A Case of Critically Ill Infant of Coronavirus Disease 2019 With Persistent Reduction of T Lymphocytes

Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) is becoming a global threat. However, our understanding of the clinical characteristics and treatment of critically ill pediatric patients and their ability of transmitting the coronavirus that causes COVID-19 still remains inadequate because only a handful pediatric cases of COVID-19 have been reported. Methods: Epidemiology, clinical characteristics, treatment, laboratory data and follow-up information and the treatment of critically ill infant were recorded. Results: The infant had life-threatening clinical features including high fever, septic shock, recurrent apnea, petechiae and acute kidney injury and persistent declined CD3+, CD4+ and CD8+ T cells. The duration of nasopharyngeal virus shedding lasted for 49 days even with the administration of lopinavir/ritonavir for 8 days. The CD3+, CD4+ and CD8+ T cells was partially recovered 68 days post onset of the disease. Accumulating of effector memory CD4+ T cells (CD4+TEM) was observed among T-cell compartment. The nucleic acid tests and serum antibody for the severe acute respiratory syndrome coronavirus 2 of the infant’s mother who kept intimate contact with the infant were negative despite no strict personal protection. Conclusions: The persistent reduction of CD4+ and CD8+ T cells was the typical feature of critically ill infant with COVID-19. CD4+ and CD8+ T cells might play a key role in aggravating COVID-19 and predicts a more critical course in children. The prolonged nasopharyngeal virus shedding was related with the severity of respiratory injury. The transmission of SARS-CoV-2 from infant (even very critical cases) to adult might be unlikely.

Recommendations for the Diagnosis, Prevention, and Control of Coronavirus Disease-19 in Children—The Chinese Perspectives

“…One 3-month-old infant with mild COVID-19 had NAAT negativity by DPO26. The critical COVID-19 8-month-old infant had NAAT negativity of rectal swab on DPO31 and of nasopharyngeal swab on DPO-37, which became positive on DPO38 and eventually negative only by DPO49 (54).…”

“…He presented with cough for 6 days then dyspnea for 1 day. He was mechanically ventilated upon admission and successfully extubated 13 days later and eventually discharged 45 days after admission (54). The third case had acute leukemia on maintenance chemotherapy and recovered after supported by mechanical ventilation.…”

“…During therapy, serum triglyceride, total cholesterol, and lactate levels were normal, whereas significantly decreased WBC count and transient thrombocytopenia were observed 3 days after starting LPV/RTV treatment. The leukocytopenia was corrected after a dose of granulocyte-macrophage colony-stimulating factor (GM-CSF) ( 54 ).…”

COVID-19 Associated With Life-Threatening Apnea in an Infant Born Preterm: A Case Report

“…To our best knowledge, very few articles have mentioned apneas associated with COVID-19 in children (22)(23)(24). The other symptoms presented by this child: dry cough, moderate rhinitis, fatigue, although non-specific, are commonly reported in the literature for COVID-19 infections (25).…”

COVID-19: A scoping review

“…Manifestations of SARS-CoV-2 are milder in children compared with adults [20][21][22]. Although most infected individuals are asymptomatic, some children do require hospitalization and intensive care due to respiratory syndrome caused by SARS-CoV-2 [23][24][25][26]. Recent reports from Europe and North America have described clusters of children and adolescents requiring admission to intensive care units with a multisystem in ammatory condition with symptoms like Kawasaki disease and toxic shock syndrome [27,28].…”