From asymptomatic to critical illness - different clinical manifestations of COVID-19 in children

Abstract

The global pandemic infectious disease that was named the new coronavirus disease (COVID 19), spread throughout the world, causing a major public health emergency. The causative virus of COVID-19, called SARS CoV-2, can infect all age groups. Various clinical signs and symptoms have been observed in neonates, children, and adolescents during the COVID-19 outbreak. The clinical manifestations of COVID-19 might be different due to the medical conditions and comorbid status in elderly and pediatric patients. The rise in cases among children has been reported during the COVID-19 pandemic. Although infected children generally appear to be asymptomatic or have only mild symptoms, COVID-19 in children may also involve a wide spectrum of clinical manifestations ranging from asymptomatic carriers to life-threatening and fatal diseases, as COVID-19 is a systemic disease that can affect multiple organs. Due to the lack of knowledge in the current literature, it is necessary to describe the atypical clinical features, including extrapulmonary manifestations, in pediatric patients with COVID-19. This review is conducted to identify knowledge gaps regarding the broad spectrum of clinical signs and symptoms of children with COVID-19.

Update on COVID-19 in Children

“…Children between the ages of 10 and 19 years are more likely to have symptoms similar to COVID-19 in adults, including headache (42%), cough (41%), fever (35%), myalgia (30%), sore throat (29%), and shortness of breath (16%) (6). Although fever and cough are the most commonly reported symptoms in children with COVID-19, other lower respiratory tract diseases, such as pneumonia and bronchiolitis, are also observed (3).…”

“…Numerous pediatric investigations have described the multiple unusual clinical manifestations of children with COVID-19 during the pandemic. Although pediatric age groups have also reported fatal cases, the illness appears to affect children less severely than it affects adults (3). Asymptomatic, mild, or moderate disease is present in approximately 90% of pediatric patients.…”

“…Additionally, 6.7% of cases may be severe. Generally, the disease has a severe course in patients younger than 1 year and with underlying disease (3).…”

Long-Term Clinical Consequences of Patients Hospitalized for COVID-19 Infection

“…Coronavirus disease 2019 (COVID-19), putatively caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often involves injury to multiple organs (e.g., lung and heart). 1 - 4 The general signs and symptoms of COVID-19 include fever, cough, shortness of breath, headache, palpitation, chest discomfort, loss of smell, and gastrointestinal system impairment. Nearly one-fourth of individuals hospitalized with COVID-19 have been diagnosed with cardiovascular complications, which have been reported to contribute to approximately 40% of all COVID-19-related deaths.…”

Investigation of severe acute respiratory syndrome coronavirus 2 antibodies among the paediatric population in Mogadishu, Somalia

“…1 Despite reports indicating a lower number of cases among the paediatric population, recent studies have shown a rise in the number of children with coronavirus disease 2019 (COVID-19) and some cases with fatal outcomes. 2 , 3 Large epidemiological studies suggest that children comprise only 1% to 2% of all SARS-CoV-2 cases. 4 The spectrum of COVID-19 among the paediatric age group ranges from an asymptomatic state devoid of any clinical signs, a carrier state that is characterised by mild symptoms that tend to have a fast recovery to a more severe life-threatening condition that clinically manifests with pulmonary, ophthalmological, neurological, renal, cardiovascular and gastrointestinal signs.…”