutrophils, ferritin and C-reactive protein are the most related clinical indicators for predicting CT outcomes for pediatric patients with positive RT-PCR testing. Our decision support system has managed to achieve an AUC of 0.84 with 0.82 accuracy and 0.84 sensitivity for predicting CT outcomes. Our model can effectively predict CT outcomes, and our findings have indicated that the use of CT should be reconsidered for pediatric patients, as it may not be indispensable.

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Chest CT imaging of pediatric COVID-19 infection: a case report

10.21203/rs.3.rs-21613/v1 ◽

2020 ◽

Author(s):

Huayan Xu ◽

Keke Hou ◽

Na Zhang ◽

Ming Yang ◽

Yingkun Guo

Keyword(s):

Cell Count ◽

Laboratory Tests ◽

Pediatric Patients ◽

White Cell Count ◽

Chest Ct ◽

White Cell ◽

The Other ◽

Imaging Features ◽

Rt Pcr ◽

Small Nodule

Abstract Background: Coronavirus Disease 2019 (COVID-19) outbreak in Wuhan, China spreading rapidly worldwide. Over 100 countries have reported surpassing 100,000 laboratory-confirmed cases of COVID- 19, and in which 2.1% were under aged 19 years. However, little is known about the imaging features about pediatric COVID-19 patients. Herein, we report two cases about COVID-19 involving the clinical data as well as chest images.Case presentation: Two pediatric patients admitted to hospital because of high fever or dry cough. Both children had been recent exposure to the COVID-19 confirmed patients of their family members. Real-time polymerase chain reaction(RT-PCR) test of these two patients’ sputum were positive for SARS-CoV-2 nucleic acid, and diagnosed as COVID-19 infection. Laboratory tests indicate normal white cell count (5.02 x10^9/L) and neutrophils (40.8%) in one case, and slightly increased white cell count (11.86 x10^9/L) and normal neutrophils (16.1%)in the other one. CRP of both cases were within the normal range. Computed tomography (CT) was used to evaluate the novel coronavirus pneumonia (NCP) of these two pediatric patients. Small nodule was found in the upper right lobe of one case; and bilateral peripheral ground-glass opacities were observed in the other patient.Conclusion: In summary, clinical symptoms and signs, laboratory tests and chest CT images of pediatric patients were untypical. Epidemic exposure history and RT-PCR results still play an important role in the precise diagnosis of COVID-19 children.

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Clinical features and outcomes of 197 adult discharged patients with COVID-19 in Yichang, Hubei

10.1101/2020.03.26.20041426 ◽

2020 ◽

Cited By ~ 3

Author(s):

Fating Zhou ◽

Xiaogang Yu ◽

Xiaowei Tong ◽

Rong Zhang

Keyword(s):

Clinical Features ◽

Chest Ct ◽

Rt Pcr ◽

Reactive Protein ◽

Underlying Illness ◽

Discharged Patients ◽

Infection Disease ◽

Coronavirus Infection ◽

Exposure History ◽

Lactate Dehydrogenases

AbstractPurposeTo investigate the epidemiology and clinical features of discharged adult patients with coronavirus infection disease 2019 (COVID-19) in Yichang.MethodThe retrospective study recruited 197 cases of COVID-19 discharged from Yichang Central People’s Hospital and Yichang Third People’s Hospital from Jan 17 to Feb 26, 2020. All cases were confirmed by real-time RT-PCR or chest computer tomography (CT). The survivors were followed up until March 4,2020. Clinical data, including demographic characteristic, presentation, underlying illness, exposure history, laboratory examination, radiology and prognosis were enrolled and analyzed by SPSS 19.0 software.ResultsThere were 197 adult discharged patients with COVID-19 in this study. Statistical analysis indicated that the average age was 55.94 years, and female patients were 99(50.3%).Those patients mainly resided in urban with exposure history in 2 weeks, while 7 medical staffs were infected. Fever (77.6%%), cough (43.6%) and weakness (14.7%) were the common symptoms. Leukocytes were mainly normal or decreased in 185 patients (92.9%), both lymphocytes and eosinophils were below normal range, the ratios were 56.9% and 50.3%, respectively. On the contrary, lactate dehydrogenases raised in 65 patients. C-reactive protein (72.4%) elevated in the most of patients. The sensitivity of RT-PCR was 63.5%. Chest CT indicated that bilateral patchy shadows (69.0%) were the most common imaging manifestations.169(85.8%) patients recovered and transferred to a designated hospital for observation, and the others (14.2%) turned worst and died of acute respiratory failure.ConclusionCOVID-19 infection with highly contagious have become a life-threaten public healthy problem, the sensitivity of RT-PCR was limited. Chest CT scan was recommended for the suspected patients. Furthermore, lymphocytopenia and eosinophils declining without leukocytes increasing may be considered as a useful evidence for the diagnosis.

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Optimizing diagnostic strategy for novel coronavirus pneumonia, a multi-center study in Eastern China

10.1101/2020.02.13.20022673 ◽

2020 ◽

Cited By ~ 17

Author(s):

Jing-Wen Ai ◽

Hao-Cheng Zhang ◽

Teng Xu ◽

Jing Wu ◽

Mengqi Zhu ◽

...

Keyword(s):

Eastern China ◽

Hubei Province ◽

Chest Ct ◽

N Gene ◽

Diagnostic Strategy ◽

Single Mutation ◽

Rt Pcr ◽

Pcr Multiplex ◽

Novel Coronavirus ◽

Epidemiological Characteristics

AbstractCOVID-19 caused by a novel coronavirus SARS-CoV-2 emerged in Wuhan, Hubei province since December 2019, and caused a rapid outbreak throughout China and globally. Cities outside Hubei are also facing great challenge and require implementing of effective and feasible strategy in precision diagnosing novel coronavirus pneumonia (NCP).We described a multicenter prospective study on diagnostic strategy of suspected NCP patients from January 22nd to February 9th, 2020 in Eastern China cities. Nasopharyngeal swabs were collected from the patients. The epidemiological characteristics, clinical symptoms, laboratory assessments, and computed tomographic (CT) scans were obtained. Pathogen screen were performed including RT-PCR, multiplex PCR, rapid flu antigen tests and mNGS.We enrolled 53 suspected NCP patients, among whom 20 were laboratory-confirmed. Fourteen (70%) and 3 (15%) patients were positive for the first and second SARS-CoV-2 RT-PCR test, respectively. All NCP patients were positive for mNGS. Chest CT images and the symptoms of early stage NCP patients were similar to other viral pneumonia patients. We identified 11 of 20 co-infections in NCP cases, including regular respiratory virus, fungi and bacteria synchronously. Genomic analysis showed that 8 of 10 cases had no mutation in virus genome, while 2 cases had only one single mutation in N gene.Our study discovered that a combination of chest CT, SARS-CoV-2 RT-PCR and multi-plex PCR is recommended in regions outside Hubei province. Co-infection of other pathogens with SARS-CoV-2 exists and should be acknowledged. Repeated sampling, change of specimen type or metagenomics sequencing could further facilitate during critical clinical cases.

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Assessment of a Diagnostic Strategy Based on Chest Computed Tomography in Patients Hospitalized for COVID-19 Pneumonia: an observational study

10.1101/2020.06.29.20140129 ◽

2020 ◽

Author(s):

Marine Thieux ◽

Anne-Charlotte Kalenderian ◽

Aurélie Chabrol ◽

Laurent Gendt ◽

Emma Giraudier ◽

...

Keyword(s):

Computed Tomography ◽

Observational Study ◽

Sensitivity And Specificity ◽

Chest Ct ◽

Time Interval ◽

Diagnostic Strategy ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Pcr Diagnosis ◽

Significant Difference

AbstractObjectivesTo assess the relevance of a diagnostic strategy for COVID-19 based on chest computed tomography (CT) in patients with hospitalization criteria.SettingObservational study with retrospective analysis in a French emergency department (ED).Participants and interventionFrom March 3 to April 2, 2020, 385 adult patients presenting to the ED for suspected COVID-19 underwent an evaluation that included history, physical examination, blood tests, real-time reverse transcription-polymerase chain reaction (RT-PCR) and chest CT. When the time-interval between chest CT and RT-PCR assays was longer than 7 days, patients were excluded from the study. Only patients with hospitalization criteria were included. Diagnosis accuracy was assessed using the sensitivity and specificity of RT-PCR.OutcomesSensitivity and specificity of RT-PCR, chest CT (also accompanied by lymphopenia) were measured and were also analyzed by subgroups of age and sex.ResultsAmong 377 included subjects, RT-PCR was positive in 36%, while chest CT was compatible with a COVID-19 diagnosis in 59%. In the population with positive RT-PCR, there were more men (55% vs 37%, p=0.015), a higher frequency of reticular and, or, interlobular septal thickening (53% vs 31%, p=0.02) as well as a higher frequency of bilateral lesion distribution (98% vs 86%, p=0.01) compared to the population with negative RT-PCR. The proportion of lymphopenia was higher in men vs women (47% vs 39%, p=0.03) and varies between patients >80 versus 50-80 and p<0.001).Using CT as reference, RT-PCR obtained a sensitivity of 61%, specificity of 93%. There was a significant difference between CT and RT-PCR diagnosis performance (p<0.001). When CT was accompanied by lymphopenia, sensitivity and specificity of RT-PCR were respectively 71% and 94%. CT abnormalities and lymphopenia provided diagnosis in 29% of patients with negative PCR.ConclusionsChest CT had a superior yield than RT-PCR in COVID-19 hospitalized patients, especially when accompanied by lymphopenia.

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