SARS-CoV-2 enfeksiyonu pozitif çocuk hastaların gerçek zamanlı PCR döngü eşik değeri, epidemiyolojik ve klinik özelliklerinin retrospektif olarak değerlendirilmesi

Year 2022, Volume: 15 Issue: 3, 561 - 572, 31.12.2022

Gül Bayram Harun Gülbudak Taylan Bozok Mehtap Akça Ali Türker Çiftçi Necdet Kuyucu Gönül Aslan

https://doi.org/10.26559/mersinsbd.1145014

Abstract

Amaç: COVID-19’un yol açtığı şiddetli klinik sonuçlara neden olan risk faktörleri yetişkin hastalarda çocuk hasta grubuna göre daha iyi tanımlanmıştır. Bu çalışmada hastanemize COVID-19 şüphesi ile başvuran ve SARS-CoV-2 testi pozitif saptanan çocuk hastalarda sosyo-demogrofik özellikler, klinik bulgular ve eşik değeri “cycle threshold” (Ct) değeri arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmada 1 Mayıs 2020-31 Ekim 2021 tarihleri arasında Mersin Üniversitesi Hastanesi COVID-19 laboratuvarında SARS-CoV-2 RT-qPCR testi pozitif saptanan 2971 çocuk hasta çalışmaya dahil edilmiştir. SARS-CoV-2 RT-qPCR testi, nazofarengeal ve orofarengeal sürüntü örneklerinden yapılmıştır. RT-qPCR sonucundan elde edilen Ct değerleri düşük, orta, yüksek şeklinde sınıflandırılmıştır. Bulgular: SARS-CoV-2 enfeksiyonu pozitif olan çocuk hastalarda en sık görülen semptomlar sırasıyla ateş %41.5, öksürük %28.6 ve boğaz ağrısı %24.4 olarak belirlenmiştir. SARS-CoV-2 pozitif asemptomatik ve semptomatik çocuk hastaların Ct değerleri düşüktür (<24) ve hastalar yüksek risk grubunda yer almaktadır. SARS-CoV-2 pozitif çocuklarda semptomlar ve Ct grupları arasındaki ilişki değerlendirildiğinde özellikle ateş (%43.1), halsizlik (%18.8) ve baş ağrısı (%16.3) semptomu gösteren hastaların yüksek viral yük grubunda olduğu saptanmıştır. Sonuç: Çalışmamızda yer alan temaslı hastaların çoğunun COVID-19’lu aile üyelerinden birine maruz kalması nedeniyle Ct değerinin düşük olduğu düşünülmektedir. Bundan dolayı potansiyel bulaştırıcılıkları yüksek olan bu temaslı grubunun takibi, kontrolü ve izolasyonu halk sağlığı açısından önemli bir noktadır.

Keywords

SARS-CoV-2, COVID-19, eşik değeri (Ct), semptom

Supporting Institution

Yok

Project Number

Yok

Retrospective evaluation of epidemiological, clinical and Real-time PCR cycle threshold of SARS-CoV-2 infection positive pediatric patients

Abstract

Aim: Risk factors that cause severe clinical outcomes caused by COVID-19 are better defined in adult patients than in the pediatric patient group. In this study, it was aimed to evaluate the relationship between socio-demographic characteristics, clinical findings and cycle threshold (Ct) value in pediatric patients who applied to our hospital with the suspicion of COVID-19 and were found to have a positive SARS-CoV-2 test. Method: In the study, 2971 pediatric patients with positive SARS-CoV-2 RT-qPCR test in Mersin University Hospital COVID-19 laboratory between 1 May 2020 and 31 October 2021 were included in the study. The SARS-CoV-2 RT-qPCR test was performed on nasopharyngeal and oropharyngeal swab samples. Ct values obtained from the RT-qPCR result were classified as low, moderate, and high. Results: The most common symptoms in pediatric patients with positive SARS-CoV-2 infection were fever 41.5%, cough 28.6% and sore throat 24.4%, respectively. Ct values of SARS-CoV-2 positive asymptomatic and symptomatic pediatric patients are low (<24) and the patients are in the high risk group. When the relationship between symptoms and Ct groups in SARS-CoV-2 positive children was evaluated, it was determined that patients with fever (43.1%), fatigue (18.8%) and headache (16.3%) were in the high viral load group. Conclusion: Most of the contact patients in our study were thought to have low Ct value because they were exposed to a family member with COVID-19. Therefore, monitoring, control and isolation of this contact group with high potential contagion is an important point in terms of public health.

Keywords

SARS-CoV-2, COVID-19, cycle threshold (Ct), symptom

Project Number

Yok

References

• World Health Organization. https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov. 9 Nisan 2022’ de erişildi.
• World Health Organization. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. 19 Nisan 2022’ de erişildi.
• World Health Organization. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---22-june-2022. 23 Haziran 2022’ de erişildi.
• 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. Pediatr Infect Dis J. 2020;39(5):355-68. doi: 10.1097/INF.0000000000002660.
• Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/71/wr/mm7111e2.htm. 22 Mart 2022’ de erişildi.
• Wald ER, Schmit KM, Gusland DY. A Pediatric infectious disease perspective on COVID-19. Clin Infect Dis. 2021;72(9):1660-66. doi: 10.1093/cid/ciaa1095.
• Maltezou HC, Magaziotou I, Dedoukou X, et al. Children and adolescents with SARS-CoV-2 infection: Epidemiology, clinical course and viral loads. Pediatr Infect Dis J. 2020;39(12):e388-e392. doi: 10.1097/INF.0000000000002899.
• Afonso ET, Marques SM, Costa LDC, et al. Secondary household transmission of SARS-CoV-2 among children and adolescents: Clinical and epidemiological aspects. Pediatr Pulmonol. 2022;57(1):162-175. doi: 10.1002/ppul.25711.
• Yung CF, Kam KQ, Chong CY, et al. Household transmission of Severe Acute Respiratory Syndrome Coronavirus 2 from adults to children. J Pediatr. 2020;225:249-51. doi: 10.1016/j.jpeds.2020.07.009.
• Dus-Ilnicka I, Szymczak A, Malodobra-Mazur M, Tokarski M. Role of laboratory medicine in SARS-CoV-2 diagnostics. lessons learned from a pandemic. Healthcare. 2021;9(7):915. doi: 10.3390/healthcare9070915.
• Moreno-Contreras J, Espinoza MA, Sandoval-Jaime C, et al. Saliva sampling and its direct lysis, an excellent option to increase the number of SARS-CoV-2 diagnostic tests in settings with supply shortages. J Clin Microbiol. 2020;58(10): e01659-20. doi: 10.1128/JCM.01659-20.
• Yuan X, Yang C, He Q,, et al. Current and perspective diagnostic techniques for COVID-19. ACS Infect Dis. 2020;6(8):1998–2016. doi: 10.1016/j.jpeds.2020.07.009.
• Rao SN, Manissero D, Steele VR, Pareja J. A Narrative systematic review of the clinical utility of cycle threshold values in the context of COVID-19. Infect Dis Ther. 2020; 9:573-86. doi: 10.1007/s40121-020-00324-3.
• Tom MR, Mina, MJ. To interpret the SARS-CoV-2 test, consider the cycle threshold value. Clin Infect Dis. 2020:71(16):2252–54. doi: 10.1093/cid/ciaa619.
• Aykac K, Yayla BCC, Ozsurekci Y, et al. The association of viral load and disease severity in children with COVID-19. J Med Virol. 2021;93(5):3077-83. doi: 10.1002/jmv.26853.
• Sarkar B, Sinha RN, Sarkar K. Initial viral load of a COVID19-infected case indicated by its cycle threshold value of polymerase chain reaction could be used as a predictor of its transmissibility-an experience from Gujarat, India. Indian J Community Med. 2020;45(3):278–282. doi: 10.4103/ijcm.IJCM_593_20.
• La Scola B, Le Bideau M, Andreani J, et al. Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards. Eur J Clin Microbiol Infect Dis. 2020; 39:1059-61. doi: 0.1007/s10096-020-03913-9.
• Centers for Disease Control and Prevention. Symptoms of COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/ symptoms-testing/symptoms.html. 4 Mart 2022’de erişildi.
• Bai Y, Gao L, Wang X, et al. Epidemiological characteristics and clinical manifestations of pediatric patients with COVID-19 in China: A multicenter retrospective study. Pediatr Investig. 2021:12;5(3):e12282. doi: 10.1002/ped4.12282.
• Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95. doi: 10.1111/apa.15270.
• Berksoy E, Kanik A, Çiçek A, et al. Clinical and laboratory characteristics of children with SARS-CoV-2 infection. Pediatr Pulmonol. 2021;56(12):3674-81. doi: 10.1002/ppul.25654.
• Şık N, Özlü C, Asrak HK, ve ark. Çocuk acil serviste SARS-CoV-2 PCR pozitif saptanan olguların değerlendirilmesi. Mikrobiyol Bul. 2020;54(4):629-637. doi:10.5578/mb.70086.
• Korkmaz MF, Türe E, Dorum BA, Kılıç ZB. The epidemiological and clinical characteristics of 81 children with COVID-19 in a pandemic hospital in Turkey: an observational cohort study. J Korean Med Sci. 2020;35(25):e236. doi: 10.3346/jkms.2020.35.e236.
• Özgökçe ÖB, Akça M, Bozlu G, Türkegün M, Kuyucu N. Covid 19 pandemisinin erken döneminde SARS-CoV-2 ile enfekte çocukların epidemiyolojik, klinik ve laboratuvar özelliklerinin değerlendirilmesi. Mersin Univ Saglık Bilim Derg. 2022; 15((Özel Sayı-1) 21. Mersin Pediatri Günleri Bildiri Kitabı): 157-169.
• Kociolek LK, Muller WJ, Yee R, et al. Comparison of upper respiratory viral load distributions in asymptomatic and symptomatic children diagnosed with SARS-CoV-2 infection in pediatric hospital testing programs. J Clin Microbiol. 2020;59(1):e02593-20. doi:10.1128/JCM.02593-20.
• Lyngse FP, Molbak K, Skov RL, et al. Increased transmissibility of SARS-CoV-2 lineage B.1.1.7 by age and viral load. Nat Commun. 2021;12(1):7251. doi: 10.1038/s41467-021-27202-x.
• Strutner J, Ramchandar N, Dubey S, et al. Comparison of RT-PCR cycle threshold values from respiratory specimens in symptomatic and asymptomatic children with SARS-CoV-2 infection. Clin Infect Dis. 2021:ciab403. doi: 10.1093/cid/ciab403.
• Kam KQ, Thoon KC, Maiwald M, et al. SARS-CoV-2 viral RNA load dynamics in the nasopharynx of infected children. Epidemiol Infect. 2021;149:e18. 10.1017/S095026882100008X.
• Yonker LM, Neilan AM, Bartsch Y, et al. Pediatric severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2): Clinical presentation, infectivity, and immune responses. J Pediatr. 2020;227:45-52.e5. 10.1016/j.jpeds.2020.08.037.
• Chakraborty C, Sharma AR, Bhattacharya M, Agoramoorthy G, Lee SS. A Paradigm shift in the combination changes of SARS-CoV-2 variants and increased spread of Delta variant (B.1.617.2) across the World. Aging Dis. 2022;13(3):927-942. doi:10.14336/AD.2021.1117.