Features of clinical picture of pneumonia caused by SARS-COV-2 virus in children

Aim. To study the features of the clinical manifestations of pneumonia that developed in children with COVID-19. Materials and methods. The data of the case histories of 36 children aged from 8 months to 17 years, who were hospitalized in the children’s infectious diseases department of the Mytishchi City Clinical Hospital, were analyzed for confirmed pneumonia with the release of the SARS-CoV-2 virus. On the first day of hospitalization, all children underwent examination: clinical examination, pulse oximetry, general clinical blood and urine tests; X-ray examination or computed tomography of the chest organs, biochemical blood test; coagulogram; analysis of a swab from the nasopharynx and pharynx for SARS-CoV-2 virus RNA by polymerase chain reaction. Repeated laboratory and instrumental studies were carried out after 5–7 days or more often if necessary. All patients received therapy in accordance with the current interim guidelines for the prevention, diagnosis and treatment of new coronavirus infection COVID-19. Results. Most (97 %) patients had moderate severity, 3 % were mild. The main clinical symptoms were severe intoxication, a rare dry cough, an increase in body temperature to subfebrile numbers, and harsh breathing. In 36 % of the patient, shortness of breath was revealed with anxiety or physical exertion. Dry rales were also heard in 36 %, more often in the lower sections. By localization, right-sided (78 %) upper lobe (58 %) pneumonia prevailed. In 64 % of children there were dysfunctions of the gastrointestinal tract of various origins, in 17 % was exanthema. Conclusions. In children with pneumonia caused by SARS-CoV-2, as a rule, intoxication syndrome predominates, typical auscultatory symptoms are absent, diarrhea is often noted, sometimes exanthema, enanthema, rhinopharyngitis. According to laboratory studies, lymphopenia with a normal level of leukocytes, an increase in C-reactive protein are more often detected; indicators of biochemical blood analysis and general urine analysis remain unchanged.

COVID-19, SARS-CoV-2, viral pneumonia, coronavirus, pneumonia, diarrhea, rash, urticaria

1. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020 Mar 18. DOI: 10.1056/NEJMc2005073.

2. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; S 1473–3099 (20) 30198–5. DOI: 10.1016/S1473–3099(20)30198–5.

3. Wang Y, Liu Y, Liu L, et al. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China. J Infect Dis 2020.

4. Хавкина Д. А., Руженцова Т. А., Чухляев П. В., Гарбузов А. А., Шушакова Е. К. Роль дезинтоксикационной и антиоксидантной терапии в лечении СOVID-19: теория и практика. Эпидемиология и инфекционные болезни: актуальные вопросы. 2020; 2 (10): 62–69. DOI: 10.18565/epidem.2020.2.62–69.

5. Recalcati S. Cutaneous manifestations in COVID 19: a first perspective. J Eur Acad Dermatol Venereol, 2020; 34: e212–e213. DOI: 10.1111/jdv.16387.

6. Tang K, Wang Y, Zhang H, Zheng Q, Fang R, Sun Q. Cutaneous manifestations of the Coronavirus Disease 2019 (COVID-19): A brief review [published online ahead of print, 2020 May 7]. Dermatol Ther. 2020; e13528. DOI: 10.1111/dth.13528.

7. Taylor S, Lopez P, Weckx L, Borja-Tabora C, Ulloa-Gutierrez R, Lazcano-Ponce E, et al. Respiratory viruses and influenza-like illness: epidemiology and outcomes in children aged 6 months to 10 years in a multi-country population sample. J Infect. 2017 Jan; 74 (1): 29–41. DOI: 10.1016/j.jinf.2016.09.003.

8. C. Galván Casas, A. Català, G. Carretero Hernández, P. Rodríguez-Jiménez, D. Fernández Nieto, A. Rodríguez-Villa Lario, I. Navarro Fernández, R. Ruiz-Villaverde, D. Falkenhain, M. Llamas Velasco, J. García-Gavín, O. Baniandrés, C. GonzálezCruz, V. Morillas-Lahuerta, X. Cubiró, I. Figueras Nart, G. Selda-Enriquez, J. Romaní, X. Fustà-Novell, A. Melian-Olivera, M. Roncero Riesco, P. Burgos-Blasco, J. Sola Ortigosa, M. Feito Rodriguez, I. García-Doval. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology 2020 https://doi.org/10.1111/bjd.19163.

9. Wei-jie Guan et all. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708–1720. DOI: 10.1056/NEJMoa2002032.

10. Попова Р. В., Руженцова Т. А., Хавкина Д. А., Чухляев П. В., Гарбузов А. А., Мешкова Н. А. Нарушения функции желудочно-кишечного тракта при COVID-19 у детей. Проблемы особо опасных инфекций. 2020; 3: 154–157. DOI: 10.21055/0370–1069–2020–3–154–157.