Department of Emergency, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
Department of Clinical Laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
Front Med. 2020 Dec;14(6):776-785. doi: 10.1007/s11684-020-0820-7. Epub 2020 Oct 27.
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread around the world. However, approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported. We retrospectively analyzed the clinical data of 97 children with probable COVID-19. A total of 13 (13.4%) patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing, and 41 (42.3%) patients were found to be infected with other pathogens. Notably, no pathogen was detected in 43 (44.3%) patients. Among all patients, 25 (25.8%) had familial cluster exposure history, and 52 (53.6%) had one or more coexisting conditions. Fifteen (15.5%) patients were admitted or transferred to the PICU. In the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG against SARS-CoV-2, respectively. In 22 patients with suspected COVID-19, 1 (4.5%) was positive for IgG but negative for IgM. The most frequently detected pathogen was Mycoplasma pneumonia (29, 29.9%). One patient with confirmed COVID-19 died. Our results strongly indicated that the detection of asymptomatic COVID-19 or coexisting conditions must be strengthened in pediatric patients. These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted. A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.
新型冠状病毒病 2019（COVID-19）由严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）引起，已在全球范围内传播。然而，尚未报道区分 COVID-19 与其他病原体引起的肺炎的方法。我们回顾性分析了 97 例疑似 COVID-19 的儿童的临床数据。共有 13 例（13.4%）患者通过核酸 RT-PCR 检测证实 SARS-CoV-2 感染阳性，41 例（42.3%）患者感染了其他病原体。值得注意的是，43 例（44.3%）患者未检测到病原体。所有患者中，25 例（25.8%）有家族聚集性暴露史，52 例（53.6%）有一个或多个共存疾病。15 例（15.5%）患者被收入或转至 PICU。在 11 例确诊 COVID-19 病例中，5 例（45.5%）和 7 例（63.6%）对 SARS-CoV-2 的 IgM 和 IgG 呈阳性。在 22 例疑似 COVID-19 患者中，1 例（4.5%）IgG 阳性而 IgM 阴性。最常检测到的病原体是肺炎支原体（29 例，29.9%）。1 例确诊 COVID-19 患者死亡。我们的结果强烈表明，必须加强对儿科患者无症状 COVID-19 或共存疾病的检测。除非进行病因分析，否则这些病例可能难以诊断为 COVID-19。在高度怀疑 SARS-CoV-2 感染但核酸检测阴性的情况下，血清学检测可作为一种有用的辅助诊断工具。
