Background
Severe cases of coronavirus disease 2019 (COVID-19) among pediatric patients are more common in children less than 1 year of age. Our aim is to address the underlying role of immunity and inflammation conditions among different age groups of pediatric patients.
Methods
We recruited pediatric patients confirmed of moderate COVID-19 symptoms, admitted to Wuhan Children's Hospital from January 28th to April 1st in 2020. Patients were divided into four age groups (≤ 1, 1–6, 7–10, and 11–15 years). Demographic information, clinical characteristics, laboratory results of lymphocyte subsets test, immune and inflammation related markers were all evaluated.
Results
Analysis included 217/241 (90.0%) of patients with moderate clinical stage disease. Average recovery time of children more than 6 years old was significantly shorter than of children younger than 6 years (P = 0.001). Reduced neutrophils and increased lymphocytes were significantly most observed among patients under 1 year old (P < 0.01). CD19+ B cells were the only significantly elevated immune cells, especially among patients under 1 year old (cell proportion: n = 12, 30.0%, P < 0.001; cell count: n = 13, 32.5%, P < 0.001). While, low levels of immune related makers, such as immunoglobulin (Ig) G (P < 0.001), IgA (P < 0.001), IgM (P < 0.001) and serum complement C3c (P < 0.001), were also mostly found among patients under 1 year old, together with elevated levels of inflammation related markers, such as tumor necrosis factor γ (P = 0.007), interleukin (IL)-10 (P = 0.011), IL-6 (P = 0.008), lactate dehydrogenase (P < 0.001), and procalcitonin (P = 0.007).
Conclusion
The higher rate of severe cases and long course of COVID-19 among children under 1 year old may be due to the lower production of antibodies and serum complements of in this age group.
Background
Convexal subarachnoid hemorrhage (cSAH) is characterized by isolated bleeding in one or a few adjacent sulci and has diverse etiologies and symptoms. Acute ischemic stroke co-occurring with cSAH has been infrequently reported. Nearly all cases of cSAH have been described to occur on the side with acute ischemic stroke, and it is unusual for cSAH to occur on the opposite side of the infarct territory.
Case presentation
Our report presents two cases of acute ischemic stroke associated with contralateral cSAH. The first patient had left atherosclerotic internal carotid artery (ICA) occlusion with developing right parietal cSAH. The other patient developed left parietal cSAH in the setting of right ICA occlusion caused by cardiogenic embolism with acute right cerebral hemisphere infarction. Both patients remained clinically stable with good prognosis after antithrombotic treatment.
Conclusions
Our report suggest that cSAH may simultaneously occur on the opposite side of an infarction. Although there is no consensus on the etiology and treatment of this rare phenomenon, cSAH did not lead to a poor outcome in our patients.
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