Clinical and CT Imaging Features of the COVID-19 Pneumonia: Focus on Pregnant Women and Children

Abstract

s u m m a r yBackground: The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported. Methods: Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared. Findings: Compared with the non-pregnant adults group ( n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed ( n = 16) and clinically-diagnosed ( n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults ( P = 0 ·007, P < 0 ·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults ( P = 0 ·001, P < 0 ·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twentythree patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans. Interpretation: Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.

Clinical Manifestations of Children with COVID-19: a Systematic Review

“…11,16,35,37,[39][40][41]45,[23][24][25]27,29,[31][32][33] Elevated C-reactive protein (CRP) levels were described in 59 of 305 cases (19.3%), reported in 25 studies. 3,11,26,27,29,[31][32][33][34][35][36][37]13,[39][40][41][42]45,16,[19][20][21][22][23][24] Co-infections with other pathogens were reported in 5 studies. 12,13,16,19,34 Two patients were reported with influenza A, 5 with influenza B, 3 with respiratory syncytial virus (RSV), 1 with cytomegalovirus, 7 with Mycoplasma pneumoniae and 1 with Enterobacter aerogenes.…”

“…Twenty-seven studies reported 184 cases which underwent chest CT. 3,11,[21][22][23][24][25][26][27]29,30,32,12,[34][35][36][39][40][41][42]13,14,[16][17][18][19][20] One hundred sixteen (63.0%) CT scans presented abnormalities. The most prevalent abnormalities reported were ground glass opacities, patchy shadows and consolidations.…”

“…,13,24-33,14,[34][35][36][37][38][39][40][41][42][43]16,45,[17][18][19][21][22][23] Of these, 13 (7.5%) were elevated, 29 (16.6%) were decreased, and 132 (75.8%) were within normal ranges. Normal or elevated lymphocytes count were detailed in 28 studies, involving 154 cases 11,13,…”

“…Normal or elevated lymphocytes count were detailed in 28 studies, involving 154 cases 11,13,16,[36][37][38][39][40][41][42][43]45,17,19,[21][22][23][24][25] Normal lymphocyte count were reported in 69.5% and elevated in 11.7% of cases. Reduced lymphocyte count were reported in 45 of 350 (12.9%) cases.3,11,24-33,12,34-43,13,45,16,17,19,21- 23 .…”

Effects of COVID-19 infection during pregnancy and neonatal prognosis: what is the evidence?

“…All the analytical cross-sectional studies (25%) [21,22,23] were conducted in China and in total addressed 72 (60.5%) pregnant women infected with COVID-19, 50 (69.4%) of whom were in the third trimester of pregnancy.…”