Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, 630 W. 168th St, New York, NY 10032, USA.
Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA.
Am J Emerg Med. 2021 May;43:287.e1-287.e3. doi: 10.1016/j.ajem.2020.09.034. Epub 2020 Sep 15.
We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with "COVID-19 croup," SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.
我们描述了三例先前健康的儿童，他们从我们的急诊部（ED）被收入我们的独立儿童医院，这是首批记录的作为 SARS-CoV-2 感染表现的喉炎病例。所有三例（年龄分别为 11 个月、2 岁和 9 岁）均表现出非特异性上呼吸道症状，随后发展为伴有喘鸣的犬吠样咳嗽，并伴有静息时呼吸困难。所有患儿均通过聚合酶链反应检测鼻咽样本诊断为 SARS-CoV-2 感染，这些样本对所有其他病原体（包括喉炎最常见的病因）均为阴性。每位患儿均接受了多次（≥3 次）雾化吸入肾上腺素治疗，但在用药后不久症状改善甚微。所有患儿从 ED 就诊到静息时喘鸣缓解的时间均较长（13、19 和 21 小时）。所有患儿在 ED 治疗早期均接受了地塞米松治疗，且均住院治疗。所有患儿都因症状持续时间较长而至少接受了一剂额外的地塞米松，这种情况在我们医院比较少见。有 1 例患儿需要接受氦氧治疗并收入重症监护病房。所有患儿最终均出院。通常情况下，喉炎不需要进行病原体检测，但考虑到“COVID-19 喉炎”的预后意义和延长隔离的影响，应考虑对 SARS-CoV-2 进行检测。我们对这种新描述的 COVID-19 喉炎的有限经验表明，该病的病例可能表现出显著的病理学特征，并且可能不像典型喉炎那样迅速改善。
