Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic
Background: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted t...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-01-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.629040/full |
| _version_ | 1818566212307648512 |
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| author | Angelo Mazza Angelo Di Giorgio Laura Martelli Ciretta Pelliccia Moira Alessandra Pinotti Vera Quadri Lucio Verdoni Alice Decio Maurizio Ruggeri Lorenzo D'Antiga |
| author_facet | Angelo Mazza Angelo Di Giorgio Laura Martelli Ciretta Pelliccia Moira Alessandra Pinotti Vera Quadri Lucio Verdoni Alice Decio Maurizio Ruggeri Lorenzo D'Antiga |
| author_sort | Angelo Mazza |
| collection | DOAJ |
| description | Background: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted to our unit shortly after the first outbreak.Methods: we retrospectively reviewed the notes of all pediatric patients diagnosed with COVID-19. We enrolled patients with positive swabs or serology and classified them based on the pattern and the timing of presentation after the first outbreak. This setting was considered a reliable reflection of the consequences of unmitigated SARS-CoV-2 circulation.Results: We diagnosed 35 patients over a 3-month period and we identified six patterns presenting in two temporal phases: Early phase, Group 1 (median of 20 days from epidemic start, IQR: 15–27): neonatal sepsis (n.7), pneumonia (n.5), flu-like symptoms (n.2). Late phase, Group 2 (59:51–66 days, p < 0.001): MIS-C (n.18), neurological manifestations (n.3). Group 1 differed from Group 2 for younger age (1 vs. 8 years, p = 0.02), lower C-reactive protein (0.9 vs. 16.6 mg/dl, p = 0.008), procalcitonin (0.16 vs. 7.9 ng/ml, p = 0.008) and neutrophil count (3,765 vs. 6,780/μl, p = 0.006), higher rate of positive swabs (14/14 vs. 9/21, p < 0.001), higher lymphocyte count (3,000 vs. 930/μl, p = 0.006) and platelet count (323,000 vs. 210,000/μl, p = 0.009).Conclusions: Following an outbreak of unmitigated SARS-CoV-2 diffusion, infected children may present with clinical patterns suggesting two temporal clusters, the first characterized by markers of direct viral injury, the second suggesting an immune-mediated disease. |
| first_indexed | 2024-12-14T01:50:52Z |
| format | Article |
| id | doaj.art-34235f0adaf9432a94076d56027fdc4a |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-14T01:50:52Z |
| publishDate | 2021-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-34235f0adaf9432a94076d56027fdc4a2022-12-21T23:21:23ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-01-01910.3389/fped.2021.629040629040Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the PandemicAngelo Mazza0Angelo Di Giorgio1Laura Martelli2Ciretta Pelliccia3Moira Alessandra Pinotti4Vera Quadri5Lucio Verdoni6Alice Decio7Maurizio Ruggeri8Lorenzo D'Antiga9Paediatric Pulmonology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Gastroenterology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Nephrology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Endocrinology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Endocrinology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Allergology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Rheumatology, Paediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyChild Neuropsychiatry Service, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyPaediatric Department, Hospital Papa Giovanni XXIII, Bergamo, ItalyBackground: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted to our unit shortly after the first outbreak.Methods: we retrospectively reviewed the notes of all pediatric patients diagnosed with COVID-19. We enrolled patients with positive swabs or serology and classified them based on the pattern and the timing of presentation after the first outbreak. This setting was considered a reliable reflection of the consequences of unmitigated SARS-CoV-2 circulation.Results: We diagnosed 35 patients over a 3-month period and we identified six patterns presenting in two temporal phases: Early phase, Group 1 (median of 20 days from epidemic start, IQR: 15–27): neonatal sepsis (n.7), pneumonia (n.5), flu-like symptoms (n.2). Late phase, Group 2 (59:51–66 days, p < 0.001): MIS-C (n.18), neurological manifestations (n.3). Group 1 differed from Group 2 for younger age (1 vs. 8 years, p = 0.02), lower C-reactive protein (0.9 vs. 16.6 mg/dl, p = 0.008), procalcitonin (0.16 vs. 7.9 ng/ml, p = 0.008) and neutrophil count (3,765 vs. 6,780/μl, p = 0.006), higher rate of positive swabs (14/14 vs. 9/21, p < 0.001), higher lymphocyte count (3,000 vs. 930/μl, p = 0.006) and platelet count (323,000 vs. 210,000/μl, p = 0.009).Conclusions: Following an outbreak of unmitigated SARS-CoV-2 diffusion, infected children may present with clinical patterns suggesting two temporal clusters, the first characterized by markers of direct viral injury, the second suggesting an immune-mediated disease.https://www.frontiersin.org/articles/10.3389/fped.2021.629040/fullCOVID-19childrenclinical manifestationSARS–CoV−2immunity |
| spellingShingle | Angelo Mazza Angelo Di Giorgio Laura Martelli Ciretta Pelliccia Moira Alessandra Pinotti Vera Quadri Lucio Verdoni Alice Decio Maurizio Ruggeri Lorenzo D'Antiga Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic Frontiers in Pediatrics COVID-19 children clinical manifestation SARS–CoV−2 immunity |
| title | Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic |
| title_full | Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic |
| title_fullStr | Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic |
| title_full_unstemmed | Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic |
| title_short | Patterns of Presentation of SARS-CoV-2 Infection in Children. Experience at the Italian Epicentre of the Pandemic |
| title_sort | patterns of presentation of sars cov 2 infection in children experience at the italian epicentre of the pandemic |
| topic | COVID-19 children clinical manifestation SARS–CoV−2 immunity |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.629040/full |
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