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[新型冠状病毒感染儿童的鉴别诊断、接触者追踪及诊断检测的成本效益:横断面观察性研究]

[Differential clinic in children infected by SARS-CoV-2, traceability of contacts and cost-effectiveness of diagnostic tests: Cross-sectional observational study].

作者信息

Fiel-Ozores Antia, González-Durán María Luisa, Novoa-Carballal Reyes, Portugués-de la Red María Del Mar, Fernández-Pinilla Isabel, Cabrera-Alvargonzález Jorge Julio, Martínez-Reglero Cristina, Rey-Cao Sonia, Concheiro-Guisán Ana

机构信息

Servicio de Pediatría, Instituto de Investigación Sanitaria Galicia Sur, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España.

Servicio de Pediatría, Instituto de Investigación Sanitaria Galicia Sur, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España.

出版信息

An Pediatr (Engl Ed). 2021 May;94(5):318-326. doi: 10.1016/j.anpedi.2020.12.001. Epub 2020 Dec 10.

Abstract

INTRODUCTION

Given the possible coexistence of infection by the SARS-CoV-2 with other seasonal infections, the aim is to identify differential symptoms. There has been studied the role of children in intrafamily contagion and the sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) in an area with low community transmission.

MATERIAL AND METHODS

Cross-sectional observational study. Patients between 0-15 years studied by RT-PCR technique due to clinical suspicion of infection by SARS-CoV-2 virus in the months of March-May 2020. Survey on symptoms and contacts. Determination of Anti-SARS-CoV-2 antibodies at least 21 days after the RT-PCR test.

RESULTS

126 patients were included, 33 with confirmed infection and mean age 8.4 years (95% CI 6.8-10,5), age higher than not infected. Fever was the most common symptom and with greater sensitivity. The differences found were a greater frequency of anosmia (P=0.029) and headache (P=.009) among children infected with a specificity of 96.7% and 81.5% respectively. There were no differences in the duration of the symptoms. 81.8% of those infected were probably infected in the family nucleus, 85.2% by a parent who worked outside the home. The sensitivity of RT-PCR was 70.9% and its negative predictive value 91.1%.

CONCLUSIONS

The clinical picture is nonspecific and the more specific symptoms difficult to detect in younger children. Children had a reduced role in the intrafamily transmission. The sensitivity of RT-PCR could be related to a less contagiousness in children after one week of infection.

摘要

引言

鉴于严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染可能与其他季节性感染并存,目的是确定不同症状。研究了儿童在家庭内传播中的作用以及逆转录聚合酶链反应(RT-PCR)在社区传播率低的地区的敏感性。

材料与方法

横断面观察性研究。对2020年3月至5月因临床怀疑感染SARS-CoV-2病毒而采用RT-PCR技术研究的0至15岁患者进行研究。调查症状和接触情况。在RT-PCR检测后至少21天测定抗SARS-CoV-2抗体。

结果

纳入126例患者,33例确诊感染,平均年龄8.4岁(95%可信区间6.8-10.5),年龄高于未感染者。发热是最常见的症状且敏感性更高。发现感染儿童中嗅觉丧失(P=0.029)和头痛(P=0.009)的发生率更高,特异性分别为96.7%和81.5%。症状持续时间无差异。81.8%的感染者可能在家庭核心成员中感染,85.2%由在外工作的父母感染。RT-PCR的敏感性为70.9%,其阴性预测值为91.1%。

结论

临床表现不具特异性,年幼儿童中更具特异性的症状难以检测。儿童在家庭内传播中的作用较小。RT-PCR的敏感性可能与感染一周后儿童传染性较低有关。

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