• Linda Von Zeuner

How COVID-19 infection differs in children versus adults


Paediatric cases of COVID-19 infection are typically mild and underlying coinfection may be more common in children according to a recent study of paediatric inpatients in Wuhan, China.


The most common symptoms in the children in the study sample (which was quite small-20 kids) were fever and coughing. Coinfection was detected in 40% of the cases (8 patients). Clinical manifestations were similar to those seen in adults but symptoms were mild and prognosis was good, even though children with underlying congenital or acquired conditions were more prone to severe infection.

Laboratory findings further suggested that 80% of the children had a raised Procalcitonin which is a marker for bacterial infection, suggesting bacterial coinfection and a greater need for antibiotics than the case in adults.

CT chest findings were similar in children than adults.


In this study sample of 20 patients, 18 were discharged after an average stay of 13 days and 2 neonates remained under observation because of positive swab results with negative CT findings.

The investigators concluded that COVID-19 in children is generally mild, most common symptoms are fever and coughing and bacterial coinfections are much more common than adults dictating the need for antibiotics.


In an interview regarding the findings of this study, Prof Stephen Pelton, professsor of Paediatrics and Epidemiology at Boston University, noted the absence of fever in 40% of cases, and concluding that the absence of fever is not inconsistent with COVID-19 disease.Another important point in the study is that the highest attack rates appear to be children less than one year old, and that the finding of concurrent Influenza A,B or RSV underscores that concurrent infection can occur, and 'the presence of another virus in diagnostic tests does not mean that COVID-19 is not causal.'


As for whether the finding of elevated PCT levels reflects only COVID-19, viral coinfection or bacterial coinfection, the answer is unclear. None of the children in the study proved to have bacterial disease and 'this marker will need to be interpreted with caution in the setting of COVID-19 disease.'


SOURCES:

Article from Medscape, adjusted.

SOURCES: Xia W et al. Ped Pulmonol. 2020 Mar 5. doi: 10.1002/ppul.24718; Liu W et al. N Engl J Med. 2020 Mar 12. doi: 10.1056/NEJMc2003717.




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