COVID-19 in a child with down syndrome and extensive pulmonary tuberculosis: a case report

Stefanuto, Pedro Pollini Gonçalves; Fernandes, Carla Jéssica da Silva; Cruz, Camilla Gomes da; Leite, Raquel Crosara Maia; Tavares, Lohanna Valeska de Sousa

doi:10.1590/1806-9304202100s200013

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…The mean age of the patients was 24.8 years (26 days to 60 years), and 29 of the 55 patients were male (Supporting Information S1: Table ) 13–28 . Comorbid conditions were described for 51 cases.…”

Section: Resultsmentioning

confidence: 99%

“…The mean age of the patients was 24.8 years (26 days to 60 years), and 29 of the 55 patients were male (Supporting Information S1: Table 1 ). 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Comorbid conditions were described for 51 cases. Obesity was the most common comorbid condition reported (49.0%, 25) followed by hypothyroidism (21.6%, 11) (Figure 1 , Supporting Information S1: Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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COVID‐19 in patients with Down syndrome: A systematic review

Pitchan Velammal,

Balasubramanian,

Ayoobkhan

et al. 2024

Immunity Inflam & Disease

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IntroductionDown syndrome (DS) is associated with multiple comorbid conditions and chronic immune dysfunction. Persons with DS who contract COVID‐19 are at high risk for complications and have a poor prognosis. We aimed to study the clinical symptoms, laboratory and biochemical profiles, radiologic findings, treatment, and outcomes of patients with DS and COVID‐19.MethodWe systematically searched PubMed, MEDLINE, Web of Science, Scopus, and the Cochrane Library using the keywords COVID‐19 or coronavirus or SARS‐CoV‐2 and DS or trisomy 21. Seventeen articles were identified: eight case reports and nine case series published from December 2019 through March 2022, with a total of 55 cases.ResultsPatients averaged 24.8 years (26 days to 60 years); 29 of the patients were male. The most common symptoms were fever, dyspnea, and cough. Gastrointestinal and upper respiratory tract symptoms were commonly reported for pediatric patients. The most common comorbidities present in patients with DS were obesity (49.0%), hypothyroidism (21.6%) and obstructive sleep apnea (15.6%). The patients were hospitalized for a mean of 14.8 days. When the patients were compared with the general COVID‐19 population, the mean number of hospitalized days was higher. Most patients had leukopenia, lymphopenia, and elevated inflammatory markers (d‐dimer and C‐reactive protein). Bilateral infiltrations and bilateral ground‐glass opacifications were frequently seen in chest radiographs and chest computed tomographic imaging. Most of the patients were treated with methylprednisolone, macrolides, and hydroxychloroquine. Of the 55 patients, 22 died. The mean age of the patients who died was 42.8 years. Mortality rate was higher in individuals with DS over 40 years of age.ConclusionMore studies are needed to better understand COVID‐19 infections among persons with DS. In addition, the study was limited by a lack of statistical analyses and a specific comparison group.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

COVID‐19 in patients with Down syndrome: A systematic review

Pitchan Velammal,

Balasubramanian,

Ayoobkhan

et al. 2024

Immunity Inflam & Disease

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“…Data collected from adults suggest that people with latent or active TB are more susceptible to novel coronavirus [7]. Recently, a case of pediatric COVID-TB has been described in a patient with Down syndrome [21]; the severity of the clinical course, in this case, could be suggested by factors related to proinflammatory cytokines rather than expression levels of angiotensin-converting enzyme (ACE) 2 as in adults. Our patients showed no evidence of immune deficiency (Table 1); in particular, they had a normal distribution of lymphocyte subpopulations and a normal CD4/CD8 ratio.…”

Section: Discussionmentioning

confidence: 96%

Pediatric COVID-TB: A Clinical Perspective Based on the Analysis of Three Cases

et al. 2023

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Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are currently two major causes of death among infectious diseases. Active tuberculosis and a history of tuberculosis appear to be associated with an increased risk of COVID-19. This coinfection, named COVID-TB, was never described in previously healthy children. We report three cases of pediatric COVID-TB. We describe three girls affected by tuberculosis, who tested positive for SARS-CoV-2. The first patient is a 5-year-old girl who was hospitalized for recurrent TB lymphadenopathy. As she never had any complications related to the concomitant infection with SARS-CoV-2, she received TB treatment. The second case is a 13-year-old patient with a history of pulmonary and splenic tuberculosis. She was admitted to the hospital due to deteriorating respiratory dynamics. She was already undergoing treatment for TB, but in the absence of improvement, she also required treatment for COVID-19. Slowly, the general condition improved until discharge. The last patient, a 10-year-old girl, was hospitalized for supraclavicular swelling. The investigations showed disseminated TB characterized by lung and bone involvement without COVID-19-related complications. She was treated with antitubercular and supportive therapy. Based on the data obtained from the adult population and our small experience, a pediatric patient with COVID-TB infection should be considered potentially at risk of worse clinical outcomes; for this reason, we suggest close observation, careful clinical management, and consideration of targeted anti-SARS-CoV-2 therapies.

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“…Heart defects were recurrent in DS individuals with COVID-19, mainly in the pediatric age group. [20][21][22][23][24][26][27][28][29]35,36,[40][41][42][43][44][45] Children with DS seem more likely to be exposed to severe COVID-19 than those without DS. 46 Simpson et al 24 presented a case series of seven children, three infection.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the same group developed protocols for healthcare professionals, with guidance on testing and managing COVID-19 in individuals with trisomy 21 8. One study described SARS-CoV-2 and tuberculosis coinfections,23 in which the latter was diagnosed during hospitalization despite the individual having classic symptoms and having been in contact with a sibling already treated for tuberculosis. Furthermore, bacterial coinfections were prevalent complications in individuals with DS and COVID-19 and were described as the leading cause of death 21,28,35,38,51,52.…”

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confidence: 99%

Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review

Silva,

Pereira,

Avó

et al. 2024

Sao Paulo Med. J.

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BACKGROUND: Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE: To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING: This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS: This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS: A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION: Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION: The Open Science Framework registered the research protocol (https://osf.io/jyb97/).

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COVID-19 in a child with down syndrome and extensive pulmonary tuberculosis: a case report

Cited by 5 publications

References 8 publications

COVID‐19 in patients with Down syndrome: A systematic review

COVID‐19 in patients with Down syndrome: A systematic review

Pediatric COVID-TB: A Clinical Perspective Based on the Analysis of Three Cases

Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review

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