Çocuklarda COVID-19 Enfeksiyonunun Tanısı, Tedavisi ve Korunma Yolları

Abstract

Koronavirüsler (KoV), tek-zincirli RNA virüsleri olup alfa, beta, gamma ve delta olmak üzere dört gruba ayrılır. İnsanlarda genelde solunum ve gastrointestinal sistemde hastalıklara neden olurlar. Koronavirüsler çok hızlı mutasyon geçirdiklerinden dolayı yeni KoV tipleri ortaya çıkar ve hayvanlardan bulaşarak insanlarda hastalık yapabilir. 2002 yılında Çin’de ağır akut solunum sendromu koronavirüsü (SARS-KoV) ve 2012 yılında Suudi Arabistan’da Orta Doğu solunum sendromu koronavirüsü (MERS-KoV) olarak iki yeni koronavirüs ortaya çıktı. 2019 sonunda, yine Çin’de yeni bir koronavirüs (SARS-KoV-2) küresel bir salgın hastalığına (COVID-2019) neden oldu. İlk bulgulara göre SARS-KoV-2 çocuklarda asemptomatik veya hafif semptomlara neden olduğu gösterilmiştir. Erişkinlerde klinik tablo soğuk algınlığından bronşit, pnömoni, ağır akut solunum sıkıntısı sendromu (ARDS) ve ölümle sonuçlanan çoklu-organ yetmezliğine kadar değişebilir. Çocukların virüsün yayılmasındaki rolü tam olarak bilinmemektedir. Bu derlemede, çocuk hastalardaki yeni KoV enfeksiyonunun (COVID-19) klinik ve tanısal bulgularını, tedavisini ve önleme yollarını anlatmayı hedefledik.

Keywords

• SARS-KoV-2,çocuk,ateş,COVID-2019

Diagnosis, Treatment and Prevention Methods of Pediatric COVID-19 Infection

Abstract

Coronaviruses (CoVs) are single-stranded RNA viruses classified into four genera: alpha, beta, gamma and delta. They often cause the respiratory and gastrointestinal tract diseases in human. As coronaviruses rapidly evolve by new mutations, new types of CoVs emerge and cause disease through transmission from animals to humans. Two novel CoVs [severe acute respiratory syndrome coronavirus (SARS-CoV)] in China in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, have emerged. At the end of 2019, a new coronavirus (SARS-CoV-2) in China caused a disease (called as COVID-2019) and global outbreak. Based on the first reports, SARS-CoV-2 has been shown to cause asymptomatic or mild symptoms in children. In adults, the clinical presentation can range from common cold to bronchitis, pneumonia, severe acute respiratory distress syndrome (ARDS), and multi organ failure even resulting in death. The role of children in the transmission of the virus is not fully known. In this review, we aim to discuss the clinical and diagnostic findings, treatment and prevention methods of the new CoV infection (COVID-19) in pediatric patients.

Keywords

• SARS-CoV-2,children,fever,COVID-2019

References

1. 1. Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: what the neonatologist need to know. J Med Virol 2020; 1-4.
2. 2. Saif LJ. Animal coronaviruses: what can they teach us about the severe acute respiratory syndrome? Rev Sci Tech. 2004;23:643–660.
3. 3. Cabeça TK, Granato C, Bellei N, et al. Epidemiological and clinical features of human coronavirus infections among different subsets of patients. Influenza Other Respir Viruses. 2013;7:1040–1047
4. 4. Shi Z, Hu Z. A review of studies on animal reservoirs of the SARS coronavirus. Virus Res 2008; 133: 74-87.
5. 5. Huynh J, Li S, Yount B, et al. Evidence supporting a zoonotic origin of human coronavirus strain NL63. J Virol. 2012;86:12816–12825.
6. 6. Ovalı F. Yenidoğanlarda COVID-19 Enfeksiyonları. Anadolu Klin 2020;5(1), pp.23-35.
7. 7. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person to person transmission: a study of a family cluster. Lancet 2020; 395: 514-523.
8. 8. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 32. 2020. Available at:https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/20200221-sitrep-32-covid-19. pdf?sfvrsn=4802d089_2. Accessed March 2, 2020

9. 9. World Health Organization. Novel coronavirus situation report -2. January 22, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200122-sitrep-2-2019-ncov. pdf (Accessed on January 23, 2020).
10. 10. McIntosh K, Coronavirus Disease 2019 (COVID-19), UpToDate, retrieved from “https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19. pdf (Accessed on March 27, 2020).
11. 11. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; pii: e20200702
12. 12. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395:809.
13. 13. Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9:51.
14. 14. American College of Obstetricians and Gynecologists. Practive Advisory: Novel Coronavirus 2019 (COVID-2019).https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019 (Accessed on February 26, 2020).
15. 15. Zeng H, Xu C, Fan J et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA.2020;EPUB:E1-E2
16. 16. The Society of Pediatrics of Hubei Medical Association, The Society of Pediatrics of Wuhan Medical Association, Hubei Pediatric Medical Quality Control Center. Suggestions on the diagnosis and treatment of novel coronavirus infection in children in Hubei province (trial version 1). CJCP. 2020;22:96–9
17. 17. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-523.
18. 18. Shen K, Yang Y, Wang T, et al. China National Clinical Research Center for Respiratory Diseases; National Center for Children’s Health, Beijing, China; Group of Respirology, Chinese Pediatric Society, Chinese Medical Association; Chinese Medical Doctor Association Committee on Respirology Pediatrics; China Medicine Education Association Committee on Pediatrics; Chinese Research Hospital Association Committee on Pediatrics; Chinese Non-government Medical Institutions Association Committee on Pediatrics; China Association of Traditional Chinese Medicine, Committee on Children’s Health and Medicine Research; China News of Drug Information Association, Committee on Children’s Safety Medication; Global Pediatric Pulmonology Alliance. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr. 2020 Feb 7.
19. 19. Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020.
20. 20. Wang XF, Yuan J, Zheng YJ, et al. Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi. 2020;58:E008.
21. 21. Wei M, Yuan J, Liu Y, et al. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020.
22. 22. National Health Commission of People’s Republic of China. Diagnosis and treatment of pneumonia caused by novel coronavirus (trial version 4). https ://www.nhc.gov.cn/xcs/zheng cwj/202001/42945 63ed3 5b4320 9b31 739bd 0785e 67/files /7a930 91112 67475a99d4 30696 2c8bf 78.pdf. Access 28 Jan 2020.
23. 23. Hon KL, Leung CW, Cheng WT, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet. 2003;361:1701–1703.
24. 24. Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med. 2003;4:279–283.
25. 25. Bitnun A, Allen U, Heurter H, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics. 2003;112:e261.
26. 26. Feng K, Yun YX, Wang XF, et al. Analysis of CT features of 15 children with 2019 novel coronavirus infection. Zhonghua Er Ke Za Zhi. 2020;58:E007
27. 27. Babyn PS, Chu WC, Tsou IY, et al. Severe acute respiratory syndrome (SARS): chest radiographic features in children. Pediatr Radiol. 2004;34:47–58.
28. 28. 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 Clin Microbiol. 2010;48:2940–2947.
29. 29. Vabret A, Mouthon F, Mourez T, et al. Direct diagnosis of human respiratory coronaviruses 229E and OC43 by the polymerase chain reaction. J Virol Methods. 2001;97:59–66.
30. 30. Al Johani S, Hajeer AH. MERS-CoV diagnosis: an update. J Infect Public Health. 2016;9:216–219
31. 31. Wang BX, Fish EN. Global virus outbreaks: interferons as 1st responders. Semin Immunol. 2019;43:101300.
32. 32. Al-Tawfiq JA, Momattin H, Dib J, et al. Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational study. Int J Infect Dis. 2014;20:42–6.
33. 33. Wang HQ, Ma LL, Jiang JD, et al. Recombinant human interferon alpha 2b broad-spectrum anti-respiratory viruses pharmacodynamics study in vitro. Acta Pharmaceu Sin. 2014;49:1547–53
34. 34. Ji XG, Zhao YH, Zhang M, et al. The Experimental Study of the Anti-SARS-CoV Effect of Arbidole. Pharm J Chin PLA. 2004;20:274–6.
35. 35. National Health Commission of People’s Republic of China. Influenza diagnosis and treatment protocol (revised edition 2019). https://wenku .baidu .com/view/00f0d 41d20 79168 88486 8762c aaedd3383c 4b57f .html. Access 30 Nov 2019.
36. 36. Chu CM. Role of lopinavir/ritonavir in the treatment of SARS:initial virological and clinical findings. Thorax. 2004;59:252–6.
37. 37. AbbVie Deutschland GmbH & Co.KG. Lopinar veletonavir tablet specification. https ://www.jiank e.com/produ ct/79823.html. Access 7 July 2017.
38. 38. Savarino A, Di Trani L, Donatelli I, et al. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6:67–69.
39. 39. Vincent MJ, Bergeron E, Benjannet S, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69.
40. 40. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020:269–271.
41. 41. Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nature Communications 2020; 11:222.
42. 42. Karimi A, Tabatabaei SR, Rajabnejad M, et al. An Algorithmic Approach to Diagnosis and Treatment of Coronavirus Disease 2019 (COVID-19) in Children: Iranian Expert’s Consensus Statement. Arch Pediatr Infect Dis 8(2): e102400.
43. 43. National Health Commission of People’s Republic of China. Code for the diagnosis and treatment of community-acquired pneumonia in children (2019 edition). https ://www.nhc.gov.cn/yzygj /s7653 /20190 2/bfa75 8ad6a dd48a 599bc 74b58 8a6e8 9a.shtml. Access 11 Feb 2019.
44. 44. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. The Pediatric Infectious Disease Journal, 2020; Online First.