Clinical and Immune Features of Hospitalized Pediatric Patients With Coronavirus Disease 2019 (COVID-19) in Wuhan, China

Abstract

IMPORTANCE The epidemiologic and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19) have been reported, but information on immune features associated with disease severity is scarce. OBJECTIVE To delineate and compare the immunologic features of mild and moderate COVID-19 in pediatric patients. DESIGN, SETTING, AND PARTICIPANTS This single-center case series included 157 pediatric patients admitted to Wuhan Children's Hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were collected from January 25 to April 18, 2020. EXPOSURES Documented SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES Clinical and immunologic characteristics were collected and analyzed. Outcomes were observed until April 18, 2020. RESULTS Of the 157 pediatric patients with COVID-19, 60 (38.2%) had mild clinical type with pneumonia, 88 (56.1%) had moderate cases, 6 (3.8%) had severe cases, and 3 (1.9%) were critically ill. The 148 children with mild or moderate disease had a median (interquartile range [IQR]) age of 84 (18-123) months, and 88 (59.5%) were girls. The most common laboratory abnormalities were increased levels of alanine aminotransferase (ALT) (median [IQR], 16.0 [12.0-26.0] U/L), aspartate aminotransferase (AST) (median [IQR], 30.0 [23.0-41.8] U/L), creatine kinase MB (CK-MB) activity (median [IQR], 24.0 [18.0-34.0] U/L), and lactate dehydrogenase (LDH) (median [IQR], 243.0 [203.0-297.0] U/L), which are associated with liver and myocardial injury. Compared with mild cases, levels of inflammatory cytokines including interleukin 6, tumor necrosis factor α, and interferon γ were unchanged, whereas the level of immune suppressive interleukin 10 was markedly increased in moderate cases compared with mild cases (median [IQR], 3.96 [3.34-5.29] pg/mL vs 3.58 [3.10- 4.36] pg/mL; P = .048). There was no statistically significant difference in absolute number of lymphocytes (including T cells and B cells) between mild and moderate cases, but moderate cases were associated with a decrease in neutrophil levels compared with mild cases (median [IQR],

COVID-19-associated gastrointestinal and liver injury: clinical features and potential mechanisms

“…(%) Abnormal TBil, no. (%) COVID-19 Wang et al 5 China 105 40 (38.1%) 33 (31.4%) 24 (22.9%) Guan et al 4 China 1099 158 (21.3%) a 168 (22.2%) b 76 (10.5%) c Yang et al 17 China 149 18 (12.1%) 27 (18.1%) 4 (2.7%) Fan et al 58 China 148 27 (18.2%) 32 (21.6%) 9 (6.1%) Chen et al 59 China 99 28 (28.3%) 35 (35.4%) 18 (18.2%) Zhang et al 60 China 82 22 (30.6%) d 44 (61.1%) d 22 (30.6%) d Huang et al 61 China 36 4 (13%) 18 (58.1%) 4 (12.9%) Richardson et al 57 USA 5700 2176 (39.0%) 3263 (58.4%) NA Wu et al 62 China 157 12 (7.6%) 25 (16.9%) NA SARS Cui et al 63 China 182 128 (70.3%) 57 (31.3%) NA Duan et al 64 China 154 41 (26.6%) 4 (2.6%) 13 (8.4%) Zhang et al 65 China 128 …”

Immune responses during COVID-19 infection

“…In cases of severe SARS-CoV-2 infection, significant B cell lymphopenia was unevently observed. 96,133,134 Mathew et al identified a subgroup of severe hospitalized patients with a immunotype characterized by T cell activation and plasmablast responses >30% of circulating B cells. 118 Critically ill patients with COVID-19 accumulated cells exoding from germinal centers, produced of a considerable number of antibodies secreting cells and lose unique transitional B cell populations that correlated with good prognosis.…”

“…In cases of severe SARS-CoV-2 infection, significant B cell lymphopenia was unevently observed. 96 , 133 , 134 Mathew et al . identified a subgroup of severe hospitalized patients with a immunotype characterized by T cell activation and plasmablast responses >30% of circulating B cells.…”

Effect of COVID-19 in Paediatric Population: Review of Recent Studies

“…There were no deaths and all 148 patients were discharged. 21 Dermatology Doctors have identified a new symptoms in COVID-19 patients, informally dubbed as "COVID TOES". Purple or blue lesions were noticed on patient's feet and toes.…”