Background

During the coronavirus disease 2019 (COVID-19) pandemic, Iran reported its first confirmed cases of syndrome coronavirus 2 (SARS-CoV-2) infections on 19 February 2020 in Qom. Although the numbers of cases are increasing, no report about clinical manifestations, laboratory results, and imaging findings of the children infected with COVID-19 in Iran has been published. The aim of this study was to evaluate the epidemiological, clinical, and radiological and laboratory findings of 24 children who had proven SARS-CoV-2 infection and performed chest computed tomographic (CT) in Qom, Iran.

Methods

Demographic information and clinical characteristics of the patients including signs and symptoms, chest CT scan manifestation, laboratory findings and clinical outcomes were collected. Diagnosing of the confirmed case was based on positive real-time reverse-transcriptase-polymerase-chain-reaction test for SARS-CoV-2.

Findings

During the first 3 months of the epidemic in Qom, Iran, 24 children with confirmed diagnosis of COVID-19 were included. The median age of the cases was 6 years [inter-quartile range 3.5–9.5 years]. The most common presenting symptoms were fever (100%), dry cough (62.5%), tachypnea (29%), abdominal pain (21%), and vomiting (21%). Three cases (12.5%) presented with a history of diarrhea in addition to fever and cough. According to the chest CT findings, 2 cases (8%) showed no abnormality. Typical CT findings were found in 6 patients (25%), 2 patients showed indeterminate appearance, and 14 patients (58%) showed atypical findings. Two children with SARS-CoV-2 infection manifested as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome. Seventy-one percent of the patients showed severe SARS-CoV-2 infection and the mortality of 12.5% (3 cases) were reported.

Interpretation

High frequency of atypical chest CT finding in children should raise concern for pediatricians. Early recognition of patients with SARS-CoV-2 infection is of crucial importance in controlling of the outbreak and atypical imaging features should be interpreted with caution.

中文翻译：

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伊朗儿童2019年新型冠状病毒病（COVID-19）暴发：不典型CT表现和重症COVID-19感染的死亡风险

 背景

在 2019 年冠状病毒病 (COVID-19) 大流行期间，伊朗于 2020 年 2 月 19 日在库姆报告了首例冠状病毒 2 综合征 (SARS-CoV-2) 感染确诊病例。尽管病例数量不断增加，但尚未发表有关伊朗感染 COVID-19 儿童的临床表现、实验室结果和影像学结果的报告。本研究的目的是评估伊朗库姆 24 名已确诊 SARS-CoV-2 感染并进行胸部计算机断层扫描 (CT) 的儿童的流行病学、临床、放射学和实验室结果。

 方法

收集患者的人口统计信息和临床特征，包括体征和症状、胸部 CT 扫描表现、实验室检查结果和临床结果。确诊病例的诊断基于 SARS-CoV-2 实时逆转录酶聚合酶链反应检测呈阳性。

 发现

伊朗库姆疫情爆发的前 3 个月内，纳入了 24 名确诊感染 COVID-19 的儿童。病例的中位年龄为 6 岁[四分位数范围 3.5-9.5 岁]。最常见的症状是发烧（100%）、干咳（62.5%）、呼吸急促（29%）、腹痛（21%）和呕吐（2​​1%）。 3 例（12.5%）除发烧和咳嗽外，还有腹泻病史。根据胸部CT检查结果，2例（8%）未见异常。 6例患者（25%）有典型CT表现，2例患者表现不确定，14例患者（58%）表现不典型。两名 SARS-CoV-2 感染儿童表现为多器官受累的高炎症综合征，类似于川崎病休克综合征。 71% 的患者表现出严重的 SARS-CoV-2 感染，据报告死亡率为 12.5%（3 例）。

 解释

儿童中非典型胸部 CT 发现的高频率应引起儿科医生的关注。早期识别 SARS-CoV-2 感染患者对于控制疫情至关重要，对非典型影像学特征的解读应谨慎。