Clinical, laboratory, and chest radiographic characteristics of COVID-19 associated severe pediatric pneumonia. A retrospective study.

OBJECTIVES: To evaluate the demographics, clinical presentation, laboratory data, chest radiographs, and outcomes of pediatric patients with critical coronavirus disease 2019 (COVID-19). METHODS: This retrospective study included 34 children who were diagnosed with severe COVID-19 pneumonia between August 2020 and July 2021. Severe pneumonia was defined as fever, respiratory distress (tachypnea, chest retractions, and hypoxia [oxygen saturation <90% in room air]), and obvious infiltrations on chest radiography. RESULTS: Ages of the patients ranged from newborns to 12 years old, with a median of 24 months (interquartile range: 12-72 months). Preschool-aged children were the most common age group (44%). Levels of inflammatory markers (C-reactive protein, ferritin, and procalcitonin) were elevated in most patients. A total of 13 patients developed severe acute respiratory distress syndrome (ARDS), while 4 developed multiorgan failure. Despite receiving supportive therapy, 2 (5.9%) patients died due to severe septic shock and multiorgan failure. One deceased patient was born prematurely at 30 weeks, while the other had chronic granulomatous disease. CONCLUSION: This study described a single-center cohort of pediatric patients with severe COVID-19 pneumonia. In this cohort, children with cardiopulmonary comorbidities and ARDS had a high mortality and long-term morbidity, as observed in other pediatric studies.

Disseminated Pulmonary Mycosis Caused by Candida tropicalis in an 11-Year-Old Male Patient with Chronic Granulomatous Disease.

Invasive fungal infection is a major threat to chronic granulomatous disease (CGD) patients. We present a rare case of invasive mycosis in a CGD boy. An 11-year-old preadolescent boy presented with fever, hypoxia, and dyspnea. Physical examination revealed left neck enlarged lymph nodes with healed scars. The chest revealed bilateral diminished air entry with bilateral coarse crackles. Peripheral blood leukocyte count was 28.260/µL with 84% neutrophil, 11% lymphocyte, and 4.4% monocyte. The patient's condition deteriorated regardless of the empirical antibacterial against MRSA and suspected tuberculosis. A sputum sample was submitted for mycological investigation, and budding yeasts with pseudohyphae were detected in the direct smear and were isolated in pure culture using Sabouraud agar. Candida tropicalis was identified from cultural and microscopic features and confirmed by the Vitek 2 automated system. This result confirmed the invasive mycosis, obviously due to the underlying primary immunodeficiency, chronic granulomatous disease (CGD). Amphotericin was added, and he also received IV methylprednisolone for seven days. The patient improved and was weaned off oxygen with no fever. However, the patient was referred to a higher center for further workup, which confirmed CGD's diagnosis. He is on the list for HLA-identical bone marrow transplantation (BMT).

Clinical Characteristics and Laboratory Abnormalities of Hospitalized and Critically Ill Children with Coronavirus Disease 2019: A Retrospective Study from Saudi Arabia.

BACKGROUND: COVID-19 was reported in several studies characterized by milder clinical course, benign disease, and peculiar epidemiologic patterns among pediatric patients compared to adults' disease. However, other studies indicated that critical cases also exist and are associated with preexisting cardiopulmonary comorbidities and concurrent multisystem inflammatory syndrome in children. METHODS: The study period was six months, May-October 2020. Data on demographics, clinical manifestations, laboratory abnormalities were extracted from the patients' hospital records. During the study period, 644 pediatric patients attended the hospital. They were all screened for SARS-CoV-2 using RT-PCR. Only the confirmed positive patients were included in the subsequent study analysis. They were hospitalized either in the general pediatric wards (GPW) or pediatric intensive care unit (PICU). RESULTS: Out of the total patients screened, 79 (12.3%) children were confirmed to have COVID-19 infection. All the confirmed COVID-19 patients were either admitted to the general pediatric wards (58; 73.4%) or PICU (21; 26.6%). The admission diagnoses for these children were acute gastroenteritis (22.85%), acute pneumonia (19%), clinical sepsis (17.7%), and multisystem inflammatory syndrome in children (10.1%). A significantly higher percentage of the PICU admitted patients showed shortness of breath (SOB) (P= 0.016). Respiratory insufficiencies, prematurity, and congenital heart diseases are the most reported comorbid conditions among the admitted children. The oxygen saturation was significantly lower among PICU patients than those in GPW (P=0.001). The total hospital stays differ significantly between the two groups, which were ten days for the PICU group compared to 4.5 days for the GPW group with a statistical significance noted (P= 0.001). CONCLUSION: Despite the observable variations in the clinical and laboratory findings among the hospitalized pediatric COVID-19 patients, no serious consequences among all patients were observed. The history of SOB and the initial oxygen saturation level were significantly associated with PICU admissions.

Distinctive clinical and laboratory features of COVID-19 and H1N1 influenza infections among hospitalized pediatric patients.

BACKGROUND: It had been documented in many studies that pediatric coronavirus disease 2019 (COVID-19) is characterized by low infectivity rates, low mortalities, and benign disease course. On the other hand, influenza type A viruses are recognized to cause severe and fatal infections in children populations worldwide. This study is aimed to compare the clinical and laboratory characteristics of COVID-19 and H1N1 influenza infections. METHODS: A retrospective study comprising 107 children hospitalized at Abha Maternity and Children Hospital, Southern region of Saudi Arabia, with laboratory-confirmed COVID-19 and H1N1 influenza infections was carried out. A complete follow-up for all patients from the hospital admission until discharge or death was made. The clinical data and laboratory parameters for these patients were collected from the medical records of the hospital. RESULTS: Out of the total enrolled patients, 73 (68.2%) were diagnosed with COVID-19, and 34 (31.8%) were diagnosed with H1N1 influenza. The median age is 12 months for COVID-19 patients and 36 months for influenza patients. A relatively higher number of patients with influenza had a fever and respiratory symptoms than COVID-19 patients. In contrast, gastrointestinal symptoms were observed in a higher number of COVID-19 patients than in influenza patients. A statistically significant increase in white cell counts is noted in COVID-19 but not in influenza patients (P < 0.05). There are no obvious variations in the mean period of duration of hospitalization between COVID-19 and influenza patients. However, the total intensive care unit length of stay was longer for influenza compared to COVID-19 patients. CONCLUSIONS: A considerable number of children infected with COVID-19 and H1N1 influenza were noted and reported in this study. There were no significant variations in the severity of the symptomatology and laboratory findings between the two groups of patients. Significant differences between these patients in some hospitalization factors and diagnosis upon admission also were not observed. However, more severe clinical manifestations and serious consequences were observed among pediatric patients hospitalized with influenza infections than among those with COVID-19.

Pediatric gastrointestinal basidiobolomycosis.

Basidiobolomycosisis an unusual fungal infection that manifests in the skin and rarely involves other systems including the gastrointestinal tract. We retrospectively reviewed records of six pediatric patients (< or =14 years of age) diagnosed with gastrointestinal basidiobolomycosis from March 2000 to March 2002. Four patients came from the same region, suggesting environmental exposure. Basidiobolomycosis should be considered in the differential diagnosis in pediatric patients presenting with abdominal mass and eosinophilia.