Chest CT imaging of pediatric COVID-19 infection: a case report (preprint)

Background: Coronavirus Disease 2019 (COVID-19) outbreak in Wuhan, China spreading rapidly worldwide. Over 100 countries have reported surpassing 100,000 laboratory-confirmed cases of COVID- 19, and in which 2.1% were under aged 19 years. However, little is known about the imaging features about pediatric COVID-19 patients. Herein, we report two cases about COVID-19 involving the clinical data as well as chest images.Case presentation: Two pediatric patients admitted to hospital because of high fever or dry cough. Both children had been recent exposure to the COVID-19 confirmed patients of their family members. Real-time polymerase chain reaction(RT-PCR) test of these two patients’ sputum were positive for SARS-CoV-2 nucleic acid, and diagnosed as COVID-19 infection. Laboratory tests indicate normal white cell count (5.02 x10^9/L) and neutrophils (40.8%) in one case, and slightly increased white cell count (11.86 x10^9/L) and normal neutrophils (16.1%)in the other one. CRP of both cases were within the normal range. Computed tomography (CT) was used to evaluate the novel coronavirus pneumonia (NCP) of these two pediatric patients. Small nodule was found in the upper right lobe of one case; and bilateral peripheral ground-glass opacities were observed in the other patient.Conclusion: In summary, clinical symptoms and signs, laboratory tests and chest CT images of pediatric patients were untypical. Epidemic exposure history and RT-PCR results still play an important role in the precise diagnosis of COVID-19 children.

Association between Clinical, Laboratory and CT Characteristics and RT-PCR Results in the Follow-up of COVID-19 patients (preprint)

Abstract Background: Since December 2019, more than 100,000 coronavirus disease 2019 (COVID-19) patients have been confirmed globally based on positive viral nucleic acids with real-time reverse transcriptase-polymerase chain reaction (RT-PCR). However, the association between clinical, laboratory and CT characteristics and RT-PCR results is still unclear. We sought to examine this association in detail, especially in recovered patients. Methods: We analysed data from 52 confirmed patients who had been discharged with COVID-19. The clinical, laboratory, and radiological data were dynamically recorded and compared with the admission and follow-up RT-PCR results. Results: In this cohort, 52 admitted COVID-19 patients who had confirmed positive RT-PCR results were discharged after 2 rounds of consecutively negative RT-PCR results. Compared with admission levels, CRP levels (median 4.93 mg/L [IQR: 1.78-10.20]) decreased significantly (p<0.001). and lymphocyte counts (median 1.50x109/L [IQR: 1.11-1.88]) increased obviously after obtaining negative RT-PCR results (p<0.001). Additionally, substantially improved inflammatory exudation was observed on chest CT except for 2 progressed patients. At the two-week follow-up after discharge, 7 patients had re-positive RT-PCR results, including the abovementioned 2 progressed patients. Among the 7 patients, new GGO was demonstrated in 2 patients. There were no significant differences in CPR levels or lymphocyte counts when comparing the negative and re-positive PCT results (all p >0.05). Conclusion: Heterogeneity between CT features and RT-PCR results was found in COVID-19, especially in some recovered patients with negative RT-PCR results. Our study highlights that both RT-PCR and chest CT should be considered as the key determinants for the diagnosis and management of COVID-19 patients.

Acute Myocardial Injury of Patients with Coronavirus Disease 2019 (preprint)

Background: Since the outbreak of the Coronavirus Disease 2019 (COVID-19) in China, respiratory manifestations of the disease have been observed. However, as a fatal comorbidity, acute myocardial injury (AMI) in COVID-19 patients has not been previously investigated in detail. We investigated the clinical characteristics of COVID-19 patients with AMI and determined the risk factors for AMI in them. Methods: We analyzed data from 53 consecutive laboratory-confirmed and hospitalized COVID-19 patients (28 men, 25 women; age, 19-81 years). We collected information on epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, imaging findings, management methods, and clinical outcomes. Results: Cardiac complications were found in 42 of the 53 (79.25%) patients: tachycardia (n=15), electrocardiography abnormities (n=11), diastolic dysfunction (n=20), elevated myocardial enzymes (n=30), and AMI (n=6). All the six AMI patients were aged >60 years; five of them had two or more underlying comorbidities (hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease). Novel coronavirus pneumonia (NCP) severity was higher in the AMI patients than in patients with non-definite AMI (p<0.001). All the AMI patients required care in intensive care unit; of them, three died, two remain hospitalized. Multivariate analyses showed that C-reactive protein (CRP) levels, NCP severity, and underlying comorbidities were the risk factors for cardiac abnormalities in COVID-19 patients. Conclusions: Cardiac complications are common in COVID-19 patients. Elevated CRP levels, underlying comorbidities, and NCP severity are the main risk factors for cardiac complications in COVID-19 patients.