Atypical presentation of COVID-19 in young infants

Nathan, Nadia; Prévost, Bertrand; Corvol, Harriet

doi:10.1016/s0140-6736(20)30980-6

Cited by 84 publications

(87 citation statements)

References 4 publications

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“…They were mainly hospitalized because of their young age (most of them were under 3 months) and poorly tolerated fever. Their respiratory symptoms were mild and the evolution was rapidly favorable, as we previously described [ 18 ]. None of them required ICU management or prolonged hospitalization (median length: 3 days, extremes 1–7).…”

Section: Discussionmentioning

confidence: 86%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.

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Section: Discussionmentioning

confidence: 86%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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“…Our systematic review showed that the most common presenting symptoms in infants with COVID‐19 were fever and cough. However, some infants only had fever, unlike the usual combination of fever and cough in older children and adolescents 5 . Other less common symptoms included upper respiratory tract symptoms and gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 97%

“…In addition, young children have tended to develop milder diseases than adults 4 and mortality is rare 3 . Infants are a particularly vulnerable group, they are more likely to suffer critical illness, 4 and they are also more likely to have atypical presentations than older children 5 . As we have scarce information on the symptoms, diagnosis, treatment and outcomes of COVID‐19 in the paediatric population, we conducted this systematic review to collect comprehensive clinical data of neonates and infants with confirmed COVID‐19.…”

Section: Introductionmentioning

confidence: 99%

Novel coronavirus infection (COVID‐19) in children younger than one year: A systematic review of symptoms, management and outcomes

et al. 2020

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Aim The aim of this systematic review was to evaluate the clinical characteristics of COVID‐19 in neonates and children under one year of age. Methods A systematic literature review of the MEDLINE, PubMed, CINAHL, Embase and EBSCO databases was carried out for studies from January 1, 2020, to April 7, 2020. We included all papers that addressed clinical manifestations, laboratory results, imaging findings and outcomes in infants and neonates. Results Our search identified 77 peer‐reviewed papers, and 18 papers covering 160 infants were reviewed. One paper was from Vietnam, and the other 17 were from China: eight were cross‐sectional studies, eight were case reports, one was a case series, and one was a prospective cohort study. The most common clinical symptoms were fever (54%) and cough (33%). Most infants were treated symptomatically, with frequent use of various empirical medications. Infants and neonates tended to have more severe COVID‐19 disease than older children: 11 (7%) were admitted to intensive care and one infant died. The mortality rate was 0.006%, with favourable outcomes in most cases. Conclusion Infants and neonates were more vulnerable to more severe COVID‐19 disease than older children, but morbidity and mortality were low.

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“…The asymptomatic infections are the most insidious and leaky source of infection [26]; thus, the capability to identify these should be improved for such a virulent pathogen that enjoys routes of easy transmission. With less virulence discharge and no clinical symptoms, asymptomatic infections cannot be identi ed spontaneously, thereby rendering it necessary to improve the detection capability (with quantitative uorescence PCR method, trace sequencing method, serum antibody testing method, and multi-method joint diagnosis method) to recognize the asymptomatic infections, which is crucial for controlling the outbreak of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Asymptomatic Infection of COVID-19 Risen in Imported Population in Shenzhen, China

Chen¹,

Ai²,

Huang

et al. 2020

Preprint

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Background As of July 24 2020, the global reported number of COVID-19 cases was > 15.4 millions, with over 640,000 deaths. The present study aimed to carry out an epidemiological analysis of confirmed cases and asymptomatic infections in Shenzhen City to provide scientific reference for the prevention and control of COVID-19. Methods The epidemiological information of the 462 confirmed cases and 45 asymptomatic infections from January 19th to June 30th was collected in Shenzhen City, Southern China, and a descriptive analysis was performed. Results A total of 462 confirmed COVID-19 cases from January 19 to April 30, 2020 were reported in Shenzhen City, including 423 domestic cases (91.56%) and 39 imported cases (8.44%) who came back from other countries. Among domestic cases, the majority were cases imported from Hubei Province (n = 312, 67.53%), followed by local ones (n = 69, 14.94%). During the same period, a total of 45 asymptomatic infections were reported in Shenzhen City, including 31 local ones (68.89%) and 14 imported from abroad (31.11%). The proportion of asymptomatic infections in Shenzhen City was increasing over time (Z = 13.1888, P < 0.0001). The total number of local asymptomatic infections in Shenzhen City exceeded as the same pattern as that in other provinces (χ2 = 118.830, P < 0.0001). The proportion of asymptomatic infections among cases imported from abroad was higher than that of the same in domestic cases (χ2 = 22.5121, P < 0.0001, OR = 4.8983, 95%: 2.4052, 9.9756). No statistical significance was noted in the proportions of asymptomatic infections among imported cases from different countries (χ2 = 7.7202, P = 0.6561). Conclusions The majority of COVID-19 cases in Shenzhen City were imported cases who came back from Hubei Province in the early stage (before 1st March, 2020) and from abroad in the later stage (after 1st April, 2020). Scientific and effective prevention and control measures have resulted in only a few local infections in Shenzhen City. Asymptomatic infections accounted for an increasing proportion among cases imported from abroad, indicating that the prevention measures carried out in Shenzhen City did avoid the import of infected cases. Improving the detection capability to identify asymptomatic infections as early as possible will be of significance for the control outbreak of COVID-19.

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Atypical presentation of COVID-19 in young infants

Cited by 84 publications

References 4 publications

The Wide Spectrum of COVID-19 Clinical Presentation in Children

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Novel coronavirus infection (COVID‐19) in children younger than one year: A systematic review of symptoms, management and outcomes

The Asymptomatic Infection of COVID-19 Risen in Imported Population in Shenzhen, China

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