Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review.
轻度和重度冠状病毒疾病儿童的实验室异常 2019 (新型冠状病毒肺炎): 汇总分析和综述。
- 作者列表："Henry BM","Benoit SW","de Oliveira MHS","Hsieh WC","Benoit J","Ballout RA","Plebani M","Lippi G
:Limited data exists to-date on the laboratory findings in children with COVID-19, warranting the conduction of this study, in which we pool the currently available literature data on the laboratory findings seen in children with mild and severe COVID-19. Following an extensive literature search, we identified 24 eligible studies, including a total of 624 pediatric cases with laboratory-confirmed COVID-19, which report data on 27 different biomarkers. We then performed a meta-analysis to calculate the pooled prevalence estimates (PPE) for these laboratory abnormalities in mild COVID-19. As data was too limited for children with severe COVID-19 to allow pooling, results were presented descriptively in a summary of findings table. Our data show an inconsistent pattern of change in the leukocyte index of mild and severe cases of COVID-19 in children. Specifically, changes in leukocyte counts were only observed in 32% of the mild pediatric cases (PPE: 13% increase, 19% decrease). In mild disease, creatine kinase-MB (CK-MB) was frequently elevated, with a PPE of 33%. In severe disease, c-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH) were frequently elevated. Based on data obtained from early COVID-19 studies, leukocyte indices in children appear inconsistent, differing from those reported in adults that highlight specific leukocyte trends. This brings into question the utility and reliability of such parameters in monitoring disease severity in the pediatric population. Instead, we suggest physicians to serially monitor CRP, PCT, and LDH to track the course of illness in hospitalized children. Finally, elevated CK-MB in mild pediatric COVID-19 cases is indicative of possible cardiac injury. This highlights the importance of monitoring cardiac biomarkers in hospitalized patients and the need for further investigation of markers such as cardiac troponin in future studies.
: 迄今为止关于新型冠状病毒肺炎儿童实验室发现的数据有限，值得进行这项研究，其中我们汇集了目前可用的关于轻度和重度新型冠状病毒肺炎儿童实验室检查结果的文献数据。经过广泛的文献检索，我们确定了 24 项符合条件的研究，包括总共 624 例实验室确诊新型冠状病毒肺炎的儿科病例，报告了 27 种不同生物标志物的数据。然后，我们进行了一项荟萃分析，以计算这些实验室异常在轻度新型冠状病毒肺炎的合并患病率估计值 (PPE)。由于严重新型冠状病毒肺炎儿童的数据太有限，无法进行汇总，结果在结果摘要表中进行了描述性介绍。我们的数据显示，轻度和重度儿童新型冠状病毒肺炎的白细胞指数变化模式不一致。具体而言，仅在 32% 的轻度儿科病例中观察到白细胞计数的变化 (PPE: 增加 13%，减少 19%)。轻症时，肌酸激酶MB (CK-MB) 经常升高，PPE为 33%。在严重疾病中，c-rea c蛋白 (C RP) 、c前c itonin (P C T) 和la c tate脱氢酶 (LDH) 经常升高。根据从早期新型冠状病毒肺炎研究中获得的数据，儿童的白细胞指数似乎不一致，与成人报道的突出特定白细胞趋势的白细胞指数不同。这就质疑了这些参数在监测儿科人群疾病严重程度方面的效用和可靠性。相反，我们建议医生连续监测CRP、PCT和LDH，以跟踪住院儿童的病程。最后，轻度小儿新型冠状病毒肺炎病例CK-MB升高提示可能的心脏损伤。这强调了在住院患者中监测心脏生物标志物的重要性，以及在未来的研究中需要进一步研究心肌肌钙蛋白等标志物。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.