Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

doi:10.1007/s11684-020-0820-7

Front. Med.

2020, Vol. 14

Issue (6) : 776-785 https://doi.org/10.1007/s11684-020-0820-7

RESEARCH ARTICLE

Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

Xiaofang Cai¹, Hanlan Jiang¹, Simin Zhang¹, Shengying Xia¹, Wenhui Du¹, Yaoling Ma¹, Tao Yu², Wenbin Li³(

)

¹. Department of Emergency, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
². Department of Clinical Laboratory, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
³. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

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Abstract

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread around the world. However, approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported. We retrospectively analyzed the clinical data of 97 children with probable COVID-19. A total of 13 (13.4%) patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing, and 41 (42.3%) patients were found to be infected with other pathogens. Notably, no pathogen was detected in 43 (44.3%) patients. Among all patients, 25 (25.8%) had familial cluster exposure history, and 52 (53.6%) had one or more coexisting conditions. Fifteen (15.5%) patients were admitted or transferred to the PICU. In the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG against SARS-CoV-2, respectively. In 22 patients with suspected COVID-19, 1 (4.5%) was positive for IgG but negative for IgM. The most frequently detected pathogen was Mycoplasma pneumonia (29, 29.9%). One patient with confirmed COVID-19 died. Our results strongly indicated that the detection of asymptomatic COVID-19 or coexisting conditions must be strengthened in pediatric patients. These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted. A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.

Keywords coronavirus disease 2019 pediatrics emergency retrospective investigation severe acute respiratory syndrome coronavirus 2

Corresponding Author(s): Wenbin Li

Just Accepted Date: 09 October 2020 Online First Date: 27 October 2020 Issue Date: 24 December 2020

Cite this article:

Xiaofang Cai,Hanlan Jiang,Simin Zhang, et al. Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19[J]. Front. Med., 2020, 14(6): 776-785.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-020-0820-7
https://academic.hep.com.cn/fmd/EN/Y2020/V14/I6/776

Fig.1 Detection of COVID-19 nucleic acid and serum-specific IgM and IgG antibodies in 97 probable cases. Of the 97 probable COVID-19 cases, 53 (54.6%) patients, including 11 (84.6%) with confirmed COVID-19, 22 (51.2%) with suspected COVID-19, and 20 (48.8%) with non-COVID-19, underwent serum anti-SARS-CoV-2 IgM and IgG testing starting on March 5. Out of the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG, respectively. Out of the 22 suspected COVID-19 cases, 1 (4.5%) was positive for IgG but negative for IgM.

Tab.1 Baseline characteristics of confirmed COVID-19 cases, suspected COVID-19 cases, and non-COVID-19 cases

	Normal range	Median (IQR) or No. (%)				P value
	Normal range	Total (n = 97)	Confirmed COVID-19 case (n = 13)	Suspected COVID-19 case (n = 43)	Non-COVID-19 case (n = 41)	P value
White blood cell count, × 10⁹/L	5.50–12.00	7.66 (6.08–10.98)	6.99 (4.60–10.15)	8.49 (6.69–12.53)	7.66 (6.08–11.02)	0.477
<5.5		17 (17.5)	4 (30.8)	6 (14.0)	7 (17.1)	0.375
Neutrophil count, × 10⁹/L	1.08–5.90	3.10 (1.64–4.93)	2.26 (1.72–5.45)	3.04 (1.57–4.94)	3.78 (2.03–6.48)	0.143
Lymphocyte count, × 10⁹/L	1.15–6.00	3.31 (2.01–5.70)	2.96 (2.25–3.88)	4.66 (2.82–6.01)	2.93 (1.71–5.29)	0.117
<1.15		8 (8.2)	1 (7.7)	4 (9.3)	3 (7.3)	0.944
Platelet count, × 10⁹/L	100–378	324 (231–421)	314 (219–358)	376 (238–541)	306 (213–368)	0.077
<100		4	1 (7.7)	2 (4.7)	1 (2.4)	0.690
CRP, mg/L	0–3.00	5.00 (0.75–23.00)	5.01 (1.02–27.55)	2.88 (0.75–15.30)	10.00 (0.75–35.40)	0.171
PCT, ng/mL	≤0.05	0.12 (0.07–0.42) (n = 84)	0.07 (0.04–0.38) (n = 12)	0.11 (0.07–0.34) (n = 34)	0.16 (0.09–0.66) (n = 38)	0.215
ALT, U/L	9–52	23 (15–36.5)	21 (14.5–62)	28 (22–38)	19 (13–28)	0.024*
AST, U/L	15–46	39 (28–57)	46 (25–104)	41 (32–57)	33 (26–56)	0.239
LDH, U/L	161–371	284 (223–372) (n = 91)	344 (237–656.5) (n = 13)	285 (231–387) (n = 38)	270 (214–352) (n = 40)	0.224
CK, U/L	30–170	89 (69–161) (n = 91)	152 (90.5–248.5) (n = 13)	88 (68–165) (n = 38)	86 (64–141) (n = 40)	0.042*
CK isoenzyme, U/L	0–24	34 (22–47 (n = 91)	34 (19.5–94) (n = 13)	36 (27–49) (n = 38)	26 (19–43) (n = 40)	0.152
BUN, mmol/L	2.5–6.1	3.1 (2.3–4.2) (n = 95)	3.5 (2.3–5.6) (n = 12)	2.5 (2.0–4.3) (n = 43)	3.3 (2.8–3.8) (n = 40)	0.118
Cr, mmol/L	46–92	24 (21–30) (n = 95)	26 (24–61) (n = 12)	23 (20–28) (n = 43)	26 (21–37) (n = 40)	0.162
PT, s	10.2–13.4	11.6 (11.0–12.4) (n = 57)	11.4 (10.9–12.2) (n = 10)	11.6 (10.9–12.3) (n = 21)	11.8 (11.1–12.7) (n = 26)	0.567
APTT, s	25.7–39	31.0 (27.6–35.8) (n = 57)	31.4 (30.0–39.2) (n = 10)	31.3 (26.9–37.7) (n = 21)	30.0 (27.6–34.3) (n = 26)	0.609
D-dimer	0–0.55	0.45 (0.31–1.49) (n = 25)	0.92 (0.40–12.35) (n = 6)	0.45 (0.28–2.31) (n = 9)	0.41 (0.28–0.56) (n = 10)	0.326
Cytokine, pg/mL
IL-2	0–11.4	1.6 (1.3–1.8) (n = 42)	1.4 (1.3–1.8) (n = 7)	1.7 (1.3–2.2) (n = 15)	1.5 (1.3–1.7) (n = 20)	0.408
IL-4	0–12.9	2.5 (2.1–3.4) (n = 42)	3.01 (2.30–3.78) (n = 7)	2.2 (1.9–4.0) (n = 15)	2.4 (2.1–2.8) (n = 20)	0.572
IL-6	0–20.9	9.3 (4.8–30.5) (n = 42)	70.83 (7.06–177.86) (n = 7)	6.6 (4.7–27.5) (n = 15)	11.4 (4.3–28.1) (n = 20)	0.323
IL-10	0–5.9	5.9 (4.4–8.7) (n = 42)	6.68 (3.31–26.85) (n = 7)	5.9 (4.4–9.5) (n = 15)	5.7 (4.7–7.9) (n = 20)	0.968
TNF-a	0~5.5	1.8 (1.3–2.4) (n = 42)	2.1 (1.1–3.5) (n = 7)	2.2 (1.6–2.6) (n = 15)	1.6 (1.2–2.1) (n = 20)	0.200
TBNK lymphocyte detection, μL⁻¹
CD3⁺T	805–4459	2056 (1188–3098) (n = 35)	2175 (1060–4014) (n = 9)	1860 (1065–3477) (n = 10)	2196 (890–2666) (n = 16)	0.949
CD8⁺T	314–2080	766 (258–1120) (n = 35)	1068 (539–1335) (n = 9)	770 (152–977) (n = 10)	538 (251–1012) (n = 16)	0.336
CD4⁺T	345–2350	1149 (549–2168) (n = 35)	1070 (446–2921) (n = 9)	1054 (763–2332) (n = 10)	1240 (498–1725) (n = 16)	0.981
CD16⁺CD56⁺NK	210–1514	276 (139–516) (n = 35)	311 (102–516) (n = 9)	289 (147–555) (n = 10)	245 (125–533) (n = 16)	0.939
CD4⁺/CD8⁺T (Th/Ts)	0.96–2.05	1.77 (1.15–2.82) (n = 35)	1.08 (0.87–1.74) (n = 9)	2.60 (1.40–2.90) (n = 10)	1.91 (1.18–2.63) (n = 16)	0.051
Bilateral distribution of patchy shadows or ground glass opacity, and/or infiltrating shadows.	No	97/97	13/13	43/43	41/41	–

Tab.2 Laboratory findings of confirmed COVID-19 cases, suspected COVID-19 cases, and non-COVID-19 cases

Tab.3 Serological test for the specific IgM and IgG antibodies of SARS-CoV-2

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