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Clinical Presentation of Covid-19 in Children, A Narrative Review of Five Reported Case Series 05/22/2020 00:00:00

Clinical Presentation of Covid-19 in Children, A Narrative Review of Five Reported Case Series

Edgar C Bustos1, Georgina M Cabrales2.
1Emergency Room, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico,
2Ambulatory Pediatric Clinic, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

Edgar C Bustos, 162th Doctor Marquez Street, Colonia Doctores, Mexico City 02060, Mexico.
SARS-CoV-2, children, symptoms
According to previously published descriptions of the novel coronavirus [COVID-19 (SARS-CoV-2)] epidemiological and clinical behavior, it is known that the disease is less frequent and milder in pediatric patients, and the clinical manifestations are similar to those of adults.1 There are relatively few pediatric articles. We retrieved the published information from most important case series about clinical manifestations on pediatric patients diagnosed by reverse transcriptase–polymerase chain reaction (RT-PCR).2,3,4,5,6 Bibliographic research was performed via PubMed data base collecting medical investigation published from January to April 2020 reporting cases series of COVID-19 describing clinical features. Inclusion criteria were as follow: (1) Only articles in English language were included. (2) Articles reporting at least five patients in case series describing pediatric population (under 19 years of age) (3) Clinical studies showing the frequency of at least three symptoms were selected. From all of the articles, the patients with each of the symptoms were summarized. The information was analyzed and the percentage of each of the symptoms was obtained. Each of the symptoms were analyzed individually, if the article did not report a particular symptom, it was not taken into account to obtain percentages. We included five articles.2,3,4,5,6 The results are shown in table 1. Fever, cough and sore throat were the predominant symptoms, but gastrointestinal symptoms were also important. As more studies have been published, the description of the cases has become clearer. The fact that not all of the articles analyze the whole of the symptoms represents a disadvantage for the physician to detect suspicious cases. The results of our study characterize in a clearer way the clinical spectrum of the pediatric patient with COVID-19 compared to the series of adult cases. The results show clearly that pediatric patients with COVID-19 present a less florid clinical picture compared to adult patients. Separately, each one of the symptoms in the pediatric populations presents in a minor percentage of cases than in the adult population. Cough, fever and respiratory distress have been the most frequent triad of symptoms cited in publications although it is non-specific7 and shares this spectrum of symptoms with multiple viral and bacterial respiratory diseases. Even with a non-specific clinical feature, certain patterns can be defined. Fatigue, which is the third most frequent symptom in adult patients is seldom reported in children.2,3 There is low frequency of rhinorrhea, sneeze and nasal congestion in patients with COVID-19.3 This contrasts with descriptions of other respiratory virus particularly influenza virus. This becomes of special importance in the face of the feared risk of a second wave of COVID-19, which could coincide with the influenza peak expected in the following months to differentiate between COVID-19 and influenza infection. Loss of taste and smell has been described as a very specific symptom in adults but is rarely reported in children.8

Table 1. Clinical characteristics in children with COVID-19.2,3,4,5,6
Study Total Cases Fever Cough Sore Throat Headache Myalgia Shortness of Breath Diarrhea Rhinitis Nausea/Vomit Fatigue
Qiu et al 36 13 7 2 3 NA 1 2 NA 2 NA
Lu et al 171 83 71 79 NA NA 49 15 13 11 13
Wu et al 74 20 24 0 2 0 2 3 18 NA 5
Bialek et al 291 213 158 71 81 66 39 37 21 31 NA
Li et al 22 14 13 NA NA NA NA NA NA NA NA
  Positive/available(%) 343/594 (57.7) 287/594 (46.5) 152/572 (26.6) 86/401 (21.4) 66/365 (18.1) 91/572 (15.9) 57/572 (10) 52/ 536 (9.7) 44/498 (8.8) 18/245 (7.3)

Compliance with Ethical Standards
Funding None
Conflict of Interest None
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Cite this article as:
Bustos E C, Cabrales G M. Clinical Presentation of Covid-19 in Children, A Narrative Review of Five Reported Case Series. Pediatr Oncall J. 2021;18: 26-27. doi: 10.7199/ped.oncall.2021.3
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