来源:Frontiers of Medicine 发布时间:2022/2/21 10:43:54
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FMD | 前沿研究:疑似COVID-19患儿的临床和病原学特征

论文标题:Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19 (疑似COVID-19患儿的临床和病原学特征)

期刊: Frontiers of Medicine

作者:Xiaofang Cai, Hanlan Jiang, Simin Zhang, Shengying Xia, Wenhui Du, Yaoling Ma, Tao Yu, Wenbin Li

发表时间:27 Oct 2020

DOI:10.1007/s11684-020-0820-7

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01导读

华中科技大学同济医学院附属武汉儿童医院蔡小芳等和华中科技大学同济医学院附属同济医院李文斌在Frontiers of Medicine 发表研究论文《疑似COVID-19患儿的临床和病原学特征》(Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19)。

新型冠状病毒肺炎2019(COVID-19)由严重急性呼吸综合征冠状病毒-2(SARS-COV-2)引起,已在世界范围内传播,构成了国际关注的紧急公共卫生事件。SARS-CoV-2是迄今发现的第七种已知可引起人类疾病的冠状病毒,与分别导致2003年和2012年大流行的SARS和中东呼吸综合征(MERS)病毒相比,SARS-CoV-2的死亡率低一些,但传播速度更快。包括儿童在内的大多数人容易感染SARS-CoV-2。

在开展这项研究前有关儿童COVID-19的数据极少。与SARS和MARS相似,除非存在有潜在基础疾病,大多数被感染儿童仅有轻微症状。华中科技大学附属武汉儿童医院是华中地区最大的儿童医院,同时也是湖北省政府指派的第一家负责儿童COVID-19救治单位。在疫情爆发期间,武汉儿童医院只开放发热和急诊门诊,就诊的所有患儿均需接受2次5级预检分诊:所有发热或疑似COVID-19患儿均被送往发热门诊;其他患儿(包括危重患儿)经5级预检分诊后至急诊门诊就医。大多数确诊COVID-19患儿由发热门诊收治入院,也有一小部分疑似COVID-19儿童由急诊科收治入院。我们回顾性分析了这些从急诊科收治入院的疑似COVID-19患儿临床资料,其目的是为了更好理解儿童COVID-19的临床特征,同时也要注意儿童COVID-19与其他病原体感染所致肺炎相鉴别。

02摘要

由严重急性呼吸综合征冠状病毒-2(SARS COV-2)引起的新型冠状病毒肺炎2019(COVID-19)已在世界范围内传播。如何区分儿童COVID-19与其他病原体引起的肺炎尚未见报道。我们回顾性分析了97例疑似COVID-19的儿童临床资料。13例(13.4%)患者通过核酸RT-PCR检测证实SARS-CoV-2感染呈阳性,41例(42.3%)患者被发现感染其他病原体,43例(44.3%)患者未检测到病原体;25例(25.8%)有家族聚集性接触史;52例(53.6%)有一种或多种基础疾病。15名(15.5%)患者入院或转入PICU。11例确诊病例中分别有5例(45.5%)和7例(63.6%)抗SARS-CoV-2 IgM和IgG阳性,22例疑似COVID-19病例中1例(4.5%)IgG阳性、IgM阴性。最常见的病原体是肺炎支原体(29 [29.9%])。一名确诊为COVID-19的患者死亡。我们的研究结果表明,有必要提高对无症状感染或共存其他疾病儿童COVID-19的认识;因临床表现相似,在没有进行病原学检测之前,很难对这些患儿作出COVID-19的准确诊断;在高度怀疑SARS-CoV-2感染但核酸检测呈阴性的情况下,血清学检测可作为有用的辅助诊断工具。

03原文信息

标题

Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

作者

Xiaofang Cai, Hanlan Jiang, Simin Zhang, Shengying Xia, Wenhui Du, Yaoling Ma, Tao Yu, Wenbin Li

机构

1. 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

2. 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

3. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Corresponding Author Wenbin Li

Cite this article

Xiaofang Cai, Hanlan Jiang, Simin Zhang, Shengying Xia, Wenhui Du, Yaoling Ma, Tao Yu, Wenbin Li. Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19. Front. Med., 2020, 14(6): 776?785 https://doi.org/10.1007/s11684-020-0820-7

https://journal.hep.com.cn/fmd/EN/10.1007/s11684-020-0820-7

https://link.springer.com/article/10.1007/s11684-020-0820-7

摘要

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.

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