ABSTRACT
We like to share some ideas on the publication “Clinical and laboratory profile of children with COVID-19 admitted at a tertiary care hospital in Karnataka, Southern India”1. Sahana KS, et al1 concluded that “Presence of undernutrition and elevated C-reactive protein were associated with severe illness”. In this study, some laboratory parameters were studied and there might be important confounding effects. As Sahana KS, et al1 noted, some children have nutritional problems which might affect some laboratory parameters such as ferritin and haemoglobin. Additionally, a nutrition risk screening (NRS) score should be applied. In a previous report, NRS score was a good predictor for clinical outcome in cases with sepsis and it might be applicable to cases with COVID-192. Finally, the treatment given to different children might be different and it can result in different clinical outcomes. Those cases with atypical presentation may have received additional medications and it can affect both clinical outcome and clinical parameters. For example, steroids can affect the platelet count and might help to improve the clinical outcome. © 2018. Intertax. All rights reserved.
ABSTRACT
Objectives: To assess the clinical characteristics, laboratory parameters and outcomes in paediatric patients with COVID-19. Method: Case records of all paediatric patients admitted with COVID-19 were included in the study. Data regarding mode of presentation, presence of comorbid conditions, severity of COVID-19, laboratory investigations and management were noted. Results: A total of 32 children was admitted with COVID-19 infection in our institute. COVID-19 infection was mild in 16 (50%) patients, moderate in 6 (18.8%) and severe in 10 (31.3%). Ages of the children ranged from 6 months to 16 years with a mean age of 10.75 years. Of them 17 (53%) were boys and 15 (47%) were girls. Pre-existing comorbidities were present in 8 (25%) children. Respiratory symptoms were the commonest presenting complaints, being observed in 18 (59%) cases. Atypical presentation of COVID-19 (other than respiratory) was seen in 31% of cases. Presence of undernutrition and elevated C-reactive protein (CRP) were associated with severe Covid-19 illness (p<0.05). Eleven (34%) cases required intensive care and mechanical ventilation was required in 2 (6.3%) cases. Out of the 32 cases only 1 patient expired giving a case fatality rate of 3.1%. Conclusions: Atypical presentation of COVID-19 with varied manifestations involving systems other than respiratory was observed in children as a separate entity from hyper-inflammatory syndrome. Presence of undernutrition and elevated CRP was associated with severe illness. © 2021,Sri Lanka Journal of Child Health. All rights reserved.
ABSTRACT
Aims & Objectives: Introduction. Coronavirus SARS-CoV-2, has been associated with a hyperinflammatory state. This has been described as a form of secondary haemophagocyticlymphohistiocytosis that may contribute to increased mortality and is characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, HLH is most commonly triggered by viral infections and sepsis. Cardinal features of HLH include unremitting fever, cytopenias, and hyperferritinaemia;pulmonary involvement (including ARDS).We report a case where secondary HLH was noted in a patient with COVID19 infection. Patients/Materials & Methods: Case Report. A 6 year old female child was admitted to the hospital with complaints of fever since3 days. Fever was high grade in nature and of sudden onset with no previous respiratory symptoms. During her stay she developed nonproductive cough. The patient also had an episodeofhematemesis followed by 2 episodes offres hblood perrectum and 1 episode of seizure.Onphysicalexaminationpatient had tachypnea with pallor andhepatomegaly. Hematological parameters were estimated using Automated Sysmex XN-1000 and Biochemical parameters using Vitros 5600 fully automated chemistry analyzer. Results: Hb was 5.1 gm/dl, TLC was 21.2 × 103 and platelet count was 11 × 103. Peripheral smear examination showed normocyticnormo chromicanemia with neutrophilicleucocytosis and thrombocytopenia.Clotting profile and creatinine levels were with in normal range. LFT was deranged with an elevated ESR, LDH,D- Dimer and serumferritin levels.USG showed mildascites and bilateralminimalpleuraleffusion. MDCT revealed Bilateralconsolidation with airbronchogram. Dengue SPOT and IgG for SARSCoV2 was interpreted as positive. Bone marrow showed few large foamyhistiocytesexhibitingphagocytosis of blood cells. Hence the cytopenias were presumed to be due to increased peripheral destruction. Weilfelix reaction showed decreased titre and the patient was diagnosed to have Rickettsialfever. Patient was transfused with packed RBCS and platelets. She was started on antiepileptics, antibiotics and exoxaparinprophylactically. Dexamethasone was also given for 11 days for the management. Discussion & Conclusion: Conclusion: Mortality is increased in patients with Secondary HLHin COVID19. Screening for HLHis recommended in COVID19 patients presenting with bicytopeniaorpancytopenia.