What is Coronavirus Infection in Children?
Coronavirus infection in children (abbreviated CVI) is an acute viral disease of the respiratory tract, which manifests itself in a variety of symptoms, from mild catarrh of the upper respiratory tract (inflammation of the mucous membranes of the respiratory tract) to severe acute respiratory syndrome (SARS or SARS – CoV), proceeding in the form SARS with high mortality.
If ARVI diseases are taken as 100%, then CVI accounts for about 10 to 15%.
Epidemiology
Coronavirus diseases, manifested as catarrh of the upper respiratory tract, are widespread. Cases of acute pneumonia, bronchitis, rhinosinusitis, etc. are also recorded. There are many strains of coronaviruses, therefore their role in the epidemiological process is difficult to establish. Diagnostic methods are imperfect. The latest outbreak of coronavirus infection has led to the collection of more epidemiological data. In November 2002, the beginning of the first SARS pandemic was fixed in China. The infection has passed through 32 countries, including the USA, Canada, Singapore, Taiwan, Hong Kong and China, as well as many other countries. 8460 cases of SARS were recorded (according to WHO) as of June 16, 2003. Among them, there are 799 fatal cases, which is 9.4% of the total number of cases.
Wild animals became a source of coronavirus infection – a Chinese ferret badger, raccoon dog and others. They are bred in many farms in China to produce perfumes, eau de toilette and delicatessen. Infection has a chance to occur during slaughter, skinning and carcass cutting – at almost every stage of the “production process”. It is also suggested that you can become infected while feeding the animal and other care-related activities. Heat treatment helps to kill the virus.
The disease is transmitted in two main ways – contact-household and airborne, as well as others. The disease is easily transmitted from one individual to another, as well as from person to person (and from person to animal). In the high-risk group were employees of hospitals organized for the treatment of patients with SARS. About 25% (one fourth!) Of hospital workers fell ill. Those who had contact with the sick at home (family members, relatives and friends) were also infected.
Specific antibodies were found in SARS-CoV-infected individuals in the body. As an experiment, monkeys were infected with a clinical picture that usually occurs with SARS.
Causes of Coronavirus Infection in Children
The family of coronaviruses includes two genera: coronaviruses and toroviruses. Until recently, it was believed that they excite such diseases: human acute respiratory infections, bird bronchitis, infectious bronchitis of mice, hepatitis of mice and rats, pig gastroenteritis. These diseases sometimes end in death in animals.
There are 3 serological groups in the genus of coronaviruses:
- human coronaviruses, dogs, cats (2 serotypes), pigs (2 serotypes), rabbits;
- human coronaviruses, pigs, mice, rats, cattle and turkeys;
- chicken coronaviruses (chicken bronchitis) and turkeys.
Coronaviruses often change, so SARS-coronavirus (SARS-CoV) has emerged – a new version of the virus, which is an independent type. It is called atypical pneumonia coronavirus.
The largest genome among all RNA-containing viruses is precisely in coronaviruses. The organization of the SARS-CoV genome, although similar to that of other groups of coronaviruses, differs from that of the nucleotide sequence in protein composition, which suggests that SARS-CoV is not completely related to the previously studied coronaviruses.
SARS-CoV is very similar, according to many researchers, to bovine coronavirus. The least similar to coronaviruses of pigs, humans, small rodents, birds and other animals.
Pathogenesis during Coronavirus Infection in Children
Currently, the pathogenesis of infection is not well understood. It is known that mainly the human respiratory tract is affected. And in children, damage to the bronchi and lungs is recorded.
What morphological changes during SARS will be fixed depends on the stage of the disease. The early stages are characterized by changes characteristic of acute respiratory failure. The appearance of hyaline membranes, diffuse damage to the alveoli, multinucleated cells, and swelling of the interstitial tissue were recorded.
Those epithelial cells in which the coronavirus got into the cytoplasm lost cilia and died. There were cases in which pronounced metaplasia was recorded (replacement of one tissue by another). At later dates, signs of pneumonic infiltration appear, namely, gross changes in the pulmonary parenchyma combined with fungal lesions of the lung structures and other organs and systems.
Severe acute respiratory syndrome is acute. After 6 or 7 days in patients in most cases there is an improvement with the complete reverse development of inflammatory changes in the respiratory system.
In some cases, the disease was recorded in a more severe form, in which respiratory function is impaired. In such cases, artificial ventilation is necessary. In the next 2-3 months after the disease, a recurrence of pneumonia is possible, as well as pulmonary fibrosis.
Coronavirus infection in young children is most often moderate or mild. The disease is characterized by an acute onset, the development of catarrhal symptoms in the nasopharynx or gastrointestinal manifestations (symptoms from the gastrointestinal tract). Body temperature is febrile or subfebrile, in some cases it may remain within the normal range. Mixed infections that occur with a combination of coronaviruses and other respiratory viruses are generally no more severe than monoinfection options.
Symptoms of Coronavirus Infection in Children
From 2 to 7 days (maximum 10), the incubation period lasts when infected with a coronavirus infection. Symptoms of the disease are similar to respiratory syncytial, parainfluenza and rhinovirus infection.
The main symptoms are:
- rhinitis
- swallowing pain
- malaise
- headaches
- bronchial obstruction (a form of respiratory failure).
The disease often has a mild course, the symptoms are mild. Body temperature in some cases rises to subfebrile, but often it is normal. The main symptom is rhinitis. The disease lasts an average of about 5-7 days.
The combination of respiratory and gastrointestinal syndromes (disturbances in the gastrointestinal tract) is characteristic of coronavirus infection. Symptoms such as anxiety, adynamia, loss of appetite are not often expressed), they last about 2-3 days. Rare cases have been recorded when the disease becomes severe. Then the coronavirus infection develops similar to the flu, intoxication is expressed and manifests itself as repeated vomiting and severe anxiety.
In young children, not only catarrhal syndrome manifests itself, but also vomiting or regurgitation, as well as loose stools of an enteric nature. These symptoms last for 2 to 5 days. And older children complain of abdominal pain, vomiting and loose stools.
Diseases that have a course similar to SARS begin with fever. It reaches 38–39 ° C. The child feels unwell and a slight chill. Sweating, headache, throat perspiration, cough dry, without expectorant sputum. Myaglia is often manifested (muscle pain). Coughing tends to intensify in the evening and at night. In rare cases, symptoms of coronavirus infection in children appear, such as nausea, diarrhea, vomiting (mild).
At the peak of the disease, the temperature rises again, the pain intensifies. The child begins to feel that he lacks air in his lungs, breathing is difficult. Children of older age may complain of palpitations, chest tightness.
Doctors hear moist menstrual rales in the basal sections on both sides of the sick child’s lungs, crepitus. With percussion, a blunting of the pulmonary sound is recorded. At the height of inspiration, wheezing becomes more intense, after coughing they do not disappear, they do not have any dependence on the position of the patient (sitting, standing, lying). An increase in heart rate is recorded, blood pressure may decrease.
When the disease reaches the stage of acute respiratory failure, shortness of breath appears. This is also called respiratory distress syndrome. Non-invasive ventilation is often prescribed, since oxygen inhalation usually does not bring results. In severe cases, use artificial ventilation.
The X-ray diffraction pattern shows the presence of infiltrates in the peripheral departments of the pulmonary fields. When the disease progresses, infiltrates become wider, bilateral.
The analysis shows leukopenia, lymphopenia, an increase in the relative number of neutrophils, and thrombocytopenia in peripheral blood. A biochemical blood test shows an increase in the activity of lactate dehydrogenase, crea-TIMpphosphokinase, aspartic and alanine transaminases, and a decrease in sodium.
Diagnosis of Coronavirus Infection in Children
Diagnosis of coronavirus infection in children involves several stages.
Hematological parameters (indicators of blood analysis) with coronavirus infection and other acute respiratory viral infections do not differ significantly. The severity of the disease is shown by a picture of blood, it depends on the degree of damage to the respiratory tract and on the attachment and consequences of the bacterial flora.
In order to diagnose SARS, the data of an epidemiological history are used primarily. It is important whether the patient has visited endemic areas of Southeast Asia and other countries in which cases of SARS have been reported. Check if the patient had contact with patients with CVI or with those who suspected CVI.
Laboratory studies are based on PCR (identifies the causative agent of the disease), RIF (immunofluorescence reactions). Testing is also carried out in ELIZA systems with monoclopal antibodies. Also, for diagnosis, sometimes an increase in the titer of antibodies in RSK and RTGA is detected. The most promising methods are the rapid diagnosis of coronavirus infection – detection of antigen in the cells of the mucous membrane of the nasal cavity in RIF and PCR.
Treatment of Coronavirus Infection in Children
Treatment of coronavirus infection in children is carried out, similar to the treatment of other acute respiratory viral infections, if the form of the disease is mild or moderate. With SARS, doctors prescribe ribavirin (the route of administration is oral or inhalation), interferon (viferon) or drugs based on it, interferon inducers (for example, arbidol, amixin, anaferon for children, etc.).
Prevention of Coronavirus Infection in Children
In the prevention of coronavirus infection in children, interferon preparations are used: fluferferon, leukinferon ointment and other interferon inducers: arbidol, polyoxidonium, etc. There are no preventive vaccines.