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1.
Journal of Pediatric Infectious Diseases ; : 7, 2021.
Article in English | Web of Science | ID: covidwho-1532195

ABSTRACT

Objective The frequency of coinfections in pediatric Coronavirus disease 2019 (COVID-19) cases and their impact on the clinical course are not fully understood. We aimed to investigate the viral and bacterial respiratory pathogens in children admitted to the pediatric emergency department (PED), their clinical course, and the presence of coinfections during the early months of the COVID-19 pandemic. Methods Clinical, laboratory and radiological findings, viral and bacterial pathogens detected by multiplex polymerase chain reaction (PCR) tests in nasopharyngeal swabs, clinical course, and treatments of all children who were tested for severe acute respiratory coronavirus 2 (SARS-CoV-2) at the PED between March 16 and May 15, 2020, were recorded. SARS-CoV-2 PCR-positive and negative groups were compared. Results Out of 570 patients tested for SARS-CoV-2 during the study period, 43 were found positive (7.5%). Non-SARS-CoV-2 viral pathogens were more common in the SARS-CoV-2 PCR-negative group than the SARS-CoV-2 PCR-positive group (13.2%, n=68 versus 4.7%, n=2), but this result was not statistically significant. Leukocyte, neutrophil, lymphocyte, and platelet counts were lower in SARS-CoV-2 PCR-positive group. Bacterial panel positivity was significantly higher in the SARS-CoV-2 PCR-positive group compared with the SARS-CoV-2 PCR-negative group (52%, n=12 versus 28%, n=91;p<0.05). The presence of coinfection did not alter the course of therapy in SARS-CoV-2 PCR-positive cases. Conclusion While viral coinfections were rare, bacterial panel positivity was common in children with COVID-19, but this had not influenced management decisions. The limitations of the tests should be kept in mind while interpreting the results.

2.
Annals of the Rheumatic Diseases ; 80(SUPPL 1):908, 2021.
Article in English | EMBASE | ID: covidwho-1358860

ABSTRACT

Background: The severity of COVID-19 symptoms can range from mild to severe. Severe COVID-19 cases with excessive hyperinflammation have many overlap features with multisystem inflammatory syndrome in children (MIS-C). Objectives: We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with MIS-C and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country. Methods: Children (aged <18 years) who diagnosed with MIS-C and severe/ critical pediatric cases with COVID-19, were admitted to hospital between 26 March and 3 November 2020 were enrolled in the study. Results: A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only 3 deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral. Conclusion: Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count seem good diagnostic parameters for MIS-C cases.

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