Children Hospitalized With Severe Acute Respiratory Syndrome-Related Illness in Toronto

Abstract

ABSTRACT.Objective. An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS.Methods. A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations.Results. Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children.Conclusions. Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children. Pediatrics 2003;112:e261-e268. URL: http: //www.pediatrics.org/cgi/content/full/112/4/e261; severe acute respiratory syndrome, reverse-transcriptase polymerase chain reaction, probable SARS, suspect SARS.

Severe Acute Respiratory Syndrome Among Children

“…6,8,[13][14][15] In pediatric series, including the present cohort, cough is a presenting feature for 43% to 91% of children and shortness of breath for 9% to 40%. [2][3][4] The WHO case definitions would have excluded 34% of the children with laboratory-confirmed SARS in the present cohort, which is the largest single-center, pediatric case series reported to date. The lack of sensitivity of the WHO case definitions for both adult and pediatric patients is disturbing, with respect to the effects on case management at the point of care.…”

“…The lack of sensitivity of the WHO case definitions for both adult and pediatric patients is disturbing, with respect to the effects on case management at the point of care. 4,16 Physical examination findings may not be contributory in the differential diagnosis of SARS, and radiographic findings are also not diagnostic. However, despite normal or equivocal CXR findings, HRCT for demonstration of early focal consolidation should be considered if SARS is suspected.…”

“…Definitive virologic data, prognostic indicators, and short-term to medium-term follow-up information were lacking in those preliminary reports. [2][3][4] We prospectively monitored a cohort of 44 children with laboratory confirmation of SARS who were treated at a referral center for pediatric infectious diseases that admitted the largest number of pediatric patients with SARS in Hong Kong. Their epidemiologic links; clinical, laboratory, and radiologic features; and outcomes 3 to 6 months after disease onset are reported.…”

Inflammatory Cytokine Profile in Children With Severe Acute Respiratory Syndrome

“…It is interesting that corticosteroids were not used in Canada, and all children recovered with supportive treatment. 19 Corticosteroids should probably be reserved for patients with severe disease, in particular, those who require oxygen supplementation and mechanical ventilatory support.…”

Lessons Learned for Pediatric Pandemic Planning in Palliative Care: A Case Study

“…Fortunately however, there were relatively few reported cases of SARS and no reported fatalities among children (0-18 years). The literature suggests that SARS was milder in children, with older adolescents presenting symptoms similar to those observed in adults [1,[3][4][5][6].…”