ABSTRACT
Background: In the northern hemisphere, Respiratory Syncytial Virus (RSV) is more frequently detected from December to February. In Italy, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) presented a peak in incidence from the end of December 2021 to February 2022. Aim(s): To evaluate how SARS-CoV-2 pandemic has influenced RSV circulation. Method(s): We evaluated 389 children, aged 0-18 years, admitted for respiratory tract infections from September 2021 to January 2022 throughout Italy, from the north to the south. Children underwent nasal washing from 1 to 3 days after hospitalization. A (RT)-PCR was developed for detecting 15 respiratory viruses, including RSV, influenza virus A and B, human coronavirus OC43, 229E, NL-63 and HUK1, adenovirus, rhinovirus, parainfluenza virus 1-3, human bocavirus and human metapneumovirus. Result(s): We detected a virus in 338 children (86.9%): RSV was found in 267 (68.7%), other viruses in 71 (18.3%). 51 children (13.1%) resulted negative. Dividing our observational period in two-week timeframes, we found that RSV showed an early peak from October to the first half of December 2021 compared to its usual seasonality. In a previous study, we have demonstrated that RSV circulation was incredibly low from September 2020 to January 2021, in contrast with what we found in the same period in 2021-2022. Comparing RSV and SARS-CoV-2 incidences, we found that these two viruses spread in opposite ways: when SARS-CoV-2 present an incidence peak, RSV circulation reduced and viceversa. Conclusion(s): The relationship between RSV and SARS-CoV-2 showed that viral interference plays a crucial role in their epidemiology.
ABSTRACT
Introduction: Children infected with the severe acute respiratory coronavirus 2 (SARS-CoV-2) are mostly asymptomatic or mild symptomatic. Some children experience persistent symptoms after SARS-CoV-2 infection, which may be consistent with Long COVID. Aim(s): To assess the frequency of both acute and persisting Coronavirus disease (COVID-19) symptoms in children and to search for the presence of risk factors for acute or persisting COVID-19 symptoms. Method(s): We included 697 children, aged between 0 and 18 years, who had previous SARS CoV-2 infection. Children and parents were asked questions regarding symptoms in the acute phase of COVID-19 and also persistent symptoms (extending beyond or developing 30 days and 90 days after initial diagnosis). Result(s): 79,2% of children were symptomatic in the acute phase of COVID-19;the most common acute symptoms were fever (49,6%), cough (22,1%), headache (37,9%) and asthenia (25,8%). 26,8% of children reported symptoms 30 days after initial diagnosis and 10,2% of children presented symptoms 90 days after initial diagnosis;the most common reported symptom was asthenia respectively in 12,3% (after 30 days) and in 4,9% of children (after 90 days). Persisting symptoms after 30 days were mostly present in overweigh or obese girls (35,8% vs 64,2%, p-value 0,03) and in children with asthenia (41,3% vs 20,3, p-value 0,001) in the acute phase. Children with symptoms 90 days after initial diagnosis most frequently had asthenia in the acute phase. Conclusion(s): We confirm that SARS-CoV-2 infection in children is generally mild. Also children can experience persisting symptoms that are significantly more frequent if they have a symptomatic disease and asthenia.
ABSTRACT
Background: Children generally develop a mild disease after SARS-CoV-2 infection;it has been shown (Loske J al., 2021) that higher basal expression of relevant pattern recognition receptors may result in a stronger early innate antiviral than in adults. However, how the early interferon (IFN) response differs from that in adults is not fully characterized. Hence, we aimed to investigate the expression of several IFN-related genes in nasopharyngeal (NP) cells from children and adults with asymptomatic or mild COVID-19, not requiring hospitalization. Methods: Children and adults attending emergency departments (ED) of Sapienza University Hospital, to perform SARS-CoV-2 molecular tests, were enrolled from November 2020 to February 2021, after informed consent was obtained. RNA from residual NP swabs was purified and 200 ng were reverse transcribed. Gene expression of genes coding for type I and III IFNs and for the well-known markers of IFNs' activation, ISG15 and ISG56, was measured by exonuclease-based Real time PCR assays with relative quantification to the invariant gene GUS (the 2-ΔCt method). Results: Residual NP cells from a total of 132 children and adults were included in the study;56 had SARS-CoV-2 positive results and 76 resulted negative. The expression of all tested genes showed a moderate significant inverse correlation with age, with the exception of ISG15. Participants were further stratified in age groups (< 16;16-35;36-65 years) resulting in: 25 SARS-CoV-2 negative and 26-positive children;14 SARS-CoV-2 negative and 16-positive young adults and 37 SARS-CoV-2 negative and 14-positive adults. In SARS-CoV-2 negative samples, higher levels of all study genes were found in children, while significantly decreasing in young and elderly adults. Among SARS-CoV-2 positive samples, those from children showed significantly higher levels of type I IFNs and of IFN lambda2 whereas ISG15 was far more elevated in adults. Moreover, levels of all type I IFNs, and of IFN lambda2, were significantly higher in individuals with no symptoms (65% of children and 44% of the young adults), whereas ISG15 was elevated in those with a mild COVID-19. Conclusion: The higher baseline expression of IFN-related genes in children may prompt a quicker activation of the IFN response after SARS-CoV-2 infection and contribute to effective control of viral replication;the higher ISG activation in adults may be caused by the inflammatory response and associated to COVID-19 symptoms.
ABSTRACT
Background: Children generally develop asymptomatic or mild COVID-19 disease, despite the exact mechanisms that protect them from severity are yet to be defined. Since humoral response to SARS-CoV-2 infection in children is still poorly investigated, we aimed to analyze circulating levels of anti-Spike IgA and IgG in pediatric population up to 8 months after SARS-CoV-2 infection, to delineate whether COVID-19 outcomes could impact on antibody (Ab) levels. Methods: A total of 115 COVID-19 young patients (mean age: 11.5 years, range 1-19 years) were enrolled between October 2020 and March 2021. All cases were confirmed SARS-CoV-2 infection by use of a diagnostic molecular assay on nasopharyngeal swabs. Circulating anti-SARS-CoV-2 IgG and IgA were measured using ELISA assays at one-month (T1), two-month (T2) and eight-month (T3) follow-up blood samples of young partecipants. Results: Longitudinal observation of COVID-19 children showed a decreased circulating level of IgA at T2 and T3 respectively compared to T1 (p<0.001). Persistent levels of anti-Spike IgG were observed at least two-month post infection but they significantly decreased at T3 (p<0.001). Stratifying children in two age-classes (1-9 and 10-19 years old) we found significantly higher levels of IgA in younger children at T1, T2 and T3 than in children older than 10 years old (p=0.012;p=0.041;p=0.036, respectively). Differently, younger children had a significantly higher level of IgG at T2 (p=0.029) and at T3 (p=0.049), but not at T1. Stratifying children based on the presence or absence of SARS-CoV-2 correlated symptoms or on the basis of underlying diseases, we did not observe differences in blood levels of IgA and IgG in all time points analyzed. Conclusion: Our longitudinal data indicated that younger children are characterized by an elevated peak of early IgA and are also defined by a robust induction of IgG, with respect to the older. These results contrast with what is common in SARS-CoV-2 infection in adults that elicit higher levels of polyfunctional Abs in severe disease. If confirmed in larger groups, these data would suggest that pediatric patients that usually have an efficient control of SARS-CoV-2 infections without inflammation would also elicit a humoral immune response protective from reinfections.
ABSTRACT
Lung ultrasound has become increasingly used in both adult and pediatric populations, allowing the rapid evaluation of many lung and pleura diseases. This popularity is due to several advantages of the method such as the low cost, rapidity, lack of ionizing radiation, availability of bedside and repeatability of the method. These features are even more important after the outbreak of the SARS-CoV-2 pandemic, given the possibility of recognizing through ultrasound the signs of interstitial lung syndrome typical of pneumonia caused by the virus. The purpose of this paper is to review the available evidence of lung ultrasound (LUS) in children and its main applications in pediatric diseases.
ABSTRACT
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.