Clinical presentation of pediatric patients with symptomatic SARS-CoV-2 infection during the first months of the COVID-19 pandemic in a single center in Mexico City

BackgroundThe clinical spectrum of COVID-19 is broad, from asymptomatic to severe cases and death. The objective of this study is to analyze the clinical course of patients attended during the first months of the SARS-CoV-2 pandemic in a third-level pediatric hospital.MethodsDesign: prospective cohort study. Patients with viral respiratory disease or suspected cases of COVID-19 were evaluated at the Pediatric Hospital, National Medical Center XXI Century, Mexico City, from 21 March 2020 to 13 January 2021. Statistical analysis: Chi-square test and Fisher’s exact test were used for comparisons; a logistic regression model was constructed to identify clinical or laboratory characteristics associated with critical disease. A p-value < 0.05 was considered statistically significant.ResultsA total of 697 patients met the operational definition of viral respiratory disease or suspected cases of COVID-19 and underwent real-time reverse transcription polymerase chain reaction (rRT-PCR) SARS-CoV-2 testing. Patients with a positive result were included. Of the 181 patients (26%), 121 (66.8%) had mild disease and were treated as outpatients and 60 (33.1%) were hospitalized. A total of six patients met the criteria for multisystem inflammatory syndrome in children (MIS-C). Of the 60 inpatients, 65% were males, and 82% had one or more comorbidities. The main comorbidities were cancer (42%) and overweight (15%). The median hospital stay was 9 days. The inpatients had a higher frequency of fever, general malaise, dyspnea, chills, polypnea, and cyanosis than the outpatients (p < 0.05). Only 21.4% of the outpatients had one or more comorbidities, which were lower than in the hospitalized patients (p < 0.001). Laboratory data at admission were similar between critically ill and those with moderate and severe disease. The patients who developed pneumonia were at higher risk of critical disease, while older age was associated with a better prognosis. A total of 13 of the 60 inpatients died (mortality 7.1%). All but one had one or more comorbidities: four had cancer, four congenital heart disease, one chronic kidney disease and epilepsy, one Epstein–Barr virus-induced hemophagocytic lymphohistiocytosis, one obesity, and one diabetes mellitus.ConclusionHospital mortality is high, especially in children with comorbidities. Despite 2 years having passed since the beginning of the COVID-19 pandemic, the epidemiological and clinical data on children are still helpful to improve their prognosis

Basic information on COVID-19 pandemic, due to SARS-Cov-2 Virus

The World Health Organization (WHO) declared the SARS-CoV-2 virus outbreak an internationally important public health emergency on 30 January  2020, and by 11 March declared it a pandemic. By 15 November 2020, according  to the WHO weekly report, there were  53.7 million confirmed cases and  1.3 million deaths reported globally. The Americas region is the most affected. The incubation period has been documented between 3 and 6 days. Transmission occurs from person to person by  respiratory droplets, which occur when a person speaks, coughs or sneezes.  The clinical presentation can range from a mild respiratory disease, with coughing, headache, and  general discomfort, which resolves in a few days, to a severe disease with shortness of breath, that requires immediate attention.  Global lethality reported as of November 26 is 2.3%. It is higher in people over the age of 65 and with underlying diseases such as high blood pressure, obesity, and diabetes. There is currently no specific antiviral treatment. Vaccines are in development and several of them have shown promising results, but there is still a need to conclude with global trials. Until vaccination can be initiated,  prevention and control measures should be continued.  The best way to prevent the disease is to avoid exposure to infected or possibly infected people, as the virus can be transmitted even if the person has no symptoms.La Organización Mundial de la Salud (OMS) declaró al brote por el virus SARS-CoV-2 como una emergencia de salud pública de importancia internacional el día 30 de enero de 2020, y para el 11 de marzo hizo la declaratoria de pandemia. Para el 15 noviembre de 2020, de acuerdo con el informe semanal de la OMS, se reportaron de forma global 53.7 millones de casos confirmados, y 1.3 millones de defunciones. La región de las Américas es la más afectada. El periodo de incubación ha sido documentado entre 3 a 6 días. La transmisión ocurre de persona a persona gotas respiratorias, que se producen cuando una persona habla, tose o estornuda.  El cuadro clínico puede ir desde una enfermedad respiratoria leve, con tos, cefalea, malestar general, que resuelve en unos días, hasta un cuadro grave con dificultad respiratoria que requiere atención inmediata. La letalidad global mundial reportada al 26 de noviembre es de 2.3%, es mayor en personas mayores de 65 años y con enfermedades subyacentes como hipertensión arterial, obesidad, y diabetes. Al momento no se cuenta con un tratamiento antiviral específico. Las vacunas están en desarrollo y varias de ellas han mostrado resultados prometedores, pero falta concluir con los ensayos. En tanto se puede iniciar la vacunación, se debe continuar con las medidas de prevención y control.  La mejor forma de prevenir la enfermedad es evitar exponerse a personas infectadas o posiblemente infectadas, ya que el virus puede transmitirse aún si la persona no tiene síntomas

Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico

IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases