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Clinical Characteristics of Children with Corona Virus Disease: Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Mohammed Rizwanul Ahsan , Probir Kumar Sarkar, Nabila Akand, Kinkar Ghosh, Maleeha Sheefa
American Journal of Medical Sciences and Medicine. 2021, 9(2), 60-63. DOI: 10.12691/ajmsm-9-2-5
Received April 17, 2021; Revised May 22, 2021; Accepted May 30, 2021

Abstract

Background: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has spread around the world, and reports of children with COVID-19 are increasing. So for early diagnosis clinical profiles of pediatric COVID-19 patients are important. Methods: A retrospective was done analyzing clinical data from March 15th to 20th july in Dhaka shishu (children) hospital – A tertiary care hospital in Bangladesh. Only admitted patients were included. Results: Among 196 COVID 19 confirmed cases 116 (59.18%) male and 80 (40.82%) female patients were admitted in Medicine Units 160 and in Surgery units 36 patients. Regarding age distribution, 0-30 days aged 26 patients, 1-12 month aged 57 patients, 1-5 years aged patients, 5-10 years aged 42 patients, more than 10 years and less than 18 years aged 14 patients. Most patients came with fever 110 patients, Upper respiratory tract infection (URTS) 74 patients, Lower respiratory tract infection (LRTS) 68 patients, Myalgia 63 patients, Diarrhoea 41 patients, Headache 33 patients, Rash 27 patients, Conjunctivitis 5 patients and 36 patients came with different surgical emergencies. Conclusions: Symptomatic diagnosis of COVID 19 is difficult in children. So all children should be addressed properly. COVID-19 in children is often not serious, with favorable outcomes.

1. Introduction

World Health Organization (WHO), Termed coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV2 is the seventh member of the enveloped RNA human coronavirus (HCoV) family, which also includes HCoV-229E, −OC43, -NL63, -HKU1, SARS-CoV, and Middle East respiratory syndrome corona virus (MERS-CoV) 1. COVID-19 was first detected in humans towards the end of 2019 and the first cases were traced back to Wuhan city (Hubei province) in China 2. The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic 3. Although all humans are susceptible to SARS-CoV-2, it does appear that COVID-19 occurs less and is less severe in children than in adults 4, 5. Reports of pediatric vulnerability are increasing nonetheless 6, 7, 8, 9, 10. 1st case detected in Bangladesh 8th March. 1st Case detected in Dhaka shishu hospital at 15th March. In Bangladesh, COVID-19 infections are being reported from Directorate General of Health Service on daily basis. So far, we have around Total infected cases 2,07,453 and recovered 54.74%. Total death 2668 deaths, death rate 1.29% among them aged 0-10years, 18 (0.67%) and aged 11 years-20 years, 29 (1.09%) on 20th july, 2020 11, 12. In ittaly Children younger than 18 years of age who had Covid­19 composed only 1% of the total number of patients; 11% of these children were hospitalized, and none died 13. The Centers for Disease Control and Prevention (CDC) reported 2572 confirmed cases of COVID-19 in individuals younger than 18 years in the USA as of April 2, 2020, representing only 1·7% of the total number of recorded cases (n=149 760) 14. The Australian Health Protection Agency has reported that children accounted for only 4% of confirmed COVID-19 cases in Australia 15. In Bangladesh death rate of children is higher than many other countries. So it is important to identify the various presentation of COVID 19 in children. Existing papers from China contain very few clinical data on children with COVID-19. Similarly, recent epidemiological reports from Europe and North America contain little clinically relevant information 16. More medical case information is required to early diagnosis and to determine the level of support required by children is essential for pediatric service planning during the ongoing COVID-19 pandemic.

2. Methods

This study was a retrospective observational study. This study involved children younger than 18 years of age with Covid­19 confirmed by reverse transcriptase–polymerase chain reaction testing of nasal or nasopharyngeal swabs on suspected Covid-19 cases who were assessed between March 15th to 20th july in Dhaka Shisu (children) hospital. Only confirmed Covid-19 inpatients data were collected from authority with proper approval. Patient data included age, sex, clinical presentation such as fever, Upper respiratory tract infection (URTS), lower respiratory tract infection (LRTS), Myalgia, Diarrhoea, Headache, Rash 27, Conjunctivitis and symptoms suggesting different surgical emergencies. Statistical analysis was done by entering all data in the Microsoft Excel Worksheet and analyzed using proportions and percentage of the cases found.

3. Results

Among admitted patients, total 196 COVID 19 confirmed cases found. Most of them were male 116 and female 80. Figure 1 shows gender distribution.

According to department of admission among 196 patients in Medicine Units 160 and in Surgery units 36 patients were admitted. Following figure shows the distribution of patients in Medicine and Surgery Units.

According to age distribution, 0-30 days aged 26 patients, 1-12 month aged 57 patients, 1-5 years aged patients, 5-10 years aged 42 patients, more than 10 years and less than 18 years aged 14 patients were admitted. Following tables shows the age distribution with percentages.

Among 196 COVID 19 patients, most patients came with fever 110 patients, Upper respiratory tract infection (URTS) 74 patients, Lower respiratory tract infection (LRTS) 68 patients, Myalgia 63 patients, Diarrhoea 41 patients, Headache 33 patients, Rash 27 patients, Conjunctivitis 5 patients and 36 patients came with different surgical emergencies. Following table shows the clinical features with percentages.

4. Discussion

In this study 196 COVID 19 confirmed patients admitted. Among them most of them were male 116 (59.18%) and female 80(40.82%) where male and female ratio is 1.45:1. Lara s et al showed 52% male in a study. 17 Florian Götzinger et al in a multinational, multicentre cohort study found 1.15 male per female. 18 Among 196 patients in Medicine Units 160 and in Surgery units 36 patients were admitted. Other studies showed many patients needed surgical interventions with COVID 19 but little known comparison studies are available. In this study most patients aged 1 month to 5 years. Children under the age of 3 years are the most frequently affected 19, 20, 21, 22. Wei Xia et al found median age of 2 years and 1.5 months. 23 In a study Niccoldparri et al found the median age of the children was 3.3 years 24. In this study, most patients came with fever 110 (56.12%) patients, Upper respiratory tract infection (URTS) 74 patients, Lower respiratory tract infection (LRTS) 68 patients, Myalgia 63 patients, Diarrhoea 41 patients, Headache 33 patients, Rash 27 patients, Conjunctivitis 5 patients and 36 patients came with different surgical emergencies. Following table shows the clinical features with percentages. Xia et al. report the presence of fever, which was defined as axillary temperature over 37.3°C in 12 cases (12/20, 60%), cough in 13 cases (13/20, 65%), diarrhea in three cases (3/20, 15%), nasal discharge in three cases (3/20, 15%), sore throat in one case (1/20, 5%), and fatigue in one case (1/20, 5%) 25. In other studies similar symptoms such as fever 26, 27 rhinitis, 26, 27 pharyngitis 26, 27 and headache 26, 28, 29, pneumonia 26, 29, 30 and in up to 57% of cases, gastrointestinal symptoms. 31, 32 and conjunctivitis 33. In this study surgical cases were included but there clinical features were not described. In this study only admitted patients were discussed so actual clinical features may not showed up.

5. Conclusion

In children clinical features were not typical like adult in case of corona viral diseases. To diagnose corona virus diseases in this corona pandemic especially in Bangladesh this clinical features should be considered.

References

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[14]  CDC COVID-19 Response Team. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 422-26.
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[15]  COVID-19 National Incident Room Surveillance Team. COVID-19, Australia: epidemiology report 11 (reporting week 12 April 2020). Commun Dis Intell 2020; 44.
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[16]  Gudbjartsson DF, Helgason A, Jonsson H, et al. Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med 2020; published online April 14.
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[23]  Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults, Pediatric Pulmonology. 2020; 55: 1169-1174.
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[24]  Children with Covid-19 in Pediatric Emergency Departments in Italy, The New England, Meyer University Children’s Hospital Florence, Italy Journal of Medicine July 9 2020 187.
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[25]  Xia W, Shao J, Xia W, Shao J, Xia W, Shao J: Clinical and CT features in pediatric patients with COVID‐19 infection: different points from adults. Pediatr Pulmonol. 2020, [Epub ahead of print]:10.1002/ppul.24718.
In article      View Article  PubMed
 
[26]  Vabret A, Mourez T, Gouarin S, et al. An outbreak of coronavirus OC43 respiratory infection in Normandy, France. Clin Infect Dis. 2003; 36: 985-989.
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[27]  Chiu SS, Chan KH, Chu KW, et al. Human coronavirus NL63 infection and other coronavirus infections in children hospitalized with acute respiratory disease in Hong Kong, China. Clin Infect Dis. 2005; 40:1721-1729.
In article      View Article  PubMed
 
[28]  Davis BM, Foxman B, Monto AS, et al. Human coronaviruses and other respiratory infections in young adults on a university campus: prevalence, symptoms, and shedding. Influenza Other Respir Viruses. 2018; 12: 582-590.
In article      View Article  PubMed
 
[29]  Greenberg SB. Update on human rhinovirus and coronavirus infections. Semin Respir Crit Care Med. 2016; 37: 555-571.
In article      View Article  PubMed
 
[30]  McIntosh K, Kapikian AZ, Turner HC, et al. Sero epidemiologic studies of coronavirus infection in adults and children. Am J Epidemiol. 1970; 91: 585-592.
In article      View Article  PubMed
 
[31]  Esper F, Ou Z, Huang YT. Human coronaviruses are uncommon in patients with gastrointestinal illness. J ClinVirol. 2010; 48: 131-133.
In article      View Article  PubMed
 
[32]  Vabret A, Dina J, Gouarin S, et al. Detection of the new human coronavirus HKU1: a report of 6 cases. Clin Infect Dis. 2006; 42: 634-639.
In article      View Article  PubMed
 
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Published with license by Science and Education Publishing, Copyright © 2021 Mohammed Rizwanul Ahsan, Probir Kumar Sarkar, Nabila Akand, Kinkar Ghosh and Maleeha Sheefa

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
Mohammed Rizwanul Ahsan, Probir Kumar Sarkar, Nabila Akand, Kinkar Ghosh, Maleeha Sheefa. Clinical Characteristics of Children with Corona Virus Disease: Study in a Tertiary Care Hospital, Dhaka, Bangladesh. American Journal of Medical Sciences and Medicine. Vol. 9, No. 2, 2021, pp 60-63. http://pubs.sciepub.com/ajmsm/9/2/5
MLA Style
Ahsan, Mohammed Rizwanul, et al. "Clinical Characteristics of Children with Corona Virus Disease: Study in a Tertiary Care Hospital, Dhaka, Bangladesh." American Journal of Medical Sciences and Medicine 9.2 (2021): 60-63.
APA Style
Ahsan, M. R. , Sarkar, P. K. , Akand, N. , Ghosh, K. , & Sheefa, M. (2021). Clinical Characteristics of Children with Corona Virus Disease: Study in a Tertiary Care Hospital, Dhaka, Bangladesh. American Journal of Medical Sciences and Medicine, 9(2), 60-63.
Chicago Style
Ahsan, Mohammed Rizwanul, Probir Kumar Sarkar, Nabila Akand, Kinkar Ghosh, and Maleeha Sheefa. "Clinical Characteristics of Children with Corona Virus Disease: Study in a Tertiary Care Hospital, Dhaka, Bangladesh." American Journal of Medical Sciences and Medicine 9, no. 2 (2021): 60-63.
Share
[1]  N. Zhu, D. Zhang, W. Wang, et al. , A Novel Corona virus from Patients with Pneumonia in China, 2019, Lancet 395 (10223) (2020) 497-506.
In article      View Article
 
[2]  Lu R, Zhao X, Li J, et al.: Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020, 395: 565-574.
In article      View Article
 
[3]  https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020.
In article      
 
[4]  WHO-China Joint Mission, Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), (2020) Geneva Accessed March 1, 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-jointmission-on-covid-19 final -report.pdf.
In article      
 
[5]  Z.Wu, J. M.Mc Googan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese center for disease control and prevention, JAMA 323 (13) (2020) 12391242.
In article      View Article  PubMed
 
[6]  D. Wang, X.L. Ju, F. Xie, et al., Clinical analysis of 31 cases of 2019 novel corona virus infection in children from six provinces (autonomous region) of northern China, Zhonghua ErKeZaZhi58 (March2(4)) (2020) E0 11.
In article      
 
[7]  D. Sun, H. Li, X. X. Lu, et al., Clinical features of severe pediatric patients with corona virus disease 2019 in Wuhan: a single center’s observational study, World J. Pediatr. (March (19)) (2020).
In article      View Article  PubMed
 
[8]  Y. Dong, X. Mo, Y. Hu, et al., Epidemiology of COVID-19 among children in China, Pediatrics. (March (16)) (2020) e20200702.
In article      View Article  PubMed
 
[9]  W. Xia, J. Shao, Y. Guo, et al., Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults, Pediatr. Pulmonol. (March(5)) (2020).
In article      View Article  PubMed
 
[10]  W. Li, H. Cui, K. Li, et al., Chest computed tomography in children with COVID-19 respiratory infection, Pediatr. Radiol. (March(11)) (2020).
In article      View Article  PubMed
 
[11]  https://dghs.gov.bd/index.php/en/home/5343-covid-19-update.
In article      
 
[12]  https://youtu.be/D27IBGeKLx0.
In article      
 
[13]  Italian National Health Institute (IstitutoSuperiore di Sanità). Coronavirus epidemic: situation report. March 26, 2020. (In Italian) (https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino­sorveglianza­integrata­COVID­19_26­marzo%202020.pdf).
In article      
 
[14]  CDC COVID-19 Response Team. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 422-26.
In article      View Article  PubMed
 
[15]  COVID-19 National Incident Room Surveillance Team. COVID-19, Australia: epidemiology report 11 (reporting week 12 April 2020). Commun Dis Intell 2020; 44.
In article      View Article  PubMed
 
[16]  Gudbjartsson DF, Helgason A, Jonsson H, et al. Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med 2020; published online April 14.
In article      
 
[17]  JAMA Pediatr. 2020 May 11. doi: 10.1001/jamapediatrics.2020.1948.
In article      View Article  PubMed
 
[18]  https://doi.org/10.1016/S2352-4642 (20)30177-2.
In article      
 
[19]  Cabeça TK, Granato C, Bellei N. Epidemiological and clinical features of human coronavirus infections among different subsets of patients. Influenza Other Respir Viruses. 2013; 7: 1040-1047.
In article      View Article  PubMed
 
[20]  Gaunt ER, Hardie A, Claas EC, et al. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real-time PCR method. J ClinMicrobiol. 2010; 48: 2940-2947.
In article      View Article  PubMed
 
[21]  Zhang SF, Tuo JL, Huang XB, et al. Epidemiology characteristics of human coronaviruses in patients with respiratory infection symptoms and phylogenetic analysis of HCoV-OC43 during 2010-2015 in Guangzhou. PLoS One. 2018; 13:e0191789.
In article      View Article  PubMed
 
[22]  Friedman N, Alter H, Hindiyeh M, et al. Human coronavirus infections in Israel: epidemiology, clinical symptoms and summer seasonality of HCoVHKU1. Viruses. 2018; 10: 1-9.
In article      View Article  PubMed
 
[23]  Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults, Pediatric Pulmonology. 2020; 55: 1169-1174.
In article      View Article  PubMed
 
[24]  Children with Covid-19 in Pediatric Emergency Departments in Italy, The New England, Meyer University Children’s Hospital Florence, Italy Journal of Medicine July 9 2020 187.
In article      View Article  PubMed
 
[25]  Xia W, Shao J, Xia W, Shao J, Xia W, Shao J: Clinical and CT features in pediatric patients with COVID‐19 infection: different points from adults. Pediatr Pulmonol. 2020, [Epub ahead of print]:10.1002/ppul.24718.
In article      View Article  PubMed
 
[26]  Vabret A, Mourez T, Gouarin S, et al. An outbreak of coronavirus OC43 respiratory infection in Normandy, France. Clin Infect Dis. 2003; 36: 985-989.
In article      View Article  PubMed
 
[27]  Chiu SS, Chan KH, Chu KW, et al. Human coronavirus NL63 infection and other coronavirus infections in children hospitalized with acute respiratory disease in Hong Kong, China. Clin Infect Dis. 2005; 40:1721-1729.
In article      View Article  PubMed
 
[28]  Davis BM, Foxman B, Monto AS, et al. Human coronaviruses and other respiratory infections in young adults on a university campus: prevalence, symptoms, and shedding. Influenza Other Respir Viruses. 2018; 12: 582-590.
In article      View Article  PubMed
 
[29]  Greenberg SB. Update on human rhinovirus and coronavirus infections. Semin Respir Crit Care Med. 2016; 37: 555-571.
In article      View Article  PubMed
 
[30]  McIntosh K, Kapikian AZ, Turner HC, et al. Sero epidemiologic studies of coronavirus infection in adults and children. Am J Epidemiol. 1970; 91: 585-592.
In article      View Article  PubMed
 
[31]  Esper F, Ou Z, Huang YT. Human coronaviruses are uncommon in patients with gastrointestinal illness. J ClinVirol. 2010; 48: 131-133.
In article      View Article  PubMed
 
[32]  Vabret A, Dina J, Gouarin S, et al. Detection of the new human coronavirus HKU1: a report of 6 cases. Clin Infect Dis. 2006; 42: 634-639.
In article      View Article  PubMed
 
[33]  van der Hoek L, Pyrc K, Jebbink MF, et al. Identification of a new human coronavirus. Nat Med. 2004; 10: 368-373.
In article      View Article  PubMed