3.4 The severity of COVID-19 and comparison between pediatric patients with and without pneumonia
Fifty-four infected children did not develop pneumonia, including 24 asymptomatic infections and 30 cases with AURI, and they were compared to patients with mild pneumonia (Table 5 and 6). The prevalence of allergic diseases showed no difference between children without pneumonia and those with mild pneumonia (20.4% vs 25.0%, p = 0.504). When compared to asymptomatic/AURI types, COVID-19 pneumonia, though mild, occurred more in children with other past medical history (21.0% vs 7.4%, p = 0.046), manifested more as fever (50.0% vs 27.8%, p = 0.006) and cough (52.4% vs 29.6%, p = 0.005), and caused more increased level of PCT (57.9% vs 22.9%, p < 0.001), ALP (9.2% vs 0%, p = 0.035) and IL-10 (27.0% vs 0%, p < 0.001), and less decreased level of complement C3 (11.3% vs 28.8%, p = 0.006). The monocytes count, levels of PCT, AST and complement C4, and all the levels of tested cytokines (IL-2, 4, 6 and 10, TNF-α and IFN-γ) were higher, and the level of IgG was lower, in mild pneumonia group than those in non-pneumonia group (p < 0.05), though most of them were in normal ranges. Other clinical and laboratory parameters were not found different between the two groups.
There was only one severe case and three critically ill cases, which were individually described in Table 7. Three of them were male and one was female. Patient 1 was a 13 years and 5 months old boy, who had a close contact with confirmed COVID-19 family members, his mother and grandparents. He was allergic to penicillin. He presented with chest congestion and polypnea. The patient recovered after oxygen supplement and antiviral treatment (inhalation of interferon-α). Patient 2 was a 13-month-old boy, who presented with vomiting, diarrhea and polypnea. He was complicated with septic shock, multiple organ dysfunction syndrome (MODS), kidney stone, hydronephrosis. He received mechanical ventilation and treatment with antiviral, antibiotics and intravenous immunoglobulin (IVIG) and his symptoms were improved. This patient had been elaborated in a Case Report in Chinese.24 Patient 3 was a 10-month-old girl with intussusception, who had intestinal necrosis, septic shock and multiorgan failure, and died 4 weeks after admission. She was mentioned in a previous literature.8 We included these patients here for the integrity of the data. Patient 4, an 8-year-old boy, got infected by his family members and was found in the COVID-19 screening during the hospitalization for treating acute lymphoblastic leukemia. On the 24th day of hospitalization, he was transferred to ICU due to respiratory failure and accepted mechanical ventilation (February 18); although with difficulty in weaning, he finally recovered It was evident that the levels of acute phase inflammatory indicators (CRP and PCT) and cytokines (IL-6 and IL-10) dramatically increased in three critically ill cases (Patient 2, 3 and 4).