ABSTRACT
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
Subject(s)
Humans , Infant, Newborn , Child , Adolescent , COVID-19/complications , Cross-Sectional Studies , Cohort Studies , Systemic Inflammatory Response Syndrome , Tertiary Care Centers , SARS-CoV-2ABSTRACT
Avaliamos o papel da proteína M na indução de lesões similares às observadas na febre reumática (FR), utilizando o rato Lewis como modelo experimental. Identificamos a cepa M1 do S. pyogenes como a mais freqüentemente isolada em amostras locais. Produzimos a proteína M1 recombinante e, mostramos que a imunização usando esta proteína produziu lesões similares às lesões patognomônicas da FR em 50 por cento dos animais. Demonstramos resposta humoral e celular específica contra a proteína M1 e contra as regiões M1AB e M1C. Não observamos, entretanto, reações cruzadas com a miosina cardíaca. Células mononucleares infiltrantes do miocárdio de animais imunizados foram cultivadas, em presença de IL-2, mostrando que estas células foram sensibilizadas. Em conclusão, o modelo proposto ajudará a esclarecer a imunopatologia da FR...
We have evaluated M protein role in eliciting rheumatic fever-like lesions, using the Lewis rat as an animal model. We have identified S. pyogenes M1 strain as the most frequently isolated from local samples. We have produced M1 recombinant protein and shown that immunization using this protein led to rheumatic fever characteristic lesions in 50 per cent of the animals. We demonstrated a humoral and cellular specific response targeting M1 protein and M1AB and M1C regions. We did not observe, however, cross reactions with cardiac myosin. Mononuclear cells infiltrating myocardium of immunized animals were grown in presence of IL-2, showing that these cells were sensitized. In conclusion, the proposed model will help clarifying on the...