Results
SARS-CoV-2 infection was detected in 91 patients (77 detected by RT-PCR and 14 by serology). Eight pediatric COVID-19 cases were excluded for bacterial coinfection. Panel 21 was performed in 56 laboratory confirmed COVID-19 patients, seven patients had coinfection with rhinovirus. Respiratory viruses were detected in 195 patients and 31 were excluded for bacterial coinfection.
Therefore, 76 patients were included in Group 1; 157 patients in Group 2. Table 1 present demographical and clinical features of patients in Group 1 and 2.
Patients with underlying conditions were in two groups and were described in Table 2.
The ORP identified in Group 2 were: human rhinovirus/enterovirus, n=132/157 (84.0%); adenovirus, n= 18/157 (11,5%); bocavirus n=8/157 (5%); RSV, n=6/157 (3.8%); other coronavirus n=3/157 (1.9%); influenza, parainfluenza and parechovirus, n=2/157 (1.3%) each one. 17/157 (10,8%) had viral coinfections, of which 94,1% (16/17) was attributed to rhinovirus/enterovirus.
Laboratory exams and radiological abnormalities frequency of two groups were exhibited in table 3.
In Group 1, nine patients had multisystem inflammatory syndrome in children (MIS-C), of which none presented viral coinfection. 50% of all deaths (4/8) occurred in MIS-C patients. Table 4 show outcomes and treatment in two groups.
Further analysis between SARS CoV-2 infection compared to only rhinovirus showed that the last group were significantly younger [135 (1-215) months vs 63 (2-216 months of age); p=0.001]; presented higher frequency of coughing [30/74 (41%) vs 73/123 (59%); p=0.01], lower frequency of fever [52/76 (69%) vs 62/130 (48%); p=0.01] and shorter duration of fever [median of 2 (0-15) vs 1 (0-12) days; p=0.02] compared to the former group. On the other hand, SARS-CoV-2 group presented the following signs/symptoms more frequently: anosmia [7/48 (15%) vs 2/85 (2%); p=0.01]; pneumonia [17/76 (22%) vs 6/130 (5%); p<0.001]; myalgia [18/62 (29%) vs 7/88 (8%); p=0.001]; headache [18/58 (31%) vs 14/91 (15%); p=0.03] and rash [7/74 (10%) vs 2/120 (2%); p=0.03]. SARS-CoV-2 group also presented with higher ferritin levels [median 201 (15-35,976) vs 85 (18-3,837); p=0.002] and lower leucocyte count [median 6,470 (430-25,890) vs 8,630 (170-21,120); p=0.01]. Radiographic abnormalities were found more frequently in SARS-CoV-2 group [25/49 (51%) vs 20/67 (30%); p=0.03]. Use of antibiotics [40/76 (53%) vs 49/131 (38%); p=0.04], oseltamivir [20/76 (26%) vs 13/131 (10%); p=0.003], intravenous immunoglobulin [7/75 (9%) vs 2/131 (2%); p=0.01] and enoxaparin [7/76 (9%) vs 1/130 (1%); p=0.004] were more frequent in SARS-CoV-2 group. Furthermore, SARS-CoV-2 group presented with poorer outcomes: higher rates of hospitalization [51/76 (67%) vs 58/131 (44%); p=0.002], PICU admission [18/76 (24%) vs 5/130 (4%); p<0,001], need of oxygen [23/76 (30%) vs 19/131 (15%); p=0.01], shock [8/76 (11%) vs 3/131 (2%); p=0.02], mechanical ventilation [9/76 (12%) vs 3/131 (2%); p=0.01], use of vasoactive agents [5/76 (7%) vs 1/131 (1%); p=0.03] and cardiac abnormalities [10/76 (13%) vs 1/130 (1%); p<0.001].
There were no statistically significant differences between seven cases of rhinovius/enterovirus and SARS-CoV-2 coinfected patients and those in Group 1 (p>0.05).