Clinical Presentation and Outcome of Acute Respiratory Illnesses in South African Children During the COVID-19 Pandemic.
Clinical Presentation and Outcome of Acute Respiratory Illnesses in South African Children During the COVID-19 Pandemic.
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DOI：
10.1097/inf.0000000000003951
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发表时间：
2023-08-01
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来自低收入和中等收入国家的数据显示，严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的急性呼吸系统疾病(ARI)儿童的发病率和死亡率较高。然而，在这方面，SARS-CoV-2感染是否有别于其他引起ARI的原因尚不清楚。我们描述了南非患有SARS-CoV-2和非SARS-CoV-2 ARI的儿童的临床特征和转归。我们进行了一项横断面研究，研究对象包括2020年5月至12月在泰格伯格医院接受ARI治疗的0-13岁儿童。常规临床资料由主治医师收集。所有儿童均接受SARS-CoV-2聚合酶链式反应检测。对于疾病的严重性，考虑了呼吸支持的必要性和支持的持续时间。建立多因素Logistic回归模型，分析SARS-CoV-2感染和严重程度的影响因素。有176名儿童的数据可用，38名儿童(22%)SARS-CoV-2聚合酶链式反应阳性，138名儿童(78%)阴性。SARS-CoV-2阳性儿童多为女性(OR：2.68，95%CI：1.18~6.07)，年龄别体重Z评分较低(OR：0.76，95%CI：0.63~0.93)，发热多(OR：3.56，95%CI：1.54~8.24)，咳嗽少(OR：0.27，95%CI：0.11~0.66)。SARS-CoV-2感染与氧疗持续时间显著延长有关(中位数8天对3天；OR：1.1，95%CI：1.01-1.20)。总体而言，66%的儿童患有病毒合并感染，两组之间没有显著差异。总体而言，SARS-CoV-2阳性儿童因呼吸道原因在3个月内再次入院的比例为18%，而SARS-CoV-2阴性儿童的这一比例为15%(P=0.64)。我们的数据显示，来自SARS-CoV-2的ARI不容易区分，但与其他原因的ARI相比，ARI的发病率更高。总体结果是好的。严重的SARS-CoV-2肺炎对低收入和中等收入国家幼儿的长期影响需要进一步研究。
Data from low- and middle-income countries (LMICs) show higher morbidity and mortality in children with acute respiratory illness (ARI) from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, whether SARS-CoV-2 infection is distinct from other causes of ARI in this regard is unclear. We describe clinical characteristics and outcomes of South African children with SARS-CoV-2 and non-SARS-CoV-2 ARIs. We performed a cross-sectional study including 0–13 years old children admitted to Tygerberg Hospital between May and December 2020 with an ARI. Routine clinical data were collected by the attending clinicians. All children underwent SARS-CoV-2 polymerase chain reaction testing. For severity of disease, the need for respiratory support and duration of support was considered. Multivariable logistic regression models were built to determine the factors associated with SARS-CoV-2 infection and severity. Data for 176 children were available, 38 (22%) children were SARS-CoV-2 polymerase chain reaction positive and 138 (78%) were negative. SARS-CoV-2 positive children were more likely to be female (OR: 2.68, 95% CI: 1.18–6.07), had lower weight-for-age Z score (OR: 0.76, 95% CI: 0.63–0.93), presented more frequently with fever (OR: 3.56, 95% CI: 1.54–8.24) and less often with cough (OR: 0.27, 95% CI: 0.11–0.66). SARS-CoV-2 infection was associated with significantly longer duration of oxygen treatment (median 8 vs. 3 days; OR: 1.1, 95% CI: 1.01–1.20). Overall, 66% of children had viral coinfection, with no significant difference between the groups. In total, 18% of SARS-CoV-2 positive children were readmitted within 3 months for a respiratory reason, compared with 15% SARS-CoV-2 negative children (P = 0.64). Our data show that ARIs from SARS-CoV-2 cannot be easily differentiated, but were associated with a higher morbidity compared with ARIs from other causes. Overall outcomes were good. The long-term implications of severe SARS-CoV-2 pneumonia in young children in low- and middle-income countries require further study.