Clinical features, laboratory findings and persistence of virus in 10 children with coronavirus disease 2019 (COVID-19)

Hong, Jiang; Cheng, Hao‐Tsai; Cao, Qing; Fei, Anxing; Yuan, Man; Zhang, Lixia; Fei, Shinuan; Li, Jun; Yang, Shixiong; Wu, Jiang; Fu, Qin; Li, Sheng; Zhang, Xiaoqing

doi:10.1016/j.bj.2020.10.007

Cited by 9 publications

(6 citation statements)

References 31 publications

(29 reference statements)

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“…These studies included a total of 104,058 laboratory-confirmed COVID-19 cases, of which 25,050 exhibited no symptoms at the time of testing and 7,220 remained asymptomatic. We identified 170 studies that reported asymptomatic infections ( 11 – 13 , 17 – 183 ), 332 studies that reported silent infections at the time of testing ( 10 – 12 , 14 , 17 – 20 , 23 – 27 , 31 , 32 , 35 – 40 , 42 – 44 , 46 , 47 , 49 , 50 , 52 , 53 , 56 – 58 , 60 – 66 , 68 , 69 , 73 – 75 , 77 – 79 , 81 , 84 , 87 , 90 – 94 , 97 , 99 , 101 , 103 , 104 , 106 , 111 , 113 – 116 , 118 , 119 , 121 – 123 , 125 , 127 , 128 , …”

Section: Resultsmentioning

confidence: 99%

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Sah

Fitzpatrick

Zimmer

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

408

351

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Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.

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Section: Resultsmentioning

confidence: 99%

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Sah

Fitzpatrick

Zimmer

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

408

351

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“…This review included 81 articles published in English that in total included 3,557 pediatric patients. Of these, 2 were from the USA (46,86), was from Kore (58), 1 was worldwide ( 70 (46,47,75,81,82,90,104,108), 2 letters (77,79), 1 brief report (36), 2 case-control study (49,101), 2 cohort studies (66,70), 1 observational (84) and 5 observational cohort study (80,93,99,100,113) and the remained articles were descriptive studies. A total of 84 variables were extracted for this review.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Computed tomography findings in 3,557 COVID-19 infected children: a systematic review

Ebrahimpour¹,

Marashi²,

Zamanian³

et al. 2021

Quant Imaging Med Surg

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Background: Although it was assumed in the early stages of the coronavirus disease 2019 outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies.Methods: A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients Results: This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively.Discussion: This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.

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“…Our observations corroborate those of previous studies. For example, Jian et al observed comparable elevated levels of LDH in pediatric patients, which they thought to be a possible sign of COVID-19 [ 17 ]. Similarly, Du et al observed that the value and positive rate of LDH were significantly greater in children than in adults in a study of 67 adult and pediatric COVID-19 patients [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lactate dehydrogenase (LDH) was recently identified as one of the most common biochemical parameters in COVID-19-infected children. It was deemed a prospective predictor of serum biochemical changes in the bodies of COVID-19-infected children [ 17 ]. LDH was found to be significantly high in two recent studies, where they compared the biochemical parameter with that of CT and chest radiographs in COVID-19 in children [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Serum LDH: a potential surrogate to chest radiograph in pediatric Covid-19 patients to reduce radiation exposure

Das

Alkoteesh

AlBastaki

et al. 2022

Egypt J Radiol Nucl Med

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Background Chest radiographs are frequently used to evaluate pediatric patients with COVID-19 infection during the current pandemic. Despite the minimal radiation dose associated with chest radiography, children are far more sensitive to ionizing radiation's carcinogenic effects than adults. This study aimed to examine whether serum biochemical markers could be potentially used as a surrogate for imaging findings to reduce radiation exposure. Methods The retrospective posthoc analysis of 187 pediatric patients who underwent initial chest radiographs and serum biochemical parameters on the first day of emergency department admission. The cohort was separated into two groups according to whether or not the initial chest radiograph revealed evidence of pneumonia. Spearman's rank correlation was used to connect serum biochemical markers with observations on chest radiographs. The Student's t-test was employed for normally distributed data, and for non-normally distributed data, the Mann–Whitney U test was used. A simple binary logistic regression was used to determine the importance of LDH in predicting chest radiographs. The discriminating ability of LDH in predicting chest radiographs was determined using receiver operating characteristics (ROC) analysis. The cut-off value was determined using Youden's test. Interobserver agreement was quantified using the Cohen k coefficient. Results 187 chest radiographs from 187 individual pediatric patients (95 boys and 92 girls; mean age ± SD, 10.1 ± 6.0 years; range, nine months–18 years) were evaluated. The first group has 103 patients who did not have pneumonia on chest radiographs, while the second group contains 84 patients who had evidence of pneumonia on chest radiographs. GGO, GGO with consolidation, consolidation, and peri-bronchial thickening were deemed radiographic evidence of pneumonia in group 2 patients. Individuals in group 2 with radiological indications of pneumonia had significantly higher LDH levels (p = 0.001) than patients in group 1. The Spearman's rank correlation coefficient between LDH and chest radiography score is 0.425, showing a significant link. With a p-value of < 0.001, the simple binary logistic regression analysis result validated the relevance of LDH in predicting chest radiography. An abnormal chest radiograph was related to LDH > 200.50 U/L (AUC = 0.75), according to the ROC method. Interobserver agreement between the two reviewers was almost perfect for chest radiography results in both groups (k = 0.96, p = 0.001). Conclusion This study results show that, compared to other biochemical indicators, LDH has an 80.6% sensitivity and a 62% specificity for predicting abnormal chest radiographs in a pediatric patient with confirmed COVID-19 infection. It also emphasizes that biochemical measures, rather than chest radiological imaging, can detect the pathogenic response to COVID-19 infection in the chest earlier. As a result, we hypothesized LDH levels might be potentially used instead of chest radiography in children with COVID-19, reducing radiation exposure.

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Clinical features, laboratory findings and persistence of virus in 10 children with coronavirus disease 2019 (COVID-19)

Cited by 9 publications

References 31 publications

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Computed tomography findings in 3,557 COVID-19 infected children: a systematic review

Serum LDH: a potential surrogate to chest radiograph in pediatric Covid-19 patients to reduce radiation exposure

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