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Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses.
Yonker, Lael M; Neilan, Anne M; Bartsch, Yannic; Patel, Ankit B; Regan, James; Arya, Puneeta; Gootkind, Elizabeth; Park, Grace; Hardcastle, Margot; St John, Anita; Appleman, Lori; Chiu, Michelle L; Fialkowski, Allison; De la Flor, Denis; Lima, Rosiane; Bordt, Evan A; Yockey, Laura J; D'Avino, Paolo; Fischinger, Stephanie; Shui, Jessica E; Lerou, Paul H; Bonventre, Joseph V; Yu, Xu G; Ryan, Edward T; Bassett, Ingrid V; Irimia, Daniel; Edlow, Andrea G; Alter, Galit; Li, Jonathan Z; Fasano, Alessio.
  • Yonker LM; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: lyonker@mgh.harvard.edu.
  • Neilan AM; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA.
  • Bartsch Y; Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA.
  • Patel AB; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA.
  • Regan J; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.
  • Arya P; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Gootkind E; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Park G; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Hardcastle M; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • St John A; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Appleman L; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Chiu ML; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Fialkowski A; Harvard Medical School, Boston, MA.
  • De la Flor D; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Lima R; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA.
  • Bordt EA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Yockey LJ; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA.
  • D'Avino P; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA.
  • Fischinger S; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA.
  • Shui JE; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Lerou PH; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
  • Bonventre JV; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA.
  • Yu XG; Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.
  • Ryan ET; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA.
  • Bassett IV; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA.
  • Irimia D; Harvard Medical School, Boston, MA; Center for Engineering in Medicine, Department of Surgery, Boston, MA.
  • Edlow AG; Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital Boston, Boston, MA.
  • Alter G; Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA.
  • Li JZ; Harvard Medical School, Boston, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.
  • Fasano A; Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
J Pediatr ; 227: 45-52.e5, 2020 12.
Article in English | MEDLINE | ID: covidwho-872293
Semantic information from SemMedBD (by NLM)
1. 2019 novel coronavirus COEXISTS_WITH Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
Subject
2019 novel coronavirus
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COEXISTS_WITH
Object
Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
2. 2019 novel coronavirus COEXISTS_WITH Severe Acute Respiratory Syndrome
Subject
2019 novel coronavirus
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COEXISTS_WITH
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Severe Acute Respiratory Syndrome
3. Acute infectious disease PROCESS_OF Child
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Acute infectious disease
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PROCESS_OF
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Child
4. Fever PROCESS_OF Child
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Fever
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PROCESS_OF
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5. Patient in hospital PROCESS_OF Adult
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Patient in hospital
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PROCESS_OF
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Adult
6. Severe disorder PROCESS_OF Adult
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Severe disorder
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PROCESS_OF
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Adult
7. M Protei PART_OF C5203676
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M Protei
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8. M Protei AUGMENTS C0265267
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M Protei
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AUGMENTS
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C0265267
9. Symptoms NEG_PROCESS_OF Child
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NEG_PROCESS_OF
Object
Child
10. Immune dysregulation NEG_PROCESS_OF Child
Subject
Immune dysregulation
Predicate
NEG_PROCESS_OF
Object
Child
11. 2019 novel coronavirus COEXISTS_WITH Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
Subject
2019 novel coronavirus
Predicate
COEXISTS_WITH
Object
Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
12. 2019 novel coronavirus COEXISTS_WITH Severe Acute Respiratory Syndrome
Subject
2019 novel coronavirus
Predicate
COEXISTS_WITH
Object
Severe Acute Respiratory Syndrome
13. Acute infectious disease PROCESS_OF Child
Subject
Acute infectious disease
Predicate
PROCESS_OF
Object
Child
14. Fever PROCESS_OF Child
Subject
Fever
Predicate
PROCESS_OF
Object
Child
15. Patient in hospital PROCESS_OF Adult
Subject
Patient in hospital
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PROCESS_OF
Object
Adult
16. Severe disorder PROCESS_OF Adult
Subject
Severe disorder
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PROCESS_OF
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Adult
17. M Protein, multiple myeloma PART_OF 2019 novel coronavirus
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M Protein, multiple myeloma
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PART_OF
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2019 novel coronavirus
18. M Protein, multiple myeloma AUGMENTS Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
Subject
M Protein, multiple myeloma
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AUGMENTS
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Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
19. Symptoms NEG_PROCESS_OF Child
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Symptoms
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NEG_PROCESS_OF
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Child
20. Immune dysregulation NEG_PROCESS_OF Child
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Immune dysregulation
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NEG_PROCESS_OF
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Child
ABSTRACT

OBJECTIVES:

As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical. STUDY

DESIGN:

Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified.

RESULTS:

A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed.

CONCLUSIONS:

This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn / Young adult Country/Region as subject: North America Language: English Journal: J Pediatr Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn / Young adult Country/Region as subject: North America Language: English Journal: J Pediatr Year: 2020 Document Type: Article